Oestrogen (HRT)

Estradiol

Brand names: Estraderm, Estradot, Sandrena, Oestrogel, Vagifem, Femseven

Adult dose

Dose: Indication-dependent: transdermal patch 25–100 micrograms/24h twice weekly; oral 1–2mg OD; gel/spray per product

Route: Oral / Transdermal / Vaginal

Frequency: OD or twice-weekly (patch)

Clinical pearls

NICE NG23: HRT for menopause; transdermal preferred if VTE/migraine/obesity risk
Add cyclical or continuous progestogen in women with intact uterus
BMS / British Menopause Society guidance
MHRA: known but small breast cancer risk, individual benefit-risk discussion documented

Contraindications

Oestrogen-dependent malignancy (breast, endometrial)
Undiagnosed vaginal bleeding
Active or past VTE (transdermal lower risk than oral)
Active arterial thromboembolic disease
Severe liver disease
Pregnancy

Side effects

Breast tenderness
Headache
Nausea
Endometrial hyperplasia (unopposed in uterus)
VTE (oral > transdermal)
Stroke
Breast cancer (combined HRT, prolonged)
Gallbladder disease

Interactions

CYP3A4 inducers (rifampicin, carbamazepine — reduced efficacy)
Lamotrigine (reduces lamotrigine levels)
Levothyroxine (oral oestrogen increases TBG)

Monitoring

BP
Breast awareness / mammography per programme
Endometrial bleeding patterns
Annual review of indication

Reference: BNF; NICE NG23; British Menopause Society; MHRA Drug Safety Update; https://bnf.nice.org.uk/drugs/estradiol/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Pathways