Estradiol alternatives: What can I take instead of estradiol?

Compare estradiol alternatives | Vivelle dot | Estrace 0.01% | Paxil CR | Neurontin | Catapres | Natural alternatives | How to switch meds

Estradiol, a form of estrogen, is a female sex hormone drug available by prescription in a variety of dosage forms. Estradiol is primarily prescribed to treat symptoms of menopause caused by low estrogen levels. It may also be used to prevent bone loss (osteoporosis) in menopausal women. 

So what is menopause exactly? Menopause is the term used to describe the point in time that begins 12 months after a woman’s last period. You may also have heard the term “perimenopause”. This describes the period of time leading up to menopause which can last years and be characterized by irregular menstrual cycles or vaginal bleeding, hot flashes, or trouble sleeping. Some women experience migraines, night sweats, and vaginal dryness too. During perimenopause, sex hormone production varies greatly and contributes to these symptoms. If you begin experiencing these symptoms, your healthcare provider may order a blood test to look at your estradiol levels along with your hormone levels of follicle-stimulating hormone (FSH) and progesterone. If a woman undergoes a hysterectomy, she immediately goes into menopause due to an immediate inability to produce sex hormones. If your estradiol levels are low, your prescriber may order an estradiol product for you if you are an appropriate candidate for estrogen therapy to help alleviate perimenopausal or menopausal symptoms.

Generally, women who have a previous low risk for heart diseases like stroke and heart attack and are recently in menopause are considered candidates for menopausal hormone therapy (MHT). The Women’s Health Initiative (WHI) study, initiated in 1991, was intended to evaluate disease states in postmenopausal women including cardiac disease, cancer, and osteoporosis. Initially, it was thought that hormone replacement played a preventative role in these disease states. However, the hormone replacement therapy (HRT) treatment arm was stopped years early due to early, significant findings of an association to increased rates of both cancer and cardiovascular events. This study has had profound impacts on the use of HRT in premenopausal, menopausal, and postmenopausal women. The WHI study focused on oral estrogen dosage forms of HRT, including combination products with progesterone. There are other forms of estradiol therapy such as vaginal rings, vaginal creams, and transdermal patches.

Unfortunately, not everyone will be a candidate for estrogen or other hormone replacement therapy to treat menopausal symptoms. Menopause typically occurs between the ages of 45 and 55. Generally, initiating hormone therapy after the age of 60 is not recommended, and continuing past the age of 65 is also not recommended. Patients with a known or expected personal or family history of estrogen-dependent neoplasms or malignancies, such as ovarian cancer or certain types of breast cancer, are not able to take estradiol products. Patients who have an active or past case history of thromboembolism, deep venous thrombosis (DVT), thrombophlebitis, stroke, or myocardial infarction (heart attack) have a contraindication to estradiol therapy. Those with a family history of these events may not be an estradiol candidate either. Hormone replacement therapy (HRT) increases the risk of other disease states such as dementia and gallbladder disease as well. Allergic or hypersensitive reactions to estrogen products would also be a contraindication for estradiol therapy.

So what are some other treatment options in lieu of estradiol to help with symptoms and effects of menopause? While replacing estrogen in patients with low levels seems like an obvious solution, there are other treatment options for menopausal symptoms. Patients with a higher risk of blood clots or breast cancer have options for treating menopause symptoms. Keep reading to learn more!

Related: Estriol vs. estradiol

What can I take in place of estradiol?

There are hormonal and non-hormonal options for the treatment of menopause-related symptoms. Some therapies may only be indicated for a specific symptom. For example, some antidepressants have been shown to help with hot flashes, also known as “flushes”, but they would not play a role in bone loss due to menopause. For this reason, it is important to gear your alternative selection toward the menopausal symptom you are trying to treat or relieve. There will be no one answer that suits every patient. 

There are several categories of drugs that have been shown to help alleviate hot flashes including antidepressants, blood pressure medications, and seizure medications. Drugs such as calcium and bisphosphonates address osteoporosis. There are also many lifestyle changes and adaptations that can be done to minimize the impact of menopause. 

This is not intended to serve as medical advice. You should speak to your doctor before stopping estradiol and consider all alternatives.

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Other alternatives to estradiol

• Calcium
• Zoloft (sertraline)
• Remeron (mirtazapine)
• Desyrel (trazodone)
• Belladonna/ergotamine/phenobarbital

Top 5 estradiol alternatives

1. Vivelle dot (estradiol) transdermal patches

Transdermal estradiol has been proven to be more effective than placebo at controlling hot flashes in menopausal women. While there has been some belief that transdermal estrogen does not carry the same risk as an oral therapy, there is evidence that the risk vs benefit of oral and transdermal therapy is similar. In patients with little to no risk of cardiac or cancer events, transdermal therapy may present advantages over oral therapy because it can be worn for more constant absorption and the patch does not have to be changed frequently. Climara is another brand name for an estradiol transdermal patch.

2. Estrace 0.01% (estradiol) vaginal cream

Menopause presents unique vaginal symptoms which can be particularly bothersome such as vaginal dryness and vaginal atrophy. Systemic absorption of estradiol is less when applied vaginally externally as compared to oral but can provide significant relief of these symptoms. For patients whose menopausal symptoms may be limited to vaginal symptoms, the cream may be a great alternative to oral therapy.

3. Paxil CR (paroxetine)

Paxil CR is the only antidepressant that is Food and Drug Administration (FDA) approved to treat hot flashes in menopausal women. Paxil is a selective serotonin reuptake inhibitor (SSRI) and is a non-hormonal treatment option. Other SSRIs, like Zoloft (sertraline), have also been used for hot flashes similar to Paxil CR. The controlled release mechanism may lead to more consistent symptom relief than with other SSRIs. The active ingredient in Paxil CR, paroxetine, was also shown to help with insomnia associated with menopause. There is no increased risk of breast cancer with Paxil CR therapy.

4. Neurontin (gabapentin)

Neurontin is gaining popularity in its use to alleviate hot flashes in menopausal women, though its use is considered to be “off-label.” Off-label use refers to utilizing a treatment that has not been officially approved by the FDA for the drug. Gabapentin is thought to help alleviate hot flashes associated with menopause through calcium channel activity across the cellular wall. Gabapentin is a viable alternative to hormonal therapy.

5. Catapres (clonidine)

Catapres, also known as clonidine, is also a drug used off-label in the treatment of hot flashes. It has been shown to decrease the frequency of hot flashes in postmenopausal women in a clinical trial. Clonidine is a medication traditionally used to treat high blood pressure. It can lower blood pressure too much in some patients, causing lightheadedness and dizziness. Clonidine could have dangerous side effects as it can increase the chance of a serious fall. Blood pressure should be monitored while on Catapres.

Natural alternatives to estradiol

There are a variety of natural alternatives and supplements which may alleviate menopausal symptoms. There are certain food products believed to help increase estrogen levels naturally in your body such as soybeans and flax seeds. Adequate vitamin levels are necessary for estrogen production including vitamin D and the B vitamins. Adequate nutrients for your body play an important role in estrogen production. 

While there is not a “natural” estrogen, over-the-counter herbal supplements may be key in relieving menopause symptoms. Black cohosh, a Native American herb, is thought to stimulate estrogen receptors. Evening primrose oil (EPO) is also thought to be helpful. There is not a lot of scientific data for supplements, which is why they don’t make claims of “treatment” but anecdotal evidence from menopausal women suggests it is helpful in relieving symptoms. You should speak to your prescriber regarding all of your health conditions before beginning supplement or herbal treatments.

How to switch to an estradiol alternative

If you are just beginning to have premenopausal symptoms, you and your prescriber will need to sit down and do a thorough health and family history to determine if initiating estrogen or hormonal therapy is the right plan for you. Some patients are safe candidates for HRT, and HRT can be an effective way to manage menopausal symptoms.

If you are not a candidate for hormonal treatment options or just desire to treat your menopausal symptoms with non-hormonal therapy, speak to your physician about the alternatives that could be appropriate for you. Many of the non-hormonal treatment options are generic and available for a relatively low cost. You can browse SingleCare’s drug coupons to find the best pricing on estrogen alternatives and save up to 80% off the retail price.