Estradiol (or other estrogen) for menopausal symptoms, genitourinary syndrome, and selected bone indications. If the uterus is present, a progestogen is required for endometrial protection. Transdermal routes are often preferred over oral conjugated estrogen.
Estrogen therapy is prescription estrogen—usually 17β-estradiol—to treat menopausal vasomotor symptoms, prevent bone loss when indicated, and treat genitourinary syndrome of menopause (often with low-dose vaginal estrogen that has little systemic effect). Systemic estrogen without a progestogen is for people who no longer have a uterus. If the uterus is present, unopposed estrogen raises endometrial cancer risk.
What changed after WHI
WHI used oral conjugated equine estrogen plus medroxyprogesterone in a population that was, on average, older than typical new MHT starts. Modern practice, reflected in NAMS 2022, is more often transdermal estradiol plus micronized progesterone, started for symptoms closer to menopause. That is not a proof that estrogen prevents Alzheimer disease or heart attacks in everyone. Timing, dose, and route still dominate the risk conversation. Smoking plus oral estrogen is a poor mix for clotting.
Limits
Estrogen is not indicated as a first-line drug to prevent chronic disease in asymptomatic women. Personal history of hormone-sensitive breast cancer is usually a stop. Unexplained bleeding needs evaluation, not a higher patch. Compounded “Bi-Est” (estradiol + estriol) is a clinic favorite without the same labeled evidence as estradiol products.
Know your last menstrual period, hysterectomy status, clot/stroke/cancer history, and migraine-with-aura history. Bring mammogram dates.
Patches can irritate skin. Oral estrogen may cause nausea. Vaginal products stay local; systemic symptoms should not be expected to vanish from a vaginal tablet alone.
Breast tenderness, spotting, nausea, gallbladder disease, VTE and stroke (risk higher with some oral regimens), and endometrial hyperplasia if estrogen is unopposed. Breast-cancer risk is regimen- and duration-dependent—not zero and not WHI-cloned for every product.
The 2022 hormone therapy position statement of The North American Menopause Society (Menopause, 2022).
https://doi.org/10.1097/GME.0000000000002028Rossouw J.E. et al. WHI estrogen plus progestin (JAMA, 2002).
https://doi.org/10.1001/jama.288.3.321Canonico M. et al. Hormone replacement therapy and risk of venous thromboembolism: transdermal vs oral (BMJ, 2008).
https://doi.org/10.1136/bmj.39510.537191.BEACOG. Compounded bioidentical menopausal hormone therapy.
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2012/08/compounded-bioidentical-menopausal-hormone-therapy© 2026 Longevity Clinic Finder. All rights reserved.
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Continuous or cyclic, depending on regimen. Recheck symptoms in weeks; do not wait a year if bleeding is abnormal.
Symptomatic menopausal or premature-insufficiency patients after a risk screen. Not a default for every woman over 45 with a normal estradiol and a marketing consult.
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