6 Foods to Avoid If You’re Taking Estradiol

Estradiol (Estrace) is a prescription medication used to treat bothersome menopause symptoms. It works by increasing the estrogen levels in your body. Estradiol is an estrogen hormone that’s available as a pill, a vaginal cream, or patch. 

It’s important to be aware of food interactions when you start taking any medication, and estradiol is no exception. There aren’t that many foods that interfere with estradiol. But there are foods and drinks that can worsen menopause symptoms. These foods make it harder to get the full benefits of estradiol. 

Here are six foods to avoid while taking estradiol. 

1. Grapefruit

Grapefruit and grapefruit juice are the only foods that directly interact with estradiol. 

Grapefruit juice blocks an enzyme that helps break down estrogen in the body. Eating grapefruit or drinking grapefruit juice can cause estradiol to build up in the body. This can lead to a potentially unsafe increase in your estrogen levels. 

It’s still unclear exactly how much grapefruit can raise estrogen levels. Some studies suggest the impact may be small, but most experts still recommend avoiding grapefruit while taking estrogen-containing medications like estradiol.

2. Spicy foods

Hot flashes are the symptom most people associate with menopause. And for good reason — episodes of feeling abruptly hot with excessive flushing and sweating affect the majority of people going through menopause. Estradiol has been shown to be an effective treatment for treating hot flashes. But spicy foods increase your risk of experiencing these uncomfortable episodes. 

Capsaicin, the compound responsible for “bringing the heat,” actually triggers receptors in the body responsible for sensing heat. So if you’re taking estradiol to avoid hot flashes, it makes sense to limit spicy foods, which can trigger these episodes.

3. Alcohol

Research suggests that alcohol use makes symptoms like hot flashes and night sweats worse. So you may want to limit or avoid alcohol while taking estradiol to get the best benefits from your medication. 

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Drinking alcohol can also work against estradiol when it comes to protecting bone health. Hormone changes during menopause lead to loss of bone strength. Estradiol helps preserve bone strength. But heavy alcohol use can lower your estrogen levels. This can increase your risk of developing low bone density and complications like osteoporosis and hip fractures. 

4. Caffeine

You don’t necessarily have to give up your morning cup of coffee while on estradiol. But there’s evidence that caffeine use can lead to more vasomotor symptoms like hot flashes and night sweats. One study compared the effects of coffee, soda, and tea, and found that all of these beverages increased the risk of hot flashes. 

Limiting caffeine intake while taking estradiol may help you get the best results from your medication. 

5. Sugary foods and drinks

During the transition to menopause, it becomes harder for the body to handle sharp increases in blood sugar. Foods and drinks with added sugar cause quick jumps in blood sugar. Over time, these increases can lead to unwanted weight gain. 

Limit foods and drinks high in added sugar like:

• Sweetened beverages

• Sodas

• Flavored yogurts

• Breakfast cereals

• Condiments (like ketchup, BBQ sauce, and relish)

Instead, choose complex carbohydrates and whole grains. These foods are broken down more slowly, so there isn’t a rapid increase in blood sugar.  

6. Ultra-processed foods

Ultra-processed foods are designed to last a long time on the shelf and be ready to eat. Ultra-processed foods are generally high in sugar, fat, and salt. 

For people dealing with menopause symptoms, eating a lot of these foods can make things worse. A recent study found that menopause symptoms like hot flashes and trouble sleeping were more severe among people eating a diet high in ultra-processed foods. Another study found that replacing these foods with a plant-based diet resulted in weight loss and improvement in hot flashes. 

While taking estradiol, it’s best to avoid ultra-processed foods, such as:

• Potato chips

• Processed meats

• Ramen 

• Pretzels

What are the best ways to minimize estradiol side effects?

Estradiol is generally well tolerated. But there are some common side effects that you should keep in mind. Typically these can be managed at home.  

Common estradiol side effects include headaches, breast tenderness, and stomach upset. 

Breast tenderness

Breast tenderness is more common if you’re taking higher doses of estradiol. You can manage breast tenderness by wearing a supportive bra and using over-the-counter (OTC) anti-inflammatory medication. 

Headache

You may notice headaches the first few months after starting estradiol. To manage headaches, stay hydrated, try resting in a dark room, and avoid other headache triggers such as alcohol.

Gastrointestinal discomfort

People taking estradiol may notice bloating, gas, or nausea. You can manage an upset stomach by eating smaller meals, avoiding spicy or acidic foods, and sticking to a bland diet. 

Increased risk of cancer or blood clots

Estradiol isn’t right for everyone. It’s important to talk with your healthcare team about the link between estrogen therapy and certain medical conditions, like breast cancer, uterine cancer, and blood clots. Let them know about your medical history and whether anyone in your family has a history of cancer or blood clots. Your team can help you decide if it’s safe for you to start taking estradiol. 

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Written by:

Christine Giordano, MD

Christine Giordano, MD, is board-certified in general internal medicine. She received her medical degree from Rutgers New Jersey Medical School and completed residency at Thomas Jefferson University.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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