HRT

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Estradiol: what is it?

Estradiol: what is it?

Estradiol is a hormone that’s naturally present in the female body. It has a number of important functions, like regulating the menstrual cycle and increasing bone density.

In the time leading up to menopause (known as perimenopause), a woman will likely notice a number of symptoms as the frequency of her periods reduces caused by a decrease in the production of oestrogen. This can cause many symptoms like insomnia, fatigue and hot flashes. These symptoms can last for several years, making them difficult to deal with. But taking synthetic oestrogen, such as estradiol, can help alleviate these symptoms.

Alexandra Cristina Cowell
Medically reviewed by
Alexandra Cristina Cowell, Writer & Clinical Content Reviewer
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Medically reviewed by
Dr Alexandra Cristina Cowell
Writer & Clinical Content Reviewer
on February 27, 2024.
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What does estradiol treat?

Estradiol helps treat and manage menopausal symptoms. Menopause marks the end of a woman’s fertility and the end of monthly periods. Perimenopause tends to begin during your forties, whilst the actual menopause is usually around age 51.

During the shift to menopause, the hormones oestrogen and progesterone start to drop causing symptoms like hot flashes, mood changes, tender breasts and insomnia. You’re also at a higher risk of cardiovascular diseases and osteoporosis (fragile bones). Choosing to use an HRT, with estradiol as one of the active ingredients, can help improve these symptoms.

How does it work?

Estradiol is a hormone that naturally occurs in your body. It’s the most common type of oestrogen found in your body (E2). Oestrogen is known as the female sex hormone and is important for many processes in your body including puberty and pregnancy. It plays a significant role in ovulation by helping mature an egg by increasing levels of luteinising hormone (LH). But if no egg is fertilised, the uterus lining breaks down and causes bleeding, which is your monthly period.

When you go through menopause, your periods start to decrease throughout the years until they stop completely. At this point, there are no eggs that need maturing so the production of oestrogen is decreased.

When you take synthetic estradiol, it elevates your oestrogen levels essentially reversing the effects of menopause. This helps relieve symptoms of menopause as the majority of the symptoms are caused by a drop in oestrogen and progesterone. One specific health concern it can help to address is lowering the levels of LDL (bad cholesterol) and increasing HDL (good cholesterol). This prevents the build-up of fats in your arteries near your heart, therefore, lowering your risk of getting strokes and heart attacks.

Additionally, oestrogen plays a significant role in regulating the process of bone-making and bone-breaking. The bones in your body contain oestrogen receptors, which inhibit the activity of osteoclasts, the cells responsible for breaking down bone tissue. As the level of oestrogen decreases, more bone tissue can be broken down, which can lead to lower bone density and fragile bones – a condition known as osteoporosis. When you take oestrogen, your bone density increases and consequently your risk of bone fractures lowers.

Is estradiol effective?

Estradiol has been proven to be an effective treatment for managing menopausal symptoms.

A study for the HRT treatment Kliofem, a tablet containing the hormones estradiol hemihydrate, an oestrogen, and norethisterone acetate, a synthetic progesterone, found it improved many common menopausal symptoms. The results showed that 70% of patients had reduced hot flushes and 91% of patients maintained or gained bone mineral density. It also provided relief of other symptoms including vaginal dryness, mood swings, reduced sex drive and night sweats.

Similarly, another study found patients using estradiol had hot flashes reduced by 75% compared to the placebo.

Additionally, the use of HRT may improve the sex drive of some of the women that use it. During the menopausal changes, sex can become uncomfortable because of vaginal dryness and irritation. Using a vaginally applied low dose oestrogen can keep your vaginal tissues healthy by maintaining the thickness and elasticity of the vaginal lining. For some women this will allow sex to feel more comfortable.

The different forms of estradiol

Hormone replacement therapy (HRT) containing estradiol can come in different forms. The three main versions are:

  • Estradiol – the synthetic version of the most potent form of oestrogen found in the body.
  • Estradiol valerate – a modified version of estradiol with valerate attached to it. It converts into estradiol in your body.
  • Estradiol hemihydrate – a hydrated form of estradiol. It doesn’t need to convert to be active.

Estradiol is most commonly used in the form of patches and oral tablets, but you can also get them as vaginal tablets and gels.

  1. Patches are attached to your skin and only replaced every couple of days. The active ingredient gets absorbed through your skin. They’re convenient as you don’t have to replace them often. Some examples of patches that used estradiol include Estraderm MX and Evorel Conti.
  2. Gels are similar to patches in that they are absorbed into your skin. They can be less irritating than the patches but need to be applied once a day. Examples of gels containing estradiol are Oestrogel and Sandrena.
  3. Oral tablets are taken daily compared to vaginal tablets (sometimes called pessaries) which are taken daily for the first two weeks and then twice a week. Examples of oral tablets are Femoston and Elleste Solo.
  4. Vaginal pessaries are inserted into your vagina. Compared to other forms, they work locally so the risks of side effects are reduced. Vagifem is a vaginal pessary containing estradiol.

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What doses of estradiol are available?

There are several different doses of estradiol and the dosage you take will vary depending on the type of treatment you’re using. For instance, Evorel Conti patches only come in a single dose of 3.2mg of estradiol hemihydrate (and 11.2 mg of norethisterone acetate), while Estraderm MX patches offer doses ranging from 0.75mg to 3mg of estradiol.

Tablets and gels also come in different doses. Usually, you’ll start on a lower dose; if needed, your clinician can switch you to a higher dose. If you’re confused by the different doses, you can just message your clinician and they’ll help decide for you.

Are there similar treatments to estradiol?

You can get HRT that doesn’t contain estradiol, like Premarin which contains conjugated oestrogen. Even though both contain oestrogen, they use different forms. So you can try Premarin if you find estradiol treatments aren’t working well for you but you should always speak to a clinician. Many HRTs also come combined with progesterone. This is because taking combined treatment can help lower the risk of womb cancer.

Do I always need to take progesterone with estradiol?

If you have had a hysterectomy (when your womb is removed) taking oestrogen-only treatment is usually fine. However, if you still have a womb, it’s recommended you take combined treatment with oestrogen and progesterone.

Taking combined treatment means that you’re not at an increased risk of womb cancer. If you have questions about your treatment, you should always seek advice from a clinician. Popular combined treatments include estradiol/norethisterone and estradiol/dydrogesterone.

Estradiol/norethisterone

Norethisterone is a progestin that when taken with oestrogen, has been proven effective in alleviating menopausal symptoms. According to a study, the combined treatment demonstrated positive outcomes:

  • 91% experienced either maintenance or improvement in bone density, thereby reducing the risk of osteoporosis.
  • 70% reported a reduction in the frequency of hot flushes.

Is estradiol only available on prescription?

care-iconYes, you can only get estradiol HRT with a prescription. This is so our clinicians can check it’s safe and suitable for you to use. Throughout your treatment, your clinician will also keep in touch with you to make sure everything is fine.

How long does it take for estradiol to work?

It can take up to three months for HRT to improve your symptoms. This will vary depending on the type of HRT you’re taking as the concentration and active ingredients can vary. When starting HRT, you might experience some side effects in the first few weeks. This is normal, as your body is adjusting to the new treatment. However, once your body gets used to it, the side effects should ease with time. If you still experience side effects after eight weeks or don’t feel any different, it’s best to let your clinician know and they’ll recommend trying different doses or medication to suit your body.

What are the benefits of estradiol?

There are several benefits to taking a HRT treatment containing estradiol, including:

  • a reduction in vasomotor symptoms like hot flashes and night sweats. This can in turn help with insomnia thanks to a more comfortable night.
  • a reduced risk of osteoporosis. Taking oestrogen can help to maintain bone density which keeps your bone strong and less prone to breakage.
  • a reduced risk of coronary heart disease. Oestrogen has been found to reduce cholesterol for some women which can have a positive outcome on your chances of developing heart disease or having a heart attack.
  • a reduced risk of developing several cancers including, breast (with oestrogen-only HRT), endometrial and colon cancer.

What are the risks of estradiol?

There are some risks to address when taking HRT including treatments that use estradiol. Taking combined HRT can increase your risk of breast cancer, but studies show that the risk is very low. In every 1000 women who take combined HRT, there are only five extra cases of breast cancer, a 0.5% increase. With oestrogen-only therapy, there is little to no risk. If you want to read more on this topic, check out our earlier blog post on the cancer risk associated with HRT treatments here.

While rare, there is an increased risk of blood clots in women using HRT. In two studies, one with 2500, and another with 16,000, patients using HRT had an increased risk of getting blood clots. The risk determined was 2.3 cases per 1000 women using HRT for one year.

If you have concerns about the potential risks of using HRT you should speak to your doctor. For a lot of women, the benefits of using HRT outweigh the risks.

You may want to discuss low-dose treatments like Gina, an oestrogen-only vaginal tablet that only contains 10 mcg of estradiol. HRT that is localised to the vagina (vaginal tablets or pessaries) tend to have a reduced risk of side effects. This is because they don’t enter the bloodstream, unlike oral tablets and patches. But this does mean that they usually only help vaginal symptoms. So, you may benefit from localised HRT if you have vaginal dryness or irritation. But further symptoms may require a different type of treatment.

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This page was medically reviewed by Dr Alexandra Cristina Cowell, Writer & Clinical Content Reviewer on February 27, 2024. Next review due on February 27, 2026.

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