How should a history of blood clots or serious cardiovascular disease influence hormone therapy decisions?

A personal history of blood clots (such as deep vein thrombosis or pulmonary embolism) or serious cardiovascular disease (like heart attack or stroke) is a key factor in deciding whether hormone therapy (MHT) is appropriate and, if so, which type is safest.

Here at Alloy, we want to ensure your safety and tailor treatment to your unique history:

Oral estrogen (like the estradiol pill) and low-dose birth control pills are generally not recommended for people with a personal history of blood clots or serious cardiovascular disease.
Transdermal estrogen options (patch, gel, or spray) may be considered safer for some people with a history of provoked blood clots (those caused by surgery, trauma, or immobility), as studies show these forms do not significantly increase clot risk. However, this decision should always be made in consultation with a menopause-trained doctor and, often, a hematologist or cardiologist.
If your blood clot was unprovoked (no clear cause) or you have a genetic clotting disorder, extra caution is needed, and hormone therapy may not be advised.
For those with a personal history of heart attack or stroke, hormone therapy is generally not recommended, but there can be exceptions in special cases with close medical supervision.

It's essential to work with a menopause specialist to review your individual risks and benefits. At Alloy, our intake process ensures a menopause-trained doctor will review your medical history and help you find the safest and most effective solution for you.

For more details, check out our product pages for transdermal options:

You may also find it helpful to watch these specific chapters from our expert webinars:

Hormone Therapy and Blood Clot History (Dr. Corinne Menn): Explains the difference between provoked and unprovoked clots and the safety of transdermal estrogen.
Hormone Therapy Contraindications and Individualized Assessment: Discusses how personal history of blood clots and cardiovascular disease affects hormone therapy decisions.
Hormone Therapy After Cardiac Events: Covers considerations after heart attack or stroke.

If you want to get started or have your history reviewed by a menopause-trained doctor, visit our Get Started page.

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