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But its a useful framing for thinking beyond the monthly sticker price

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Though overall the risk remains low, oral estradiol is associated with increased venous thromboembolism (VTE) risk, whereas transdermal estradiol was not found to be associated with significant increased risk of VTE.7 The reason for the discrepancy is thought to be the result of procoagulant factors being formed as a result of first pass hepatic metabolism for estradiol, a factor that doesnt apply to the transdermal route

Most women notice it only if they are specifically tracking their hunger levels