When considering hormone therapy—whether for birth control, menopause symptoms, or hormone replacement—it's natural to wonder about the risks. One concern that often comes up is the risk of blood clots. The short answer is yes: hormone therapy, especially those containing estrogen, can increase your risk of developing blood clots like deep vein thrombosis (DVT). However, that risk varies depending on your health history and the type of therapy.
At Genesis Lifestyle Medicine, we provide personalized hormone therapy plans that are designed to suit your body and your goals while minimizing risks like blood clots. With expert care and a holistic approach, we’re here to help you feel your best.
How does hormone therapy cause blood clots?
Hormone therapy doesn’t directly cause blood clots, but it can increase your risk by altering how your body handles clotting. Let’s break down how this happens.
Estrogen increases clotting factor levels
Estrogen, a key ingredient in many hormone therapies, plays a significant role in your body’s clotting system. It increases the levels of clotting factors—proteins in your blood that help form clots. This makes your blood more prone to clotting, which is especially concerning if you already have risk factors like smoking, obesity, or a family history of clotting disorders.
Estrogen-progestin birth control mimics pregnancy conditions
Combination birth control methods (containing both estrogen and a synthetic progesterone called progestin) mimic the hormonal state of pregnancy to prevent ovulation. During pregnancy, estrogen levels rise significantly, which naturally increases clotting factor levels to protect against bleeding during childbirth. However, when this hormonal environment is replicated through medication, your risk of forming unintended clots can go up.
Postmenopausal hormone therapy alters vascular health
If you’re taking hormone therapy to manage postmenopausal symptoms, you may be using a regimen that includes estrogen or estrogen plus progestin. This therapy not only impacts your hormones but also influences the health of your blood vessels. It can lead to changes in blood vessel walls, increasing the chance of clot formation—especially in women with a prior history of thrombosis or genetic clotting disorders (thrombophilia).
Higher estrogen absorption in some delivery methods
Not all hormone therapies deliver the same dose of estrogen. Patches like Ortho Evra® and rings like NuvaRing® release higher levels of estrogen directly into your bloodstream, bypassing digestion. While convenient, this delivery method can result in higher estrogen exposure and, in turn, a higher risk of blood clots compared to traditional oral pills.
Underlying genetic conditions magnify the risk
If you have a genetic predisposition to blood clots—such as Factor V Leiden or other thrombophilias—hormone therapy can significantly raise your clot risk. For women with such conditions, even standard doses of estrogen can trigger clot formation. This is why individualized care is essential when considering hormone therapy.
Tips to prevent blood clots while on hormone therapy
There are several ways to lower your risk of developing blood clots while still benefiting from hormone therapy. Here’s how you can protect your health.
Know your personal and family health history
Before starting hormone therapy, it’s crucial to discuss your personal and family medical history with a qualified provider. At Genesis Lifestyle Medicine, we conduct comprehensive evaluations to identify any underlying risk factors for clotting, such as past blood clots, smoking, or a family history of thrombosis. This information helps us tailor your treatment to ensure your safety.
Consider progestin-only options
If you need contraception or hormone management and have a higher risk of blood clots, ask about progestin-only options. These include progestin-only pills, the Mirena® IUD, Depo-Provera® injections, or the Implanon™ implant. Unlike estrogen-containing therapies, progestin-only methods have not been shown to increase the risk of deep vein thrombosis.
Stay active and avoid prolonged immobility
Sitting or lying down for long periods—like during flights or extended bed rest—can increase your risk of clots, especially when combined with hormone therapy. Regular movement, leg exercises, and walking breaks can improve circulation and lower your risk.
Manage heavy periods with medical support
If you’re on anticoagulants and experience heavy menstrual bleeding, don’t stop your medication—seek help. At Genesis Lifestyle Medicine, we offer several treatment options to manage bleeding, such as hormonal support with birth control pills or IUDs, and procedures like endometrial ablation or hysterectomy if needed.
Talk to your provider before any surgery
If you’re planning surgery while on hormone therapy, your anticoagulation or hormone regimen may need to be adjusted. Because surgery increases clot risk, special planning—often involving a temporary stop or modification of medication—is usually essential.
While hormone therapy can increase your risk of blood clots, especially if it contains estrogen, the overall risk is manageable—especially with expert medical guidance. At Genesis Lifestyle Medicine, we don’t just offer hormone therapy; we offer personalized, evidence-based care that takes your full health profile into account. Our goal is to help you feel better, look better, and live better. If you’re considering hormone therapy, schedule a consultation with us today.
