Estrogens: Uses, common brands, and safety info

If you experience menopausal symptoms like hot flashes, sleep disturbances, night sweats, and vaginal dryness, your healthcare provider may have mentioned estrogen replacement, or hormone replacement therapy (HRT). These uncomfortable symptoms happen when the ovaries and adrenal glands (part of the endocrine system) in the body make less estrogen. So, medications that replace estrogen can help improve symptoms of menopause, and also prevent osteoporosis. 

Hormone replacement therapy may include estrogen alone, or estrogen and progesterone. 

• In women with a uterus, hormone therapy includes both estrogen and progesterone. This is because estrogen alone increases the risk for endometrial cancer in women with a uterus. 

• Women who have had a hysterectomy and do not have a uterus do not need to take progesterone with estrogen. These women can use estrogen-only products. This article focuses on estrogen-only products.

In this article, we will discuss various estrogens, including their common brand names and formulations, side effects, safety information, and more. Continue reading below to learn more about estrogens. 

Other estrogens

• EstroGel (estradiol) gel

• Evamist (estradiol) skin spray

• Femring (estradiol acetate) vaginal ring

• Menest (esterified estrogen) tablet

• Menostar (estradiol) patch (only used for osteoporosis prevention)

• Minivelle (estradiol) patch

• Ogen (estropipate) pill or vaginal cream

• Osphena (ospemifene) pill (estrogen agonist/antagonist)

What are estrogens?

Women have two main sex hormones: estrogen and progesterone. (Men also have small amounts of estrogen.) Estrogen has an important role. It brings on puberty and is responsible for the menstrual cycle. Estrogen also protects the bones and has effects on other areas of the body. Estrogen is made mainly in the ovaries, and the adrenal glands produce a small amount of estrogen, too. The body makes three types of estrogen: estradiol, estriol, and estrone. Estrone is the only estrogen the body produces after menopause begins.

Sometimes, estrogen levels can be too high. For example, your body may make too much or you can take in too much estrogen, for example, through birth control pills (oral contraceptives). 

Estrogen levels fluctuate throughout the monthly cycle. In the follicle, or follicular phase (between your period and ovulation), estrogen levels increase. The levels are highest in the middle of your menstrual cycle (ovulation) and lowest during your menstrual period. Estrogen levels decrease during menopause.

When women go through menopause, the body makes less estrogen, creating an estrogen deficiency. These low levels can cause menopause symptoms, such as:

• Irregular periods/periods stop

• Hot flashes

• Night sweats

• Sleep problems

• Vaginal dryness and thinning

• Mood swings

• Dry skin 

• Low libido

• Menstrual migraine

• Weight gain

Estrogen therapy, or hormone replacement therapy, helps to replace estrogen. Replacing estrogen helps the symptoms listed above.

How do estrogens work?

When menopause occurs, the body makes fewer estrogen hormones. These lower hormone levels cause symptoms like hot flashes, night sweats, vaginal discomfort, and sleep problems. Estrogen medication replaces the estrogen your body stops making. By boosting levels of estrogen, menopause symptoms improve. 

What are estrogens used for?

The most common indication for estrogens is to alleviate menopause symptoms, such as vaginal dryness and hot flashes. The specific indications for menopause include:

• Treatment of moderate/severe vasomotor symptoms (such as hot flashes) due to menopause.

• Treatment of moderate/severe symptoms of vulvar and vaginal atrophy due to menopause.

It is recommended that topical vaginal products are used when the indication is solely to treat vulvar and/or vaginal symptoms due to menopause.

Estrogens have other indications as well. Specific indications vary by individual medications and formulation. Other indications for estrogens include:

• Treatment of painful intercourse due to vulvar and vaginal atrophy

• Treatment of low estrogen due to hypogonadism, castration, or primary ovarian failure

• Treatment of breast cancer (to improve quality of life) in certain women and men with metastatic disease

• Treatment of advanced androgen-dependent prostate cancer (to improve quality of life)

• Prevention of postmenopausal osteoporosis (only if at high risk and cannot take non-estrogen medications; along with exercise, calcium, and vitamin D as recommended by your healthcare provider or endocrinology specialist)

Some estrogens are also used as fertility treatments in cases of infertility. In these cases, estrogens are used to prepare the uterine lining for pregnancy.

Estrogen may also be used as part of transitioning from male to female, in combination with other drugs. 

Birth control pills contain estrogen and progesterone, or progesterone alone. 

Your healthcare provider can give medical advice on the different estrogen types and if any of them are appropriate for you. 

Who can take estrogens?

Can men take estrogens?

In certain cases, men may take estrogens for certain indications. Some examples of when men may take estrogen products are:

• Male hypogonadism

• Removal of the testicles (castration)

• To improve quality of life in certain cases of metastatic breast cancer or advanced androgen-dependent prostate cancer

• When undergoing gender change from male to female (in combination with other medications)

Can women take estrogens?

Women can take estrogen hormone therapy to treat menopausal symptoms, and for several other indications outlined above. Women who are pregnant or breastfeeding should not take estrogen. 

Can children take estrogens?

Generally, children do not take estrogens. Estrogens have not been tested for safety and efficacy in children. Although it is not indicated for pediatric use, estrogen cream is sometimes used for off-label reasons, such as to treat labial adhesions. Estrogen therapy has also been used off-label to induce puberty in certain cases of delayed puberty. In large doses and over time, estrogen can cause shortened stature. 

Can seniors take estrogens?

There have not been sufficient studies in older adult women and estrogen medications. In the Women’s Health Initiative (WHI) studies, there were higher risks of stroke and dementia in women over 65 years old who took estrogen alone. (In women over 65 who took estrogen plus progestin, there was a higher risk of stroke and breast cancer.) 

Your healthcare provider can give medical advice on whether it is appropriate to take estrogen, and the risks and benefits involved. 

Are estrogens safe?

Estrogen recalls

You can search the FDA’s database here to find updates on recalls. 

Estrogens restrictions

Estrogens have a boxed warning, which is the strongest warning required by the FDA (United States Food and Drug Administration). The warnings apply to all formulations of estrogen.

Estrogen alone:

• Using estrogen alone (without a progestin) in a woman with a uterus can increase endometrial cancer risk. Adding progestin can lower this risk, but can increase the risk of breast cancer. Postmenopausal women who have abnormal bleeding/abnormal menstruation should be tested to rule out a malignancy. 

• Estrogen should not be used alone to prevent cardiovascular disease or dementia. The Women’s Health Initiative (WHI) study determined that there was an increased risk of stroke and DVT (deep vein thrombosis, or a blood clot in the leg) in postmenopausal women who took estrogen alone (without progestin). 

• The study also found an increased risk of dementia in postmenopausal women who took estrogen alone. 

Estrogen plus progestin:

• Do not use estrogen plus progestin to prevent heart disease or dementia. The WHI study found higher risks of DVT, PE (pulmonary embolism), stroke, and MI in postmenopausal women who took estrogen plus progestin. The study also found a higher risk of dementia in postmenopausal women who took estrogen with a  progestin. 

• The WHI study also determined that there is an increased risk of invasive breast cancer with estrogen plus progestin. 

Estrogens, regardless of whether they are prescribed with or without progestins, should be prescribed at the lowest dose and for the shortest period of time. Talk with your healthcare provider about the risks vs benefits of various types of estrogen replacement therapy. 

Your doctor will give you medical advice on screening. All women should have a yearly breast exam by a healthcare professional and do a monthly self-exam. All women should also have mammography based on age, risk factors, and history.

Allergic reactions to estrogens have occurred in rare cases. If you have hives, itching, difficulty breathing, vomiting, or swelling of the face, lips, tongue, hands, or feet, seek immediate medical care. In women with hereditary angioedema, estrogen medication may worsen angioedema symptoms.

Do not take estrogens if you:

• Have unusual (undiagnosed) vaginal bleeding

• Have breast cancer (or history of breast cancer)

• Have uterine cancer (or history of uterine cancer)

• Have blood clots in the legs or lungs (or history of blood clots)

• Have a bleeding disorder

• Have had a heart attack or stroke

• Have liver problems

• Have had serious reactions to estrogens

• Are pregnant or think you might be pregnant

• Are breastfeeding

Your healthcare provider can give medical advice on the risks and benefits of estrogens for you, based on your personal medical history. 

Can you take estrogens while pregnant or breastfeeding?

Do not take estrogens if you are pregnant or breastfeeding. 

Are estrogens controlled substances?

No, estrogens are not controlled substances.

Common estrogens side effects

Side effects can vary by product. For example, a vaginal estrogen product may have more local effects like irritation, while an oral tablet may have more systemic effects like breast tenderness. 

Common side effects of estrogen products include:

• Headaches 

• Breast tenderness/pain

• Vaginal bleeding

• Bloating or cramping

• Nausea and vomiting 

• Hair loss 

• Fluid retention/swelling

• Vaginal yeast infection

Serious side effects of estrogen products include:

• Blood clots 

• Stroke 

• Endometrial cancer (in women with a uterus who do not use progestin along with estrogen)

• Dementia 

• High triglycerides (a type of cholesterol)

• Gallbladder disease

• Vision loss

• Liver problems 

• High blood pressure

• Severe allergic reactions

This is not a complete list of side effects. Other side effects may occur. Ask your healthcare provider about what side effects to expect with estrogen products.

How much do estrogens cost?

Estrogen-only treatment comes in various formulations to suit patient preferences and needs, including patches, pills, injections, vaginal creams, vaginal tablets, and vaginal rings. Prices vary based on formulation and brand or generic status, as well as your insurance coverage. You can contact your insurance provider for up-to-date information on coverage. Another option is to use a free SingleCare card for medications prescribed by your healthcare professional.