Estradiol (HRT)

How it works

Activates oestrogen receptors to replace declining endogenous oestrogen, easing vasomotor and urogenital symptoms and supporting bone density.

Prescribing in practice

• Unopposed systemic oestrogen must be avoided in women with a uterus; pair it with a progestogen to protect the endometrium.
• Choose the transdermal route preferentially where venous thromboembolism risk is a concern, as it avoids the first-pass increase in clotting risk.
• Individualise the decision around breast cancer, stroke and thrombosis risk and review at least annually.

Monitoring

Reassess symptoms, blood pressure and treatment benefit-risk at least annually, and investigate unscheduled bleeding promptly.

Counselling the patient

• Seek advice for unexpected bleeding, breast changes, or symptoms suggesting a clot.
• Continue breast and cervical screening when invited.
• Take any accompanying progestogen exactly as prescribed if you still have a womb.

Evidence & guidelines

NICE menopause guidance supports hormone replacement therapy for menopausal symptom relief with individualised risk assessment.