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What is Estradiol: Uses, Costs, and Dosage

Menopause is a natural biological process that occurs in every woman’s life, but it’s often accompanied by uncomfortable symptoms. The average onset of menopause occurs at age 51 in the United States, and for many women, physical symptoms like hot flashes, vaginal dryness, disrupted sleep, and lower energy cause serious discomfort that disrupts their lives. Hormone replacement therapy, particularly with estrogens like estradiol, can offer relief from symptoms for women experiencing menopause or other hormonal changes or imbalances, especially as a result of issues with the adrenal glands and other endocrinology-related issues. 

What is Estradiol?

Estradiol is a female sex hormone that is a form of estrogen. Estradiol, sometimes referred to as oestradiol (E2), is the strongest of the three estrogens that are naturally produced in the body. Both men and women have estradiol, but women have the hormone in much higher quantities. Estradiol has several important functions in a woman’s body. The first and most important is to cause the reproductive system to mature; the hormone is then responsible for maintaining the reproductive system. Estradiol levels rise and fall during the menstrual cycle, and higher levels of estradiol cause the ovaries to mature and release an egg. The uterine lining also thickens, allowing a fertilized egg to implant in the uterus, causing a pregnancy. As women age, levels of estradiol decrease, particularly during pregnancy. Although estradiol is a naturally produced hormone, it can also be obtained through artificial means in the form of medication. Estradiol can be given in the form of an oral tablet, vaginal cream, topical gel or patch, or as an injection to women who need to increase their levels of the hormone for one reason or another. The generic name for the oral form of the hormone is estradiol oral, but the hormone is also marketed under a wide variety of brand names, including Climara, Menostar, Estrace, Vivelle, Elestrin, Estradot, and many more. Interestingly, estradiol also seems to keep liver disease at bay, with menopausal women and postmenopausal women taking estradiol showing lower levels of fat accumulation in the liver compared to premenopausal women not taking estradiol.

What is Estradiol Used to Treat?

Estradiol is used to treat a variety of medical conditions as part of hormone replacement therapy. It is primarily prescribed for the management of menopausal symptoms, which include hot flashes, painful intercourse, sleep disorders, decreased sexual desire, vaginal dryness, mood changes, and anxiety. Menopause results in a drop in estradiol levels, which causes these uncomfortable symptoms in many women. Taking estradiol can also help reduce the risk of osteoporosis, which increases as women enter menopause. In addition to treating the symptoms of menopause, estradiol can also help manage or resolve other conditions resulting from a hormonal imbalance, such as primary ovarian insufficiency, certain types of acne, symptoms of endometriosis, delayed puberty, ovarian failure issues, and certain cases of prostate cancer. 

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How Much Does Estradiol Cost?

The cost of estradiol varies significantly depending on the form in which the medication is prescribed (oral tablet, vaginal cream, topical gel or patch, or as an injection), as well as whether the generic or brand name form of the hormone is prescribed. A 30-day supply of generic estradiol tablets costs approximately 13 dollars, while the same quantity of Vagifem, a brand name form of the medication, costs approximately 670 dollars and is only available in limited strengths. Estradiol cream costs approximately 57 dollars for a one month supply. Substantial savings on estradiol can be achieved through the use of a pharmacy discount card, which offers discounts on all FDA-approved medications, whether brand name or generic, regardless of your insured status.  

Choosing the generic version of estradiol can also help patients save money on their prescriptions. Although some people are concerned about the quality and safety of generic drugs, there is no reason to worry. The U.S Food and Drug Administration (FDA) subjects generic medications to the same stringent quality and safety testing as brand name medications, so they are guaranteed to be both safe and effective. Generic medications use the same active ingredient in the same quantity as the brand name medication. However, generic medications typically use different inactive ingredients that can affect the color, size, shape, or taste of the medication, but that do not impact its effectiveness. 

What Dose of Estradiol Should I Take?

The dosage of estradiol that each patient should take will vary depending on their age, the form of estradiol that is prescribed, and the condition or symptoms being treated. Patients who are taking oral tablets for the treatment of postmenopausal symptoms will generally take a dose of 1 to 2 mg taken once per day, and the dose is taken cyclically (3 weeks on, 1 week off). When used as a topical gel for the treatment of postmenopausal symptoms, most patients will use 1 pump of gel applied as a thin layer once per day. Vaginal inserts are given in a dose of 10 mcg that is inserted vaginally daily for 2 weeks, followed by 1 insert twice per week. There are many other conditions treated with estradiol, so make sure to speak to your doctor about your specific condition and an appropriate dose of the hormone. Women with history of heart disease, cardiovascular disease, and hereditary angioedema may not be good candidates for estradiol treatment. 

What Are the Side Effects of Estradiol?

Estradiol has some side effects that are common and generally do not require medical attention, while others can be serious and should receive medical attention immediately. Common side effects of estradiol that generally do not require medical attention include:

  • Nausea
  • Diarrhea
  • Mood changes
  • Cold symptoms including stuffy nose, sore throat, and sinus pain
  • Headache
  • Breast pain
  • Vaginal itching or discharge
  • Breakthrough bleeding
  • Changes in menstrual periods
  • Vomiting
  • Stomach cramps
  • Sleep problems
  • Weight gain
  • Back pain
  • Thinning scalp hair
  • Increased blood pressure

Other side effects are serious and require immediate medical attention. These include:

  • Heart attack symptoms, including:
    • Pain or pressure in the chest
    • Pain that spreads to the jaw or shoulder
    • Sweating
    • Nausea
  • Signs of a stroke, including:
    • Sudden numbness or weakness, particularly when it occurs on one side of the body
    • Slurred speech
    • Sudden severe headache
    • Problems with balance or vision
  • Signs of a blood clot, including:
    • Sudden vision loss
    • Feeling short of breath
    • Pain or warmth in one or both legs
    • Stabbing chest pain
    • Coughing up blood
  • Swelling or tenderness in the abdomen
  • Memory problems
  • Unusual behavior
  • Pelvic pain
  • High levels of calcium in the blood, as evidenced by:
    • Nausea
    • Constipation
    • Muscle weakness
    • Lack of energy
    • Vomiting
    • Increased thirst or urination
    • Bone pain
  • Jaundice (yellowing of the eyes or skin)
  • Confusion
  • Unusual vaginal bleeding
  • A lump in the breast

What Are the Benefits of Estradiol?

Estradiol and other types of estrogen therapy offers four significant health benefits. When natural estrogen production falls over time, it can create uncomfortable symptoms associated with menopause, including hot flashes, chills, excessive sweating, vaginal dryness, and difficulty sleeping. Estradiol therapy can help reduce or eliminate these symptoms, allowing you to feel more comfortable. Other common symptoms of low estrogen levels include changes to the vaginal tissue, lining, and pH balance. Vaginal dryness, atrophic vaginitis, and vulvar atrophy can cause inflammation, dryness, soreness, and irritation that is relieved or improved by estradiol therapy. Estradiol also helps improve issues with the ovaries. When the ovaries fail to produce estrogen or are affected by a different health condition, estradiol may offer help. Female hypogonadism, failure of both ovaries, and removal of the ovaries can all benefit from the use of supplemental estradiol and hormone replacement therapy. Finally, estradiol can help to decrease bone loss that is more likely to occur after menopause. While other medications are better equipped to stop and reverse bone loss, estradiol usually causes fewer side effects and can be more effective in some cases.

Are There Any Risks Associated With Estradiol?

Although estradiol has many benefits and can make life more comfortable for many people, it is not without risks. In fact, hormone replacement therapy is no longer as popular as it once was because some studies have unveiled a link between long term use of hormones and significant medical conditions, such as cancer and heart risks. Estradiol use is associated with four major categories of risk:

  • Blood clots: Different forms of estrogen can increase the risk of experiencing blood clots, which can lead to heart attack, stroke, and death.
  • Birth defects: Women who become pregnant while using estradiol or other forms of estrogen are more likely to miscarry their babies. When a woman taking estrogen therapy is able to carry the pregnancy to full term, birth defects are likely.
  • Cancer: Estradiol and other forms of estrogen have increased risk of developing certain types of cancers, including breast cancer and endometrial cancer. Women with a family history of these cancers should be especially careful and provide a complete medical history to their doctors prior to starting estrogen therapy.
  • Dense breast tissue: Women using estrogen hormone replacement therapy like estradiol may experience breast development issues in the form of developing dense breast tissue, which can make mammograms hard to read. As a result, detecting breast cancer at an early stage becomes more challenging.

Before starting estradiol, talk to your healthcare provider for medical advice, and to make sure you have access to important health information such as drug interactions or interactions with supplements and herbal products, possible interactions with breastfeeding and breast milk, and any other questions or concerns you may have. 

References:

https://www.uofmhealth.org/health-library/d00537a1 

https://www.hormone.org/your-health-and-hormones/glands-and-hormones-a-to-z/hormones/estradiol 

https://www.webmd.com/drugs/2/drug-5186/estradiol-oral/details 

https://www.drugs.com/estradiol.html 

https://medlineplus.gov/druginfo/meds/a605041.html 

https://www.healthline.com/health/womens-health/benefits-of-estrogen# 

https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397 

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Published September 28th, 2020 by Bridget Reed
Fact Checked by Chris Riley

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