Estradiol (menopause)

Used for

• Hot flashes and night sweats
• Vaginal dryness and urinary symptoms (vaginal estrogen)
• Preventing bone loss after menopause
• Sleep and mood changes around menopause

How it works

Replaces the estradiol the ovaries stop making. It acts on estrogen receptors in the brain’s temperature control, the vagina and urinary tract, and bone. Vaginal products work mostly where they are placed, with little reaching the blood.

Half-life: oral about 13–20 hours; a patch holds steady levels for 3–7 days

What the research shows

• The Women’s Health Initiative (16,608 women, oral conjugated estrogens plus a synthetic progestin) found more breast cancer, strokes, clots and heart disease. Most of the women were over 60 or more than 10 years past menopause when they started.
• Later analyses and the 2022 Menopause Society statement say the balance is better for women under 60 or within 10 years of menopause, who have the most to gain for hot flashes and bone.
• In the French ESTHER study, oral estrogen was linked to a higher risk of clots in the veins, while skin patches and gels were not. This is observational data.
• The Menopause Society advises the lowest dose that works for the shortest time needed, with yearly review, and says vaginal estrogen alone is safe to use longer for local symptoms.

Dosing

Dosing isn’t listed on the public site. In the app, each published option is shown with its source (a drug label, a clinical guideline, a trial or community reports) and can be turned into a protocol you review.

Side effects

• Breast tenderness
• Nausea, headache
• Bloating, fluid retention
• Spotting or irregular bleeding
• Mood changes

Cautions

• A woman with a uterus needs a progestogen as well (see Progesterone): estrogen alone raises the risk of endometrial cancer.
• Not for anyone with a history of breast or other estrogen-sensitive cancer, blood clots, stroke or heart attack, active liver disease, or unexplained vaginal bleeding.
• The guideline favors starting under age 60 or within 10 years of menopause; the balance is less favorable later.
• Smoking raises the clot and stroke risk. Skin products carry less clot risk than pills in observational data.
• Needs a yearly review with a clinician, including breast screening.

Storage

Interactions

Not a full list. Tell your doctor and pharmacist everything you take.

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