Estrogen therapy replaces some of the estrogen your ovaries stop making around menopause. It can ease hot flashes, night sweats and vaginal dryness, and help prevent bone loss. It comes as pills, patches, gels, sprays, rings and vaginal creams. If you still have a uterus, you also need a progestogen. Not everyone is a candidate.
According to MedlinePlus, estrogen may be used to:
The Menopause Society notes that hormone therapy is FDA-approved as a first-line treatment for bothersome hot flashes. Results vary from person to person.
Systemic estrogen goes into the bloodstream and acts on the whole body. ACOG and FDA list these forms:
Systemic estrogen is the type used for hot flashes, night sweats and bone protection.
Local (vaginal) estrogen releases small doses into the vaginal tissue. It comes as a vaginal cream, tablet, insert or ring (FDA). ACOG says it is used by women whose main concern is vaginal dryness. The Menopause Society's 2022 statement recommends low-dose vaginal estrogen, or other therapies, for bothersome vaginal and urinary symptoms not relieved by over-the-counter products, in women who don't need systemic therapy.
Our guide to vaginal dryness after menopause covers local options in more detail.
If you still have a uterus, usually yes. ACOG explains that estrogen alone makes the lining of the uterus grow, which can raise the risk of uterine cancer. Taking a progestin (or progesterone) helps lower that risk. This is called combined hormone therapy.
If you have had a hysterectomy, estrogen is usually given alone. That is why "estrogen therapy after hysterectomy" is a common search: it is often a simpler regimen. Whether the ovaries were also removed matters too. Our early menopause guide explains surgical menopause.
It can. ACOG says forms not taken by mouth, such as patches, sprays and rings, may carry less risk of blood clots than pills, and gallbladder risk is greatest with pills. The Menopause Society also notes that oral hormones carry a higher clot risk, and that patches, gels and sprays may carry less.
Your clinician will also look at your health history, your symptoms, and what you find easiest to use every day.
Not always. MedlinePlus explains that estradiol and estrone tests may help diagnose conditions linked to high or low estrogen, such as problems with puberty, PCOS, thyroid or pituitary disorders, infertility and perimenopause, and may help monitor hormone therapy.
But estrogen levels change a lot, especially in perimenopause, so one result may not tell the whole story. MedlinePlus notes you may need more than one test to see a trend. For most women around menopause, treatment is guided mainly by symptoms and health history.
Common side effects listed by MedlinePlus include headache, bloating, breast pain or tenderness, vaginal bleeding, upset stomach and swelling in the hands or feet. The Menopause Society adds nausea and irregular spotting, and says hormone therapy is not associated with weight gain.
Main risks, according to ACOG and The Menopause Society:
Estrogen therapy is not recommended for people with breast or uterine cancer, unexplained vaginal bleeding, liver disease, a history of blood clots, or heart disease (The Menopause Society). For more, see Is HRT safe?.
Is estrogen therapy the same as HRT? Estrogen therapy is one kind of hormone therapy. "HRT" often means estrogen plus a progestogen. Estrogen alone is usually for women without a uterus.
Can I use estrogen during perimenopause? Sometimes. The Menopause Society notes that hormone therapy can cause breakthrough bleeding in women who still have periods, so options such as birth control pills or a hormonal IUD with estrogen may be used instead. Your clinician can explain the choices.
Does vaginal estrogen help hot flashes? Low-dose vaginal estrogen works mainly on the vagina and bladder area. For hot flashes, systemic estrogen is usually used.
How soon does estrogen therapy work? It differs from person to person. MedlinePlus notes your doctor may start a low dose and raise or lower it based on how your symptoms respond.
Does estrogen cause weight gain? The Menopause Society says hormone therapy is not associated with weight gain.
Talk with us about whether estrogen therapy fits your health. Book a visit or call (210) 903-1030. In-clinic in San Antonio • Telehealth for women located in Texas Yaso Wellness Health Clinic, 1907 Goliad Rd, San Antonio, TX 78223
Education only, not medical advice. Not everyone is a candidate for hormone therapy. In an emergency, call 911.
Leticia Vargas, MD, OB/GYN, sees patients at Yaso Wellness Health Clinic in San Antonio. About Dr. Vargas
Education only, not medical advice or a diagnosis. In an emergency, call 911.
