5 foods to avoid while taking estradiol

In this article:

• How estradiol works
• Foods to avoid
• Foods to prioritize
• Gastrointestinal side effects
• Maximizing estradiol benefits

In this article

• How estradiol works
• Foods to avoid
• Foods to prioritize
• Gastrointestinal side effects
• Maximizing estradiol benefits

Estradiol (brand name: Estrace) is a generic prescription drug that is a form of estrogen, the sex hormone naturally produced by the female body. Estradiol is prescribed to women who are not making enough estrogen because of menopause, hysterectomy, or other reasons. It is most commonly prescribed as a vaginal cream or capsule. Although estradiol occurs naturally in the body, women on prescription estradiol should know that certain foods, such as grapefruit and salt, can impact the drug’s effectiveness or exacerbate gastrointestinal side effects.

How estradiol works

Estradiol is known as estrogen hormone replacement therapy (HRT). It replaces estradiol, which the body has stopped producing internally. It works by raising estrogen levels, which reduces symptoms of menopause, such as hot flashes, vaginal dryness, and bone density loss from impaired calcium absorption. 

It can take weeks for estradiol to have a noticeable effect. How fast it works and how long it stays effective may vary depending on the form and dosage of estradiol.

5 foods to avoid with estradiol

Good news: Grapefruit is the only food that must be avoided entirely on estradiol, according to Barbara Sparacino, MD, a board-certified adult and geriatric psychiatrist and women’s health specialist. “Other foods may interact with estradiol but do not necessarily need to be entirely avoided—rather, they should be consumed in moderation,” she adds.

Many healthcare professionals recommend limiting a few specific food types when taking estradiol, including:

1. Grapefruit

“Grapefruit and grapefruit juice both contain compounds that inhibit enzymes in the liver responsible for breaking down estradiol,” says Supriya Rao, MD, a board-certified gastroenterologist and internist in Massachusetts. When the enzyme is inhibited, estradiol can build up in the bloodstream, exacerbating HRT side effects like nausea, breast tenderness, headaches, and fluid retention. You should avoid grapefruit and grapefruit-containing products while on estradiol.

2. Alcohol

The Centers for Disease Control and Prevention defines moderate drinking as one drink or less per day for women. However, it’s a good idea to avoid alcohol completely or limit it even further while on estradiol. Alcohol does not directly interact with estradiol, but research shows that alcohol can cause changes in sex hormone levels to the point where it may even increase the risk of breast cancer in postmenopausal women. “Additionally, alcohol can put stress on the liver, which is responsible for processing estradiol,” Dr. Sparacino says. 

3. Foods high in refined sugar

Limiting sugar foods and drinks while on estradiol is a good idea. While sugar does not react with estradiol, it can contribute to one of HRT’s potential side effects: weight gain. Research has found a clear link between sugar consumption and being overweight, and it’s easy to understand why. Sugar represents empty calories in your daily diet. If you’re on estradiol to combat the side effects of menopause, sugary foods will only subvert your efforts.

4. Processed foods

Like sugar, processed foods introduce empty calories into your diet. But Dr. Sparacino says processed foods, which include both fast food and packaged snacks, can also disrupt the body’s hormone balance.

Research shows that additives such as phthalates, artificial dyes, and sweeteners in processed food can disrupt endocrine function (aka, hormone function), which increases the risk of hormone-related health issues. If you’re already taking estradiol to rebalance your hormones, why undermine the process by consuming endocrine-disrupting foods?

5. Excess sodium

Salt is an essential mineral, but too much salt can increase water retention and exacerbate bloating, according to Drs. Rao and Sparacino. 

Breaking out the salt shaker every time you eat or snacking on salty potato chips or cheese dips can quickly introduce excess sodium into your diet. Deli meats and canned soups also tend to include a lot of sodium. Anyone concerned about bloating on estradiol should avoid these so-called salt bombs.

An important note: Research on diet’s impact on estrogen is ongoing. Some healthcare providers recommend that people on estradiol limit phytoestrogens—plant-based foods like soy and flaxseed that have estrogen-like qualities. “But current studies show that soy doesn’t interfere with estradiol therapy,” Dr. Rao explains. Until more studies confirm whether certain foods block or promote estrogen production in a meaningful way, it’s a good idea to seek personalized dietary advice from a healthcare professional who knows your medical history, conditions, and current medications.

What should you eat while taking estradiol?

Women typically take estradiol to combat unpleasant symptoms of menopause, such as hot flashes, weight gain, mood swings, poor sleep, and increased risk of osteoporosis. But estradiol isn’t the only thing that combats menopause symptoms. A healthy whole-food diet helps, too. 

Research links the Mediterranean diet to healthy estrogen levels. Hence, anyone interested in supporting estradiol’s purpose through dietary should fill their plates with whole, anti-inflammatory foods, such as:

• Fruits
• Leafy greens
• Raw and cooked vegetables and legumes
• Whole grains, nuts and seeds
• Fish
• Healthy fats such as olive oil

Diet plays a significant role in maintaining good health during and after menopause. Using portion control and focusing on whole and anti-inflammatory foods can help prevent hot flashes and weight gain associated with menopause. 

Gastrointestinal side effects of estradiol

Estradiol is not without side effects or adverse reactions. Common gastrointestinal or gut-related side effects include:

• Stomach cramps or indigestion
• Fluid retention and bloating
• Nausea or vomiting
• Diarrhea
• Constipation 

Eating too much salt could exacerbate fluid retention and bloating. Processed or sugary foods might also worsen nausea, indigestion, or other stomach issues. Eating a healthy, well-balanced diet is important for overall health, but filling your plate with nutritious whole foods also helps prevent or manage gastrointestinal issues from estradiol.

Serious side effects and risks of estradiol

The foods you eat or avoid will not impact your risk of serious side effects of estradiol. However, it’s still important to know the signs. 

Seek medical advice if you experience any of the following on estradiol:

• Unusual vaginal bleeding
• Unusually high blood pressure
• Severe headache
• Unusual vaginal discharge
• Concerning fluid retention

Seek immediate medical attention if you experience any of the following: 

• Signs of blood clots, such as lower limb swelling or pain
• Signs of heart attack, such as chest pain
• Angioedema (swelling of lips, tongue, or throat associated with allergic reaction) 

Tips for maximizing estradiol benefits

It is important to tell your healthcare provider about any over-the-counter and prescription medications and supplements you take before using estradiol to avoid dangerous drug interactions. 

Tips for maintaining overall health while on estradiol include:

• Practicing good sleep hygiene
• Exercising regularly
• Reducing stress
• Prioritizing fruits, vegetables, whole grains, and lean proteins

Beyond that, the best way to maximize the benefits of estradiol is to follow your prescriber’s instructions and take a holistic approach to hormone health.