Your Guide to Estradiol: Forms, Formulations, & How to Use Them
Estradiol Basics
Estradiol is the main form of estrogen your body makes before menopause — and the one most often prescribed in bioidentical hormone therapy. When estrogen levels drop during menopause, replacing estradiol can relieve symptoms like hot flashes, night sweats, sleep changes, vaginal dryness, and even mood shifts.
But not all estradiol is delivered the same way. Here’s what you need to know.
1. Oral Estradiol (Tablets)
Examples: Estrace®, generic estradiol tablets
How to use: Taken by mouth, usually once daily, with or without food.
Pros:
Simple and familiar (just a pill)
Can be a good choice for healthy women without a history of blood clots
Cons:
Passes through the liver first (“first-pass effect”), which can slightly increase clot risk and triglycerides
Hormone levels may fluctuate a bit more compared to transdermal forms
Can increase sex-hormone binding globulin levels and make low libido worse
2. Transdermal Patches
Examples: Vivelle-Dot®, Climara®, Minivelle®, Estradiol patches
How to use: Apply to clean, dry skin (lower abdomen or buttocks) and replace twice weekly
Pros:
Steady hormone release for more consistent symptom control
Lower risk of blood clots and stroke compared to oral forms
Skips the digestive system and liver
Safe for the gym, sauna, or swimming
Cons:
Some may experience skin irritation at the patch site
Needs remembering to change on schedule
3. Transdermal Gels and Sprays
Examples: EstroGel®, Divigel®, Evamist®
How to use: Apply to skin on the arm, thigh, or shoulder each day; let dry before dressing.
Pros:
Flexible dosing
Similar safety profile to patches
No adhesive, so less risk of skin irritation
Lower dosing available for those who do better with a small amount
Cons:
Daily application required
Must be careful to avoid skin-to-skin transfer to others for several hours after applying (so applying at night is recommended)
4. Vaginal Estradiol
Examples: Vagifem® tablets, Estring® ring, Imvexxy® capsules, Estradiol vaginal tablet and Estradiol vaginal cream
How to use: Insert into the vagina; dosing depends on type
Pros:
Highly effective for vaginal dryness, discomfort, and urinary symptoms
Can improve urinary frequency, urinary tract infections and vaginal dryness
Minimal absorption into the bloodstream — no systemic risks so safe for almost all women
Cons:
Does not improve hot flashes or address other whole-body symptoms of menopause
Requires direct vaginal application or placement
Choosing the Right Estradiol for You
The right formulation depends on your:
Symptoms — vaginal symptoms vs. whole-body symptoms
Health history — clotting risk, cardiovascular health, liver function, history of cancer
Lifestyle — daily vs. weekly dosing, comfort with skin or vaginal application
At Kultivate Women’s Health, we recommend FDA-approved bioidentical estradiol in the formulation that’s safest and most effective for you. This may mean combining more than one form — for example, a transdermal patch for hot flashes plus vaginal tablets for dryness — to help you feel your best.
Considering hormone therapy?
Schedule your consultation today: www.kultivatewomenshealth.com/visit
Reference
Levy, B. S. (2023). A contemporary view of menopausal hormone therapy. The Lancet Diabetes & Endocrinology, 11(10), 734–746. https://doi.org/10.1016/S2213-8587(23)00158-9