Reduce menopausal symptoms with prescription Estradiol

Estradiol is an estrogen that is used in hormone replacement therapy to treat menopause symptoms such as hot flashes and night sweats. It also reduces the risk of osteoporosis. 

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Written by Dr Rohanti Rovikulan, MD

Information last reviewed 06/21/19


How does Estradiol work?

As women approach menopause, there is a natural decline in the body’s estrogen levels. This deficiency in estrogen causes symptoms such as hot flashes, mood swings, headaches, vaginal dryness and night sweats, which are typical of menopause.

The Estradiol in your medication is structurally similar to the estradiol produced by the body. Taking Estradiol increases the estrogen levels in your body, which helps reduce or alleviate the symptoms of menopause.

How long does it take for Estradiol to start working?

It typically takes a few weeks before you start to feel the benefits of Estradiol, but it can take up to three months to experience the medication’s full effects.

How long should I take Estradiol for?

If you are taking Estradiol to reduce menopausal symptoms, you should take it for two to three years. In order to get the full benefit of Estradiol in reducing the risk of osteoporosis, you need to take the medication for a minimum of five years. Talk to your doctor about the dose and duration of your Estradiol therapy.  


Which ingredients can cause an allergic reaction?

Estradiol comes in many different forms and their medications vary depending on manufacturers. The tablet forms contain lactose monohydrate and can cause uncomfortable side effects if taken by those with a severe lactose allergy. If you are using the patches, you might get a local skin reaction as they contain silicone and alcohol. The injections contain some form of oil, some manufacturers use sesame oil. If you are allergic to sesame, this medication is not suitable for you. 


How much Estradiol should I take?

The dose of Estradiol is based on the preparation form and the condition for which Estradiol is prescribed. For menopausal symptoms, the following doses are typically prescribed:

  • Oral tablets: 1 to 2 mg once daily
  • Intramuscular injection (estradiol valerate) : 10 to 20 mg every 4 weeks
  • Topical spray: 1 spray once a day on the inner surface of the forearm initially, followed by 1 to 3 sprays a day on other areas of the forearm
  • Topical gel: 1 pump of a gel a day
  • Patches: 1 patch applied every week
  • Vaginal inserts: 10 mcg inserted daily for 2 weeks, followed by twice weekly insertion

Depending on the condition for which you are being treated and your response to the treatment, your doctor may choose to change the dose and frequency of your Estradiol therapy.

How often do I take Estradiol?

Oral tablets, topical gels, and creams are usually taken once daily. Injections are administered once every three to four weeks. Patches are usually applied once a week and vaginal inserts are initially used once daily and then twice weekly. Follow the instructions on your prescription label carefully and use Estradiol regularly. Speak to your doctor before stopping Estradiol or changing the dose.

At what time of the day should I take Estradiol?

Oral Estradiol can be taken with or without food and is usually taken once a day. You should try to take Estradiol at around the same time every day. The frequency of Estradiol administration varies according to the preparation and the condition being treated.

What if I miss a dose of Estradiol?

If you miss a dose, take it as soon as you remember it. However, if it is almost time for the next dose, then skip the missed dose and take the next dose according to your usual schedule. Do not take two doses at once. If you forget to wear or change your Estradiol patch, apply it as soon as you remember. If it is almost time for the next patch, wait until it is time and apply the new patch. Do not apply two patches to make up for the missed dose.

Side Effects

Estradiol Side Effects

Estradiol may cause side effects in some patients. Contact your doctor if any of the following symptoms are severe or do not go away with continued use of Estradiol:

  • Weight gain or loss
  • Breast pain or tenderness
  • Heartburn
  • Vomiting
  • Diarrhea
  • Constipation
  • Discomfort in the stomach
  • Flatulence
  • Nervousness
  • Difficulty using contact lenses
  • Dizziness
  • Leg cramps
  • Depression
  • Cold-like symptoms
  • Burning or tingling sensations in the arms or legs
  • Abnormal hair loss
  • Unwanted/abnormal hair growth
  • Darkened spots on the skin of your face
  • Tight muscles
  • Vaginal discharge
  • Swelling, redness, burning, itching, or irritation of the vagina
  • Changes in sexual desire

Some side effects are rare but may be serious. Contact your doctor immediately if you experience any of the following serious side effects:

  • Hives
  • Swelling of the eyes, tongue, face, throat, or any part of the limbs
  • Bulging eyes
  • Signs of infection such as fever, cough, sore throat or chills
  • Swelling or pain in the stomach
  • Changes in appetite
  • Tiredness or weakness
  • Yellowing of the skin or eyes
  • Joint pain
  • Movements that are difficult to control
  • Rash or blisters
  • Hoarseness of voice
  • Breathing or swallowing difficulties

What precautions should I take before taking Estradiol?

Tell your doctor if you are allergic to Estradiol or any of the ingredients in the prescribed formulation. Before using Estradiol, tell your doctor if you have, or have ever had, any of the following:

  • Blood clots or stroke
  • Any type of cancer
  • Family history of breast lumps, cancer, or blood clots
  • High blood pressure, diabetes, or thyroid problems
  • Abnormal uterine bleeding or masses
  • Gallbladder disease, asthma, or  migraine
  • Hereditary angioedema (an autoimmune disorder)
  • Any bleeding or clotting problems
  • Seizures/epilepsy
  • Autoimmune disorders
  • Abnormal calcium levels

Estradiol should not be taken during pregnancy. If you think you might be pregnant, let your doctor know before you start taking this medication.

Do not smoke or use tobacco while taking Estradiol, as this can increase your risk of blood clots, stroke, high blood pressure, and heart attacks, especially if you are under 35 years of age.

Drug interactions

Before you start taking Estradiol, tell your doctor or pharmacist if you are taking any other prescription or over-the-counter medications or supplements. Estradiol should not be taken in combination with:

  • Other estrogen/hormone replacement therapies
  • Tranexamic acid
  • Hormonal contraceptives  
  • Certain antiviral medications such as dasabuvir and ritonavir

You should also inform your doctor if you are taking any of the following:

  • Corticosteroids
  • Medications for treatment of seizures/epilepsy
  • Antibiotics

Overdose symptoms

Take Estradiol exactly as prescribed. Contact your doctor immediately if you experience any of the following symptoms of Estradiol overdose:

  • Severe nausea or vomiting
  • Abnormal vaginal bleeding
  • Upset stomach or discomfort

Treatment Options

What forms does Estradiol come in?

Estradiol is available in the following preparations:

  • Oral tablet
  • Injection (intramuscular)
  • Patch
  • Cream
  • Gel/jelly
  • Spray

Brands of Estradiol

Depending on the type of preparation, your doctor may prescribe Estradiol under different brand names, such as Estrace (Estradiol tablets) or Evamist (Estradiol spray).

Estradiol vs Premarin

Estradiol is a generic name referring to the female sex hormone. It may be prescribed under different brand names, which vary according to the preparation form.

Premarin is a brand name for a medical formulation containing many types of estrogens. Like Estradiol, Premarin is also used to treat symptoms of menopause.

Estradiol vs Estriol

Estradiol and Estriol are both forms of estrogen, the female sex hormone. Estriol is available in oral tablet and vaginal cream forms. Estradiol and Estriol are sometimes combined in a single formulation for increased effectiveness.


Disclaimer: This is not medical advice. You and your physician will determine if and how you should take any medication prescribed to you following a medical consultation.

  1. "Drugs & Medications: Estradiol - Webmd" [website], (accessed 27 May 2019).
  2. "Estradiol (Oral) | Michigan Medicine" [website] 2018, (accessed 27 May 2019).
  3. "Estrogen (Oral Route, Parenteral Route, Topical Application Route, Transdermal Route) Description And Brand Names - Mayo Clinic" [website] 2019, (accessed 27 May 2019).
  4. "Estrogen Therapy: Overview, Menopausal Transition, Menopause And Hormone Therapy" [website] 2018, (accessed 27 May 2019).
  5. "Estrogen: Medlineplus Drug Information" [website] 2019, (accessed 27 May 2019).
  6. Hormone Replacement Therapy (HRT) 2nd edn Guy's and St Thomas' NHS Foundation Trust, 2016, (accessed 27 May 2019).

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