03/07/2026
🧬Estrogen is not just one molecule. (But much of the medical community treats it like one). This is where a lot of the confusion around clot risk begins.
In this video I’m specifically talking about oral bioidentical estradiol (E2), not conjugated equine estrogens (CEE) like Premarin and not synthetic estrogens like ethinyl estradiol found in many oral contraceptives.Those are completely different molecules, and they behave differently in the body.
Premarin and synthetic estrogens HAVE been associated with an increased clot risk, especially in patients with clotting mutations like Factor V Leiden.
But the research around bioidentical estradiol tells a different story.
📄Short term studies show changes in certain coagulation biomarkers with oral E2… but biomarkers do not always translate to worse clinical outcomes. Long term randomized trials (the highest level of research studies we have) have not consistently demonstrated an increased risk of venous thromboembolism with oral estradiol.
I focused on oral estradiol in this video because it offers several unique physiologic benefits. However, there are other delivery methods available, including:
• Transdermal estradiol (patches, gels, creams)
• Injectable estradiol
Each route has different pharmacokinetics and clinical considerations, which is why hormone therapy should always be personalized to the individual patient.
There’s a lot of nuance here, and unfortunately this is one of the most misunderstood areas of medicine.
More videos breaking this down soon.
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