Estradiol

Hot flushes, vaginal dryness and thinning bones

Estradiol is the oestrogen the ovaries produce most of before menopause. Levels slide in the years around the last period, and that fall lies behind the familiar symptoms: sudden waves of heat and sweating, night waking, vaginal dryness, itching or soreness. Estradiol tablets put back some of what is missing. They also slow bone thinning after menopause, when bones lose strength and break more easily, and younger women whose ovaries make too little oestrogen take them for the same reason.

Starting on estradiol: what to expect and how it is taken

Anyone starting on estradiol should expect a slow build rather than a switch. Hot flushes tend to fade over the first few weeks as the oestrogen level steadies, and the vaginal dryness and soreness take longer to ease. The tablet carries the same oestrogen the ovaries make, which reaches receptors in the brain, bones, skin and the lining of the vagina.

The usual routine is one tablet a day at a regular hour, swallowed with water, and meals make no difference. Some women take it daily with no break; others leave a few tablet-free days each month.

Side effects

Breast tenderness, headache, nausea, bloating, mood swings and weight changes are the effects reported most, and they often ease as the body adjusts. The more serious risks sit with blood clotting: a clot in the leg or lung, a stroke, a heart attack. A swollen painful calf, sudden breathlessness, chest pain or weakness on one side of the body needs urgent treatment. Oestrogen taken on its own for years raises the risk of cancer of the lining of the womb, which is why a progestin is usually taken alongside it when the womb is still there.

What can interfere with estradiol

St John's wort speeds up the breakdown of estradiol, so the tablets can work less well alongside it. Medicines that push the same liver enzymes harder — the seizure medicines carbamazepine and phenytoin, and the antibiotics rifampicin and rifabutin — can have a similar effect.

The estradiol tablet sold here

Estrace 1mg and 2mg tablets are the estradiol product sold here, in the women's health range. Both strengths are the same small tablet in a blister pack, and either is taken once a day. Keep the pack out of direct heat.