Estradiol Replacement Therapy

Estradiol is a form of estrogen that helps regulate many body processes for women including reproductive tissue development and maintenance, bone growth, breast development and fullness, mood, metabolism, regulating the menstrual cycle and sexual function. 

In addition, estradiol influences other body processes, including fat distribution, blood clotting, cholesterol levels, and cognitive function. Estradiol also plays a role in maintaining bone density and joint function. It also reduces gum loss, tooth loss, the risk of macular degeneration, wrinkling and sagging of the skin.

As women age, they produce less and less estradiol which can lead to uncomfortable symptoms such as hot flashes, night sweats, vaginal dryness and painful intercourse. The loss of estradiol at menopause accelerates physical and mental decline which leads to frailty and many diseases with devastating long term health risks: cardiovascular disease, osteoporosis, Alzheimer’s Disease and the list goes on.

There are 3 main types of estrogen produced in the body : estradiol, estrone, and estriol. Terms for each form are often used interchangeably, but it’s important to understand the difference between them. 

Estradiol is the healthy, forever-safe estrogen that is naturally produced in the human body, while estrogen refers to any compound with estrogenic activity.

Most estradiol is produced in the ovaries while women are still in the reproductive phase of life.  Estrone is produced in smaller amounts by the adrenal glands and fatty tissue. Estriol is produced during pregnancy and is a metabolite of estradiol. In general, estradiol is more protective than other forms of estrogen such as estrone , estriol, or other chemically altered forms of estrogens manufactured by pharmaceutical companies such as Premarin to be more potent than estrogen.

Estradiol has greater protective effects on bone health and cardiovascular health than any other form of estrogen 

Let’s take a look at some of the most common age-related issues that can arise when estradiol levels are too low.

Estradiol and Menopause 

One of the most well-known effects of low estradiol levels is menopause. Menopause is characterized by the cessation of menstruation for 1 year and can occur anywhere between ages 45-55 with 51 being the average age in the US.. However, some women may experience menopause earlier or later  than that, due to genetics, medical interventions such as hysterectomy, chemotherapy or radiation.

During menopause, estradiol levels decline sharply, which can cause a number of symptoms like hot flashes, night sweats, vaginal dryness, and mood swings. Low estradiol levels can also lead to osteoporosis, as estradiol helps to maintain bone density. 

Estradiol and Your Cardiovascular System 

In addition to menopause, low estradiol levels have also been linked to an increased risk of cardiovascular disease. Many studies have shown that when estradiol is maintained, postmenopausal women are less likely to develop coronary artery disease than those with lower levels. Low estradiol levels can also lead to high blood pressure and an increased risk of stroke. 

Estradiol and Your Mental Health 

Low estradiol levels can also affect your mental health. One study found that postmenopausal women with low estradiol levels were more likely to experience depression than those with higher levels. Additionally, low estradiol levels have been linked to an increased risk of Alzheimer’s disease and dementia.

There are a few different ways that estradiol can cause weight gain in women. One way is by increasing appetite. When estrogen levels are low, the brain doesn’t receive the signal that the body has had enough to eat, leading to increased hunger and cravings. 

Estrogen also plays a role in regulating how the body stores fat. When estrogen levels decline, the body is more likely to store fat around the abdomen instead of the hips and thighs. This “abdominal obesity” is also associated with an increased risk of heart disease, stroke, and type 2 diabetes. 

Another way that estradiol can cause weight gain is by affecting how well the body metabolizes sugar. When estrogen levels are low, the body becomes less efficient at using insulin to metabolize blood sugar. This can lead to increased blood sugar levels, which can then lead to weight gain if left unchecked.

There are a lot of recommendations on how to increase estradiol levels naturally. But no matter what you do, it’s rarely enough to raise your levels to a therapeutic range where you’ll receive the maximum benefits.

Estradiol should be prescribed to women as soon as they experience menopause to prevent physical and mental decline, preserve health, and delay degenerative disease. When a woman goes through menopause, she loses the ability to produce estradiol, which can cause a variety of symptoms, such as hot flashes, night sweats, vaginal dryness, and mood swings. Estradiol replacement can help to alleviate these symptoms by replacing the estradiol that the body is no longer producing. 

In addition to being used for menopausal symptoms, estradiol can also be used to treat other conditions that are caused by a lack of estrogen. For example, estradiol can be used to treat gum loss, tooth loss, Alzheimer’s Disease, vaginal dryness, increases in visceral body fat, which often occurs during menopause. Estradiol can also be used to treat osteoporosis in postmenopausal women.

There are several ways that women can take estradiol, including pills, patches, gels, and injections. The method of delivery will be determined by your doctor based on your individual needs. The most cardioprotective method and our preferred method of delivery is the oral form but due to an individual patient’s need may be prescribed in an alternate form.

Estradiol Pills 

Estradiol pills come in different forms, including tablets, capsules, and lozenges. They are taken by mouth and absorbed through the digestive system. Estradiol pills are generally taken once a day, with or without food. It is important to take them at the same time each day to maintain a consistent level of estrogen in the body.

Since 90% percent have one or more risk factors for developing heart disease, we want to prevent that. Oral estradiol provides the most cardiovascular protection due to the first pass effect of the liver. Oral estradiol improves clotting factors, decreases LDL, has a positive effect on vessels, reduces blood pressure, increases nitric oxide production, and exhibits antioxidant effects. It’s also the most economical, costing about $10/month for the average daily dose.

Estradiol Patch

Estradiol patches are applied to the skin once a day. They deliver a steady dose of estrogen through the skin and into the bloodstream. Patches are usually applied to the lower abdomen, buttocks, or upper body—areas where there is little or no hair so that the adhesive will stick well. This is a transdermal delivery system and so it does not provide the same cardioprotective effects. Also, a lot of women complain that the patches fall off, and it tends to be a hassle.

Estradiol Cream

Estradiol cream/gel is applied to the skin once a day. It comes in a pump dispenser that delivers a metered dose of gel containing estradiol through the skin and into the bloodstream. The gel is usually applied to the upper arm or thigh—areas where there is little or no hair so that the gel will spread evenly over the skin. We utilize this occasionally with women for whom oral estradiol is contraindicated.

Estradiol Injection 

Estradiol injection is given as an intramuscular shot once every four weeks. It delivers a high dose of estrogen directly into the muscle tissue where it is then absorbed into the bloodstream. Injections are usually given in the buttocks—an area with plenty of muscle tissue for absorption. We do not recommend estradiol injections. We do not utilize them at all with women because it does not deliver consistent levels of estradiol.

Why Do We Avoid Estradiol Pellets?

Estradiol pellets are inserted under the skin through a small incision. They do not provide the same cardioprotective effects as the oral route and do not provide a consistent level. The levels are high initially like with injections and decline over a 4-5 month period. We have observed wide fluctuations and variability in patients with pellets in place.

Common side effects associated with estradiol are similar to PMS type symptoms and are addressed with increasing progesterone or adjusting estradiol. They  include:

1. Breast tenderness
2. Breast enlargement
3. Pelvic cramps
4. Bloating
5. Irritability 

These side effects are typically mild and go away on their own once the body becomes acclimated to having estradiol back at healthy levels.

Estradiol should not be used if you have any of the following conditions: 

1. If you are pregnant or think you may be pregnant.
2. If you are breastfeeding 
3. Have menstrual cycles

We require that all women have a mammogram prior to starting estradiol replacement therapy.

Some drugs like Aspirin and Tramadol interact with synthetic Estradiol. These interactions do not happen with bioidentical Estradiol, which is the only kind we use at Tier1 Health & Wellness.

Millions of women have been harmed by the refusal of medical professionals to provide women with Estradiol replacement and hormone therapy in general.

It is not easy to find doctors who are knowledgeable and experienced in Estradiol replacement. Physicians do not receive education on Hormone Replacement in medical school. For doctors to become knowledgeable in this area, they have to learn it themselves. And that costs a lot of money and time.

Here are some of the most common misconceptions about Estradiol Replacement we at Tier1 Health & Wellness have been trying to correct over the years.

Does Estradiol replacement cause cancer?

Does Estradiol replacement cause heart disease?

Should you avoid Estradiol replacement if you enter menopause early?

Is Estradiol replacement helpful after menopause?

Are the symptoms of menopause a “rite of passage” every woman ought to go through?