What is estradiol (estrogen) used for?

From the Guidelines

Estradiol is primarily used to treat menopausal symptoms, such as hot flashes and vaginal dryness, as well as to prevent osteoporosis in postmenopausal women, but its use should be carefully considered due to associated risks, including stroke, gallbladder disease, and urinary incontinence, as noted in the 2013 USPSTF recommendation statement 1. The use of estradiol for menopausal symptoms is well-established, with typical doses ranging from 0.5-2mg daily for oral tablets, 0.025-0.1mg/day for patches (changed twice weekly), or 0.5-1g of vaginal cream applied 1-3 times weekly. Key benefits of estradiol include:

• Reduction in the incidence of fractures, with moderate benefit as seen in the study 1
• Small reduction in the risk for developing or dying of invasive breast cancer, as found in the 2013 USPSTF recommendation statement 1 However, estradiol is also associated with significant risks, including:
• Moderate harms, such as the risk for stroke, gallbladder disease, and urinary incontinence, as well as a small increase in the risk for deep vein thrombosis (DVT), as noted in the study 1
• No beneficial effect on coronary heart disease (CHD), as concluded by the USPSTF 1 Given these findings, the decision to use estradiol should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history, and with careful consideration of the potential benefits and harms, as recommended by the USPSTF 1.

From the FDA Drug Label

Estradiol tablets are indicated in the: Treatment of moderate to severe vasomotor symptoms associated with the menopause. Treatment of moderate to severe symptoms of vulvar and vaginal atrophy associated with the menopause. Treatment of hypoestrogenism due to hypogonadism, castration or primary ovarian failure. Treatment of breast cancer (for palliation only) in appropriately selected women and men with metastatic disease. Treatment of advanced androgen-dependent carcinoma of the prostate (for palliation only). Prevention of osteoporosis

Estradiol is used for:

• Treatment of menopause symptoms: moderate to severe vasomotor symptoms and vulvar and vaginal atrophy
• Hypoestrogenism treatment: due to hypogonadism, castration, or primary ovarian failure
• Cancer treatment: breast cancer and advanced androgen-dependent carcinoma of the prostate
• Osteoporosis prevention 2

  Estradiol is used to: reduce moderate to severe hot flashes treat dryness, itching, and burning in or around the vagina, difficulty or burning on urination associated with menopause treat certain conditions in which a young woman's ovaries do not produce enough estrogen naturally treat certain types of abnormal vaginal bleeding due to hormonal imbalance treat certain cancers in special situations, in men and women prevent thinning of bones

Estradiol is also used to:

• Reduce hot flashes
• Treat vaginal dryness and itching
• Treat abnormal vaginal bleeding
• Prevent osteoporosis 2

From the Research

Estradiol Uses

Estradiol, a form of estrogen, is used for various purposes, including:

• Menopausal symptom relief, such as vasomotor symptoms and genitourinary syndrome of menopause 3, 4, 5
• Bone health improvement, reducing the risk of osteoporosis and fractures 3, 6
• Protection against chronic diseases, such as coronary heart disease and all-cause mortality, particularly in younger women or those close to menopause onset 3, 5

Hormone Replacement Therapy (HRT)

Estradiol is often used in HRT, which has undergone significant changes in recent years. Studies suggest that:

• HRT can be effective in managing menopausal symptoms and improving quality of life 4, 5, 6
• The benefits and risks of HRT vary depending on factors such as age, time since menopause, and comorbidity status 3, 4
• Estradiol-containing HRT may have a more favorable safety profile compared to other estrogens and progestins 6, 7

Efficacy and Safety of Estradiol

Research indicates that:

• Estradiol can improve menopausal symptoms, vaginal health, and bone density, while demonstrating a favorable safety profile 6
• Estradiol may have a better risk profile for venous thromboembolism and cardiovascular outcomes compared to other estrogens 7
• The use of estradiol in HRT may protect against age-related cognitive decline and bone fractures 6, 7