Treating Period Pain
Answering your questions about vaginal estrogen and blood clots, and dysmenorrhea
Time for a Q&A to answer your questions about:
Can I use vaginal estrogen if I’ve had a blood clot?
How can I help my daughter with severe period pain?
Enjoy! And remember to e-mail your questions to ask@thesavvypatient.com or leave them in the chat.
Q: My gynecologist told me that after a woman has had a blood clot, she should not use vaginal estrogen. Is that true?
—Dry Down There
A: The concern about estrogen and blood clots can be traced back to the early days of the birth control pill in in the 1960s. Early birth control pills contained many times the dose of estrogen that modern birth control pills do, and smoking—known to increase the risk of blood clots —was much more common.
Today we know that some forms of estrogen do increase the risk of blood clots. Both ethinyl estradiol, the estrogen most commonly used in birth control pills, and conjugated equine estrogen are associated with an increased risk of blood clots when taken by mouth as pills. When it comes to estradiol pills the evidence is mixed with some studies suggesting increased risk and others suggesting no increased risk of blood clots.
However, when it comes to estradiol patches and gels and vaginal estrogen, the evidence is different. Neither form of estrogen has been shown to increase the risk of blood clots at all. There is likely two reasons for this difference.
First, estrogen absorbed into the circulation through the small intestine is metabolized in the liver before circulating through the rest of the body. Those metabolites are likely responsible for the increased risk of blood clots. Second, vaginal estrogen is not absorbed into the circulation to any significant degree. That is why vaginal estrogen is safe for virtually all women, including those with a history of breast cancer or blood clots.
The Savvy Short: Vaginal estrogen does not increase the risk for blood clots even in women at increased risk for blood clots and is safe for virtually all women to use.
Q: Can you please tell me about dysmenorrhea? My teenage daughter has very painful periods. So much so, that she has fainted three times on the first day of her period and vomits because of the pain. We have ended up in the ER each time. What can be done to better manage her symptoms?
—A Worried Mother
