Will using vaginal estrogen put at risk for another blood clot?

I had blood clot&stroke from taking Osphena (oral estrogen) and now getting the Mona Lisa Touch but need relief sooner. Will using vaginal estrogen put me at risk for another blood clot?

Doctor Answers 7

Vaginal estrogen and risk of clot

Vaginal estrogen treatment (vagifem or estring) have a very small (if any) increase in estrogen in your body, and therefore4 it is unlikely to increase your risk of blood clotting.  I suggest increasing the frequency of intercourse after the MLT as it will help speed up its success.

Toronto OB-GYN
5.0 out of 5 stars 1 review

Venous thrombosis and Systemic Medication

It is unfortunate you suffered the low incidence complication of a blood clot from Osphena. Local estrogen in the vaginal canal likely has low systemic absorption which in turn should not increase your risk of another blood clot. It seems you have exhausted your conventional medical options and I would highly recommend he MonaLisa Touch for your vaginal symptoms. To answer your question, a small amount of vaginal estrogen can bridge you until your MonaLisa Touch treatment. 

L. Jennifer Murphy, MD
Valparaiso OB/GYN
5.0 out of 5 stars 5 reviews

Risks and benefits of vaginal estrogen cream

Thanks for a great question. Many women like yourself are fortunate to have vaginal laser therapy, such as FemiLift and MLT, available for the treatment of atrophic changes related to low estrogen. This is the safest treatment for you but it does not treat the atrophic changes which take place at the entrance of the vagina, including vulva (labia). My suggestion would be to use a small amount by fingertip application to your vulva, but not inside. Use it almost like a lotion 2-3 times per week. The risk is minimal, not zero, and completely your choice.

Osphena is not an estrogen, so don't make a direct correlation between estrogen and your recent stroke. You apparently have other risk factors, but the risk of another clot if you use a small amount on your vulva is negligible. Your risk of worsening atrophic changes and associated uncomfortable sex if you don't do anything is 100%...your choice.

Best of luck,

Oscar A. Aguirre, MD
Aguirre Specialty Care - Pelvic Surgery & Intimate Aesthetics®

Oscar A. Aguirre, MD
Denver Urogynecologist
5.0 out of 5 stars 34 reviews

Vaginal estrogen and clots

While oral estrogen does increase the risk of blood clots, vaginal estrogen is more controversial. We know that using estrogen vaginally avoids the "first pass effect" through the liver, and theoretically should reduce the risk of clotting, I don't know that we have shown this conclusively.  What I do tell my patients is that using a small amount of estrogen cream in the lower 1/3 of the vagina is safe, as there are good studies showing that there is little to no absorption into the systemic circulation from that part of the vagina. If the symptoms are primarily external, then treating just externally should be safe.

Rebecca Dunsmoor-Su, MD
Seattle OB/GYN
5.0 out of 5 stars 5 reviews

Estrogen and clots

Studies do show there is an increased risk of blood clots if you take oral estrogen and are over 60 years old. However, there is no risk if the estrogen is given transdermally (i.e. through the skin), for it does not have a "first pass" effect through the liver that would change clotting factors. Thus, you're good to go with the vaginal cream.

Robert L. True, MD
Grapevine OB/GYN
4.9 out of 5 stars 9 reviews

Vaginal estrogen

When my patients have used 1/2-1 gram 2-3x per week to vagina and labia, their blood estrogen level has not gone up. Have it measured before and then after 1-2 weeks and convince yourself and your doctor or start with less and do the same. MonalisaTouch is safer.

Lawrence Eisenhauer, MD
Encinitas OB/GYN
5.0 out of 5 stars 2 reviews

Your risk of recurrent blood clots is higher with any estrogen

Osphena is not an estrogen. Nonetheless, it has a similar effect of increasing the risk of blood clots in some women as estrogen. Most of the safety data on vaginal estrogen is related to breast cancer more than blood clots. You would be an ideal candidate for laser resurfacing with either FemiLift or MonaLisa.

Marco A. Pelosi III, MD
Jersey City OB/GYN
4.7 out of 5 stars 26 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.