When Hormone Therapy Goes Wrong

Vivian was the kind of patient every surgeon hopes for—a healthy 58-year-old woman preparing for a routine hip replacement. She told us she wasn't on any medications. The surgery went smoothly, but what happened afterward revealed a dangerous truth about medical culture that every woman needs to understand.

When Routine Becomes Critical

After surgery, Vivian took an unusually long time to wake up—what we call "delayed emergence." At the hospital, she remained deeply lethargic. A brain scan revealed the shocking truth: she'd had a stroke caused by a blood clot that formed during surgery and traveled to her brain.

Blood clots don't commonly occur in routine surgeries. Deep investigation uncovered something Vivian had never disclosed: she was taking oral estrogen.

The Right Hormone Delivered the Wrong Way

Vivian made a slow, difficult recovery. When she was finally well enough to speak, we asked about the oral estrogen. Her response broke my heart:

"All my doctors brushed off my questions about hormones, so I went online and ordered HRT"

Despite feeling so much better with balanced hormones, she felt too ashamed to bring it up with her medical team. That fear nearly killed her, because we would have asked her to stop her oral estrogen prior to surgery. Because she was too shy to speak up, she'll never be quite the same.

How You Given Hormone Replacement Matters

I'm a strong advocate for hormone balancing—it can be life-changing and life-saving. But it must be done correctly to be safe.

Research consistently shows that hormone replacement therapy increases the risk of blood clots two- to fivefold compared to non-users. However, here's what most patients don't know: the route of administration dramatically affects thrombotic risk.

Estrogen's First-Pass Effect

When estrogen is taken orally, it passes through the liver first, triggering changes in blood clotting factors. Studies demonstrate that oral estrogens increase thrombin generation and induce resistance to activated protein C, while transdermal estrogens (patches, gels, creams) have minimal effects on clotting factors.

The numbers are striking: in one meta-analysis, the risk for blood clots ranged from 60-100% higher for oral estrogen than for transdermal estrogen users.

Surgery Compounds Estrogen's Stroke Risk

The risk of thrombosis with oral estrogen becomes dangerously high during surgery, especially orthopedic procedures. The risks of blood clots from orthopedic surgery combine with the risks of blood clots from estrogen hormone replacement therapy.

Vivian's stroke likely could have been prevented if she had been on a transdermal formulation or if she had disclosed her oral estrogen use so it could be discontinued before surgery.

The Cost of Gaslighting Women over Hormone Replacement Therapy

Unfortunately, negative publicity from early hormone studies led many doctors to dismiss women's hormone concerns entirely, leaving patients without adequate guidance. There are many nuances to hormone replacement therapy that your doctor must discuss with you. Unfortunately, many women still face dismissal, though tides are changing with changes in FDA's black box warning labels.

This creates dangerous situations where women:

• Seek treatment outside traditional medical channels
• Don't disclose treatments out of fear of judgment
• Miss critical safety precautions
• Suffer preventable complications like Vivian's stroke

What You Need to Know about Hormone Replacement Therapy

Before Any Surgery

• Disclose ALL medications and hormones—even those purchased online
• If you're on oral estrogen, discuss whether it should be discontinued before surgery
• Don't let embarrassment stop you from sharing complete information
• Your surgical team has seen everything—there's nothing to be ashamed of!

When Seeking Hormone Replacement Therapy

• Ask explicitly about transdermal versus oral formulations and why they're recommending one over the other
• Research shows transdermal hormone therapy is effective for menopausal symptoms without minimal increases in clotting risk in healthy postmenopausal women
• Find a provider trained in hormone replacement therapy, like those at Clarus Health, who understands thrombotic risks
• Discuss your complete medical history, including any history of blood clots or stroke
• Don't accept dismissive responses—seek a second opinion

Choosing the Right Hormone Replacement Formulation

For most women, transdermal estrogen (patches, gels, or creams) is the safer choice. Even women who have had previous blood clots can often receive estrogen as a skin patch with little-to-no increased risk of blood clots.

Your Hormone Health Is Worth Fighting For

Vivian deserved medical providers who took her hormone concerns seriously from the start. She deserved to know that the route of hormone administration could mean the difference between a safe surgery and a life-altering stroke.

Speak with a doctor at Clarus Health today to learn if you are a candidate for bioidentical hormone replacement therapy.