Will using vaginal estrogen put at risk for another blood clot?
Doctor Answers 6
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.
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®
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.
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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.
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.
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.
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.