Menopause patches and gels showed no rise in clot risk in a big Danish study

If you are thinking about hormone therapy for menopause, here is something useful to know: how you take it may matter. In a large Danish study, hormone pills were linked to more blood clots. Patches and gels, which work through the skin, were not.

That gives you a good question to bring to your doctor. It does not mean anyone should change anything on their own.

How the study worked

Researchers used Denmark’s national health records to look at women ages 50 to 69 between 2003 and 2021. They left out women with a history of clots, cancer and several other conditions. Then they compared women who had a first blood clot, stroke or heart attack with women of the same birth year who did not, and checked who was currently using hormone therapy. It was published Sept. 23, 2026, in The BMJ. Because it looks at records rather than assigning women to a treatment, it shows links, not proof of cause.

What they found

The study counted 9,807 women with a clot in a vein. It also counted many women with an ischemic stroke (the kind caused by a blocked artery in the brain) and many with a heart attack.

Start with the baseline. Among women not using hormone therapy, clots in a vein happened at a rate of 15.8 per 10,000 women per year. So these events are uncommon to begin with.

Women currently taking estrogen by mouth, alone or with a progestin, had higher rates of all three problems than women using no hormones. The clearest signal was for clots in a vein, then stroke, then heart attack.

Here is what that looks like in everyday terms. The extra risk for a clot in a vein was 0.09% per year of use. In plain words, about 1 extra clot for every 1,055 women taking the pills for a year. For stroke and heart attack, the extra yearly risk was smaller still.

Dose and time also played a part. Estradiol pills above 1 mg a day, taken for more than a year, were linked to more strokes and heart attacks. The risk grew the longer women used them. Past five years, it was clearly higher than for women using no hormones.

Now the part you may be here for. Patches and gels were not linked to more clots, strokes or heart attacks compared with using no hormone therapy. That is the main takeaway.

There was one exception. Women using a skin product as a combined cyclic therapy, where the progestin is taken in a repeating pattern, had a higher heart attack risk. The study does not explain why, and that group was small.

What does “through the skin” mean?

Doctors call it transdermal. The hormone goes in through your skin instead of being swallowed. Patches, gels and sprays are the usual forms. Pills, tablets and anything you swallow are called oral.

The study compared these two routes directly, and that is why its findings are useful. Both can ease symptoms like hot flashes. The difference showed up in clot risk.

What you can do today

Take two minutes to find out exactly what you use or have been offered. Check the pharmacy label or your patient portal for the type of hormone, the dose and how you take it. Write those three things on a note in your phone. At your next visit, ask your doctor whether a patch or gel could be a good fit for you, and how long you should stay on your current dose.