Estradiol
Also called Estrace, Vivelle-Dot, Climara, Divigel, EstroGel; 17-beta estradiol
The main estrogen made by the ovaries. Prescribed as tablets, patches, gels and vaginal cream to treat menopause symptoms such as hot flashes and vaginal dryness.
Overview
What it is
A steroid hormone, not a peptide. Prescription estradiol is chemically identical to the estradiol the body makes. It comes as daily tablets, skin patches changed once or twice a week, daily gels, and low-dose vaginal creams, tablets and rings.
How it works
Estrogen levels fall at menopause. Replacing estradiol reduces hot flashes and night sweats, helps prevent bone loss, and restores the vaginal and urinary tissues. Low-dose vaginal products act mostly on local tissue, with much less reaching the bloodstream.
What the research shows
Hormone therapy is the most effective treatment for hot flashes and night sweats, and vaginal estrogen is a first-line treatment for genitourinary syndrome of menopause. The Women's Health Initiative trials found higher risks of stroke, blood clots and (with a progestin) breast cancer in women who started hormones at an average age in the 60s. Later analyses show a more favorable balance for healthy women who start before age 60 or within 10 years of menopause. Skin patches and gels have been linked to lower blood-clot risk than pills in observational studies.
Studied for
- Hot flashes and night sweatsFDA approved
- Vaginal dryness and painful sex after menopauseFDA approved
- Prevention of postmenopausal osteoporosisFDA approved
- Low estrogen from removed or failing ovariesFDA approved
Safety and regulatory status
Safety and side effects
Labels carry boxed warnings for endometrial cancer when estrogen is used without a progestogen in people with a uterus, and for stroke, blood clots, breast cancer and probable dementia seen in the Women's Health Initiative. Not for people with unexplained vaginal bleeding, a history of breast cancer, blood clots, stroke, heart attack or active liver disease. Breast tenderness, bloating, nausea and spotting are common at the start.
Regulatory status
FDA approved prescription medicine in many forms (tablets, patches, gels, vaginal cream, tablets and rings). Requires a prescription.
Common questions
Do I need progesterone with estradiol?
If you have a uterus and use estradiol tablets, patches or gel, yes: a progestogen protects the uterine lining from overgrowth and cancer. Low-dose vaginal estrogen usually does not need one.
Is "bioidentical" estradiol safer?
FDA-approved estradiol is already bioidentical. Custom-compounded hormone mixes are not FDA approved and have not been shown to be safer.
How long can I stay on it?
There is no set limit. Current guidance is to use the dose that controls symptoms and to review the benefits and risks with your provider each year.
Related in Hormones and Reproductive Health
Sources and further reading (4)
- Estradiol products, FDA prescribing information.
- The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 2022.
- The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.
- Manson JE, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative. JAMA, 2013.