Oral (pills or tablets)
||Cenestin, Enjuvia, Premarin
Enjuvia contains plant-based, rather than animal-based,
estrogen. Risks and benefits are thought to be the same for both types of
Transdermal (patch placed on the skin that releases estrogen continuously)
||Alora, Estraderm, Vivelle-Dot
Vaginal ring (inserted high into the vagina; releases estrogen continuously for 3 months)
Skin cream (applied daily to the legs, thighs, or calves)
Skin gel (applied daily to an arm from wrist to shoulder)
How It Works
Estrogen therapy (ET)
estrogen level in your body. Estrogen impacts multiple
systems of the body.
When given through an estrogen patch,
vaginal ring, or skin cream or gel (transdermal estrogen), estrogen enters the
bloodstream directly, without passing through the liver. The estrogen in pills
must be processed by the liver before entering the bloodstream, which puts
stress on an impaired liver.
Low-dose vaginal estrogen affects
only the urinary and genital area. For more information, see
Low-Dose Vaginal Estrogen for Dryness and Atrophy.
Why It Is Used
Estrogen therapy (ET)
is used to increase estrogen levels in
postmenopausal women who have no uterus. This
treatment may help prevent
osteoporosis, and colon cancer.
their 20s, 30s, and 40s who experience early menopause after having their
ovaries removed (oophorectomy) or because of other medical reasons typically
take ET to reduce their risk of early bone loss and osteoporosis.
Historically, women have continued using ET for years beyond menopause. Some
women now discontinue ET around the age of menopause.
a uterus who take estrogen also need the hormone
progestin to prevent the estrogen from overgrowing the
uterine lining, which can lead to
endometrial (uterine) cancer. Estrogen-progestin is
hormone therapy (HT).
Do not use estrogen treatment if you:
- Are pregnant.
- Have unexplained
- Have active liver disease or chronic impaired
liver function. (Transdermal estrogen does not stress the
- Have a personal history of
ovarian cancer, or
- Are a
- Have a history of blood clots.
- Have had a
Talk to your doctor about your risks versus benefits if you have a family history of breast cancer,
stroke, blood clots, or endometrial cancer.
How Well It Works
therapy (ET) affects your entire body and reverses the effect of low estrogen.
Systemic ET may:
- Reduce the
frequency and severity of
- Improve moodiness and sleep problems related to hormone changes.2
- Maintain the lining of the
vagina, reducing irritation.
- Increase skin
collagen levels, which decline as estrogen levels
decline. Collagen is responsible for the stretch in skin and
- Help prevent postmenopausal
osteoporosis by slowing bone loss and promoting some
increase in bone density.1
- Reduce the risk of dental problems, such as tooth loss and
Low-dose estrogen. Researchers are
studying the effects of low-dose estrogen therapy. Low-dose estrogen may keep
bones strong and may relieve hot flash symptoms.3 But
the long-term risks of taking low-dose estrogen are not yet known.
Side effects that can occur
with all forms of estrogen but are more common with oral estrogen (and less
common with a patch, cream, gel, or vaginal ring) include:
- Fluid retention.
- Breast tenderness.
- Spotting or darkening of the
skin, particularly on the face.
rare cases, an increased growth of preexisting
uterine fibroids or a worsening of
Some of these side effects, such as headaches, nausea,
fluid retention, weight gain, and breast tenderness, may go away after a few
weeks of use.
The estrogen patch (transdermal estrogen) may cause
An estrogen ring must be replaced every 3 months.
If the ring falls out at any time during the 3-month treatment period, you may
rinse it with lukewarm water and reinsert it.
See Drug Reference
for a full list of side effects. (Drug Reference is not available in all
What To Think About
Risks of estrogen therapy
therapy (ET) may increase the risk of health problems in a small number of women. This
increase in risk depends on your age, your personal risk, and when ET is started.2 Talk with
your doctor about these risks. Using ET may increase your risk of:
- Blood clots.
- Ovarian cancer.
- Urinary incontinence.
If you are taking ET after
early menopause caused by a surgical hysterectomy, talk with your doctor about
long-term ET risks and benefits.
sunlight or high heat can increase, then decrease, the amount of hormone released
from a patch. This can give you a big dose at the time and leave less hormone
for the patch to release later in the week. Avoid direct
sunlight on the hormone patch. Also avoid using a tanning bed, heating pad,
electric blanket, hot tub, or sauna while you are using a hormone patch.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
Fritz MA, Speroff L (2011). Menopause and perimenopausal transition. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 673–748. Philadelphia: Lippincott Williams and Wilkins.
North American Menopause Society (2010). Estrogen and
progestogen use in postmenopausal women: 2010 position statement of the
North American Menopause Society. Menopause, 17(2):
242–255. Also available online: http://www.menopause.org/PSht10.pdf.
Fritz MA, Speroff L (2011). Postmenopausal hormone therapy. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 749–857. Philadelphia: Lippincott Williams and Wilkins.
Primary Medical Reviewer
||Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer
||Carla J. Herman, MD, MPH - Geriatric Medicine
||August 8, 2012