Estradiol dosage, forms, and strengths

Medically reviewed by Josephine Bawab, Pharm.D.
Licensed Pharmacist
Updated Aug 28, 2025  •  Published Jan 23, 2024
Fact Checked
In this article:

Key takeaways

  • The standard estradiol dosage for menopausal symptoms in adults is 1–2 mg per day.

  • The maximum dose of estradiol depends on the condition being treated.

  • Estradiol is available as a tablet, cream, gel, spray, vaginal insert, vaginal ring, implantable pellet, skin patch, and injection.

  • The best time to take estradiol depends on the condition being treated and the dosage form used.

  • Do not take estradiol if you are pregnant or have undiagnosed vaginal bleeding, a history of breast cancer, an estrogen-dependent cancer, active or recent blood clots (DVT, PE, stroke, heart attack), liver problems, or allergies to any of the ingredients in the drug.

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How much estradiol should I take? Quick reference
Patient Typical starting dose Standard dosage Maximum dose
Menopause symptoms 1–2 mg tablet once per day 1–2 mg tablet once per day for 21 days with a rest period of 7 days Not specified
Vulvovaginal atrophy due to menopause 2–4 g of 0.01% vaginal cream applied once per day 1 g of 0.01% vaginal cream applied 1 to 3 times per week Not specified

The dosages listed are general guidelines; your healthcare provider may adjust your dose based on individual health factors.

Estradiol is a natural estrogen, a sex hormone that is also an active ingredient in many prescription drugs, including oral contraceptives. Estradiol alone is FDA-approved as a hormone replacement therapy (HRT) in menopausal and postmenopausal women, as well as pre-menopausal women with low estrogen levels. In menopausal and postmenopausal women, estradiol helps relieve menopausal symptoms, reverse vaginal atrophy, and prevent osteoporosis. Finally, estradiol is also used as an end-stage treatment for breast and prostate cancer. 

Detailed estradiol dosage chart for adults
Indication Starting dose Standard dose Maximum dose
Vasomotor symptoms of menopause 1–2 mg tablet once per day  1–2 mg tablet once per day for 21 days with a rest period of 7 days Not specified
Vulvovaginal atrophy and vaginal symptoms due to menopause 2–4 g of 0.01% vaginal cream applied once per day for 1–2 weeks  2–4 g of 0.01% vaginal cream applied once per day for 1–2 weeks, followed by 1–2 g applied once per day for 1–2 weeks, followed by a maintenance dose of 1 g applied 1 to 3 times per week Not specified
Pain during sex due to menopausal vulvovaginal atrophy and vaginal dryness 4 mcg vaginal insert once per day for 2 weeks 4 mcg vaginal insert once per day for 2 weeks, followed by 4-mcg vaginal insert once every 3–4 days Not specified
Osteoporosis prevention in postmenopausal women 0.5 mg tablet once per day 0.5 mg tablet once per day for 21 days with a rest period of 7 days Not specified
Low hormone levels (hypoestrogenism) in premenstrual women 1–2 mg tablet once per day 1–2 mg tablet once per day Not specified
Palliative treatment of metastatic breast cancer 10 mg tablet 3 times per day for at least 3 months 10 mg tablet 3 times per day for 3 months or longer Not specified
Palliative treatment of inoperable prostate cancer 1–2 mg tablet 3 times per day 1–2 mg tablet 3 times per day Not specified

Detailed estradiol dosage chart for children
Indiction Age Starting dose Standard dose
Hypoestrogenism  12 years and older 0.25 mg tablet once daily in 21-day cycles, followed by a 7-day break OR 14 mcg/day transdermal patch  OR 0.2 mg estradiol cypionate intramuscular injection every 4 weeks 0.5–2 mg once daily in 21-day cycles, followed by a 7-day break OR 25–100 mcg/day transdermal patch applied twice weekly OR 1.5–2 mg estradiol cypionate intramuscular injection every 4 weeks

Personalized dosing considerations

Because of possible serious side effects, healthcare professionals prescribe estrogen at the lowest possible dose to every patient. Women should meet with the prescriber every few months to go over the effects of treatment and discuss discontinuation of the drug.

Estradiol does not require dosage restrictions or reductions in people with kidney dysfunction, and it is never prescribed to people with liver dysfunction or disease.

Estradiol safety information

Estradiol is too hazardous to take with certain medical conditions. Contraindications include:

  • Hepatic impairment

  • Any history of breast cancer, endometrial cancer, ovarian cancer, or other estrogen-related tumors

  • Pregnancy

  • History of deep vein thrombosis or pulmonary embolism

  • Any recent history of blood clot (thromboembolic) disorders, including stroke and heart attack

  • Vaginal bleeding that has not been checked by a doctor

Estradiol may cause problems in people with:

Women with an intact uterus will also need to take a progestin to reduce the risk of cancer or uterine problems.

Because of the increased risk of breast cancer, women should have regular breast exams and mammograms when taking estradiol. Ask the prescriber for medical advice about the best schedule for these exams.

Doctors should immediately stop estradiol treatment in women who experience cardiovascular complications, heart attack, stroke, blood clots, retina changes, or angioedema (facial swelling). Also, it is important to talk to your healthcare provider regarding any upcoming surgeries. Make sure all providers involved in your care are aware of any estradiol treatment you are taking. They can provide a plan of when not to take estradiol before, during, and after a surgery.

When it’s time to stop, prescribers usually just stop giving the drug. About 3 in 4 women can stop taking estradiol cold turkey with no adverse effects. If problems occur, the prescriber may restart the drug and taper the dose. There is no recommended tapering schedule or tapering method. The dose may be gradually reduced over time (“dose taper”), or the prescriber may decrease the number of days per week that doses are taken (“day taper”). 

How to take estradiol

Estradiol tablets should be swallowed whole and taken at the same time each day, with or without food.

The patches should be applied to the lower abdomen or back, not on the breasts. The frequency at which the patch should be changed depends on the brand (either weekly or twice weekly). Avoid water exposure that could loosen the patch.

Topical estradiol should be applied to clean, dry skin on the upper thigh or forearm, never on the breasts or around the vagina. Let it dry completely before dressing. Do not allow other people to apply topical estradiol to your skin. Immediately wash your hands when finished.

Vaginal creams and inserts are applied using an applicator or finger. Follow the exact dosing instructions. 

Estradiol rings are inserted into the upper vagina and left in for 90 days. When properly inserted, the ring shouldn’t be felt. Wash your hands before and after inserting the ring. Estradiol rings should be replaced as prescribed. 

Healthcare professionals administer estradiol injections and implants.

Estradiol dosage FAQs

Estradiol vs. estradiol ER: What’s the difference in doses?

Estradiol comes in a few extended-release formats: biweekly patches, weekly patches, implanted pellets, and 90-day vaginal rings. Doses are measured in the amount of estradiol released daily.

What happens if I miss a dose of estradiol?

Ask the prescribing healthcare provider or a pharmacist what to do about a missed dose. Taking a missed dose will depend on the dosing form used.

How long can you take estradiol?

Estradiol is a potentially hazardous medication when taken for a long time. When taken alone, estrogen therapy increases the risk of endometrial hyperplasia and uterine cancer, as well as a heart attack, stroke, cancer, and blood clot disorders. The FDA advises that estradiol should be taken at the lowest effective dose for a limited time.

Can you overdose on estradiol?

Oral estradiol overdoses have not been associated with serious problems. Common symptoms are nausea, vomiting, and vaginal bleeding. If too much estradiol is taken, call a poison control center or get medical attention.

Is it safe to take estradiol during pregnancy?

Estradiol induces abortion, so it should never be taken during pregnancy. Estradiol is used cautiously in women who are breastfeeding because it gets into human breast milk and decreases the quality and quantity of breast milk.

What interacts with estradiol?

Estrogen replacement therapy does not have major drug interactions when used as prescribed. Even so, tell the prescriber about all the medications and supplements you regularly take before starting estradiol.

How do I stop taking estradiol?

Estradiol can usually be stopped without causing withdrawal symptoms, but women taking estradiol for menopausal symptoms may see a return of hot flashes, night sweats, or depressed moods. Do not stop taking estradiol without talking to the prescriber. 

Sources

Medically reviewed by Josephine Bawab, Pharm.D.
Licensed Pharmacist

Josephine Bawab, Pharm.D., graduated from Virginia Commonwealth University School of Pharmacy. She began working in community pharmacy in 2012 and has worked for multiple chain pharmacies since then. She is passionate about helping patients and precepting students. She currently works and resides in Virginia, where she is just a few minutes away from the beach.

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