Estradiol

How it works

Binds oestrogen receptors to restore oestrogenic effects on the endometrium, vaginal epithelium, bone and vasomotor centres, relieving symptoms of oestrogen deficiency.

Prescribing in practice

• In women with an intact uterus, systemic oestrogen must be combined with adequate progestogen to prevent endometrial hyperplasia and carcinoma.
• Assess venous thromboembolism, stroke and breast cancer risk before starting; transdermal routes carry a lower thrombotic risk than oral.
• Avoid in oestrogen-dependent cancers, undiagnosed vaginal bleeding and active thromboembolic disease.

Monitoring

Review symptom control, blood pressure and breast and pelvic health periodically, and investigate any unscheduled bleeding.

Counselling the patient

• Report unexpected vaginal bleeding, new breast lumps, or signs of a clot such as leg swelling or breathlessness.
• Attend breast screening and cervical screening as invited.
• Use the prescribed oestrogen and any progestogen together as directed if you have a womb.

Evidence & guidelines

NICE menopause guidance frames the benefits and risks of oestrogen-based hormone replacement therapy, including route-dependent thrombotic risk.