It is a well known fact that estrogen can “cause blood clots”, but is that always true?
Blood clots are scary. You can die from them. This week we are speaking about the risks of blood clotting and what you need to know about this problem.
Blood clots or DVTs can be caused by many things in both men and women. It is a well known fact that estrogen can “cause blood clots”, but is that always true? Since men get blood clots they are not always associated with estrogen (as men have very little), and only a very small percentage of women who take birth control pills or other estrogens get a blood clot so what is the real story?
Blood Clots = Stasis (slow or no movement of blood) + overactive clotting factors
Here is the short version that includes the Risks of getting a Blood Clot:
- Genetic Risk: Only certain people, both men and women, have genetic abnormality that can cause blood clots. Anyone can be tested with a panel of 7 genetic markers to see if they are at risk for blood clots, but it is expensive and it is not considered a big enough risk to test every women going on birth control pills or hormone replacement therapy. It is true that these women who take oral estrogens (and only oral estrogen) are at a high risk of getting a blood clot… but they have to have the gene for it! This gene causes a low level of clot thinning blood factors, or a high number of clot making factors, or both.
Other risks for blood clots in both sexes, with or without the genetic issue, include
- Obesity-causes pressure on the venous return to the heart and slow the blood flow down. When blood slows down, and clots form.
- Lack of movement—long car rides or flights during which you don’t move your lower extremities causes the blood to pool in your lower legs and lack of movement of blood cause clots. A remedy for this is to wear compression stockings or socks on long flights or rides and get up and move at least once an hour.
- Low Oxygen environments—often low oxygen tension in the air like on airline flights can cause blood to thicken and that slows the movement of the blood causing a clot. Low Os plus lack of movement is high risk for most people and very high risk for those with clotting disorder genetics.
- Thick Blood—several medical conditions cause the blood to thicken with too many red blood cells, too many platelets or both and or high cholesterol and triglycerides. This environment slows the blood down causing clots. Medical conditions called Hemochromatosis, Familial Erythrocytosis, Thrombocytosis are in this group. People who are affected by these medical conditions need to therapeutically give blood to remove the cells that thicken their blood regularly. Those with high lipids need lipid lowering medications.
- Arteriosclerosis is plaque on the arteries and these plaques cause the blood to slow down and swirl, setting up the beginning of a blood clot.
- Oral estrogens only—not patches, vaginal rings, vaginal tablets or pellets placed under the skin can cause blood clots. It is the estrogen going through the liver that increases the production of clotting factors from the liver and increase the risk of clotting.
To find out if you have a genetic risk of clotting you can have the 11 test panel done for clotting. The panel includes tests for MTHFR, Lupus anticoagulant, Protein S Activity, Cardiolipin Antibody (IgG and IgM), Factor 5 Leiden Mutation, Protein C activity, Cardiolipin AB IGA, Abtithrombin III activity, Fibrinogen, Prothrombin (Factor II) .
If you have blood clots in your family your insurance may pay for this test package, however if your family has no clots and you don’t either then you will probably have to pay out of pocket.
All people who have had a blood clot should be tested for the genetic clotting risk, and if you don’t have the clotting risk then you are at no more risk than any other person to get another clot.
If you are worried about clots and need estrogen for birth control or management of your periods or for menopause then taking a NON Oral form of estrogen like pellets, and you will be at no greater risk than someone not on estrogen.
All people who have had blood clots, or who have the genetic risk for blood clots should:
- Wear compression stockings when they are inactive, pregnant, flying long distances or on bedrest
- Drink a lot of water when flying so you won’t get dehydrated and have “thickened blood”
- Take an 81 mg aspirin 3 days before a flight, and the day of the flight (unless you are on a blood clot medicine already)
- Keep your H/H normal by therapeutic phlebotomy
- Stay active, and avoid long periods of sitting
- Stay away from oral estrogen
- Avoid becoming obese
- Avoid high altitudes if you are not accommodated to that area
These are the tricks and the truth about blood clots.
This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author, with Brett Newcomb, MA., LPC., Family Counselor, Presenter and Author. www.BioBalanceHealth.com.