A Guide to Estrogen Supplements: Patches, Pills, and More

The symptoms of menopause can be frustrating and intrusive. After experiencing hot flashes, night sweats, and vaginal dryness, who wouldn’t want relief? Thankfully, there are many menopause treatment options available. And estrogen supplements are a common and effective choice.

Estrogen supplements come in many forms: patches, pills, vaginal creams, and more. So you have plenty of options for finding what works best and is most convenient for you. But is there one that’s better than the rest?

What do estrogen supplements do?

Estrogen supplements, also called hormone replacement therapy, are the most popular treatment for managing menopause symptoms. The primary cause for these symptoms is the drop in natural estrogen levels that happens during menopause. Estrogen supplements work by replacing the estrogen your body is no longer making. And more available estrogen means fewer menopause symptoms.

What hormones do estrogen supplements contain?

There are three main types of estrogen that can be found in estrogen supplements: estradiol, conjugated estrogens, and esterified estrogens. Estradiol is a lab-made form of estrogen. Conjugated estrogens are derived from the urine of pregnant horses. Esterified estrogens are a mixture of plant-based estrogens and estrogens that come from pregnant horses.

Some estrogen supplements also contain a form of progestin (a lab-made version of the hormone progesterone). A common example is medroxyprogesterone acetate. Progestin doesn’t help relieve menopause symptoms. It’s included to help protect the uterus from serious side effects that can happen when taking estrogen (more on that below).

What type of estrogen supplements are available?

There are several types of estrogen supplements available. There are some notable differences between them, such as which symptoms they can help treat and their possible side effects.

Patches

Estrogen patches can help relieve multiple menopause symptoms, including hot flashes, night sweats, and vaginal dryness. They’re typically worn on the lower stomach area or butt, and they’re changed once or twice a week.

Common brands of estrogen patches include:

• Climara (estradiol)

• Climara Pro (estradiol / levonorgestrel)

• CombiPatch (estradiol / norethindrone)

• Dotti (estradiol)

• Lyllana (estradiol)

• Vivelle-Dot (estradiol)

Pills

Out of all estrogen supplements, estrogen pills have been available the longest. Similar to patches, pills can treat all types of menopause symptoms. They’re typically taken once a day.

Brands of estrogen pills include:

• Estrace (estradiol) — brand name no longer available

• Premarin (conjugated estrogens)

• Prempro (conjugated estrogens / medroxyprogesterone acetate)

• Menest (esterified estrogens)

• Angeliq (estradiol / drospirenone)

• Prefest (estradiol / norgestimate)

• Activella (estradiol / norethindrone)

• Femhrt (ethinyl estradiol / norethindrone)

• Bijuva (estradiol / progesterone)

Gels and sprays

Estrogen gels and sprays are applied to the skin. All estrogen gels and sprays are FDA approved to treat hot flashes and night sweats. But one available gel can also help with vaginal symptoms.

Estrogen gels and sprays are typically applied once a day. But the area where you apply them varies between products.

Brand of estrogen gels and sprays include:

• Divigel (estradiol gel)

• Elestrin (estradiol gel)

• Estrogel (estradiol gel) — can also help with vaginal symptoms

• Evamist (estradiol spray)

Vaginal creams

Estrogen creams are a type of vaginal estrogen product. Using an applicator, you place a dose into your vagina. Commonly, women apply it a few times a week, but your dosage may be different, especially when you first start using it. These medications only help with vaginal symptoms, such as dryness and pain during sex.

There are two types of vaginal estrogen cream available:

• Estrace vaginal cream (estradiol)

• Premarin vaginal cream (conjugated estrogens)

Vaginal suppositories

Vaginal estrogen suppositories come as tablets or capsules (also called inserts). They’re placed into the vagina using an applicator, usually twice a week after daily use for the first two weeks. They can help with vaginal symptoms, but won’t help with hot flashes or night sweats.

Brands of vaginal suppositories include:

• Vagifem (estradiol vaginal tablets)

• Yuvafem (estradiol vaginal tablets)

• Imvexxy (estradiol vaginal inserts)

Vaginal rings

Vaginal estrogen rings are thin silicone rings that are placed inside the vagina. They’re left in place for 90 days and slowly release estrogen during this time. After 90 days, you remove the old ring and insert a new one.

There are two vaginal estrogen rings available:

• Estring (estradiol)

• Femring (estradiol acetate)

The biggest difference between the two rings is that Femring can treat all types of menopause symptoms, including hot flashes. Estring only works for vaginal symptoms.

Injections

You can also receive estrogen as an injection into a muscle (intramuscular) or beneath the skin (subcutaneously). Injections are typically given every 3 to 4 weeks, depending on the medication. Your healthcare provider can teach you how to give yourself injections, so you can take your doses at home.

There are two types of estrogen injections available:

• Delestrogen (estradiol valerate)

• Depo-Estradiol (estradiol cypionate)

Are estrogen patches or pills better for menopause relief?

In general, experts consider both estrogen patches and pills to be similarly effective for relieving menopause symptoms. But there are some notable differences that make estrogen patches the preferred choice for many women:

• More estrogen is absorbed. After taking oral estrogen, the liver starts breaking down the medication. This is a normal part of oral medication absorption. But with estrogen patches, this initial step is skipped. So you end up with higher amounts of estrogen reaching your bloodstream.

• Steadier estrogen levels. Another benefit of skipping the initial liver breakdown step with the patch is steadier estrogen levels. Estrogen pills tend to provide slightly higher estrogen levels right after your dose that decrease over a period of 24 hours. As estrogen levels fall, menopause symptoms can return or worsen. For some women, having steadier estrogen levels throughout the day can mean more predictable symptom relief.

• Smaller effect on triglycerides. Triglycerides are a type of fat found in the bloodstream. High triglycerides can raise the risk of heart disease over time. And while estrogen patches can raise triglyceride levels, they have less of an effect on them than estrogen pills.

• Potentially lower risk of blood clots. Taking estrogen can raise the risk of blood clots. But some studies suggest estrogen patches may have a lower risk of blood clots than estrogen pills. However, more studies are needed to confirm this.

What are the side effects of estrogen supplements?

Side effects vary depending on which type of estrogen supplement you’re taking. Common side effects of estrogen supplements include:

• Sore breasts

• Breast enlargement

• Headaches

• Mood changes

• Nausea

Additionally, estrogen supplements that you apply to your skin — patches, gels, and sprays — can cause skin irritation. And vaginal estrogen supplements can cause yeast infections and changes to your vaginal discharge.

Serious side effects of estrogen supplements are rare, but possible. These include a higher risk of developing:

• Breast cancer, with the risk being greatest for people taking a combination of an estrogen and a progestin

• Uterine cancer, with the risk being greatest for people taking estrogen-only supplements

• Blood clots, heart attacks, and strokes

• Gallbladder disease

If you have a history of these conditions, estrogen supplements may not be the safest choice for you. However, low-dose vaginal estrogen (estrogen creams, suppositories, and Estring) have a lower risk of these serious side effects. That’s why they’re recommended to try first if you’re only having vaginal menopause symptoms.

If you still have your uterus, you may need to take progestin in addition to your estrogen supplement. This helps protect your uterus and can lower the risk of developing uterine cancer. For low-dose vaginal estrogen, taking progestin typically isn’t necessary since the risk of uterine cancer is very low. And if your uterus has been removed, you won't need to take progestin either.

Overall, taking estrogen supplements for the shortest time needed is the best way to lower your risk of serious side effects. It’s important to follow up with your healthcare provider regularly so they can determine if you should continue taking estrogen supplements.

How do you know if you’ll benefit from estrogen supplementation?

Hot flashes, night sweats, or vaginal dryness are some of the most common symptoms of low estrogen. But sleep changes, low sex drive, and mood changes are possible too. Many women try over-the-counter remedies, like black cohosh supplements and vaginal lubricants, first. But if these options don’t help or your menopause symptoms seem excessive, that’s when it’s time to ask your provider if estrogen supplements are right for you.

Everyone’s experience with estrogen supplements is unique. But estrogen supplements are the most effective treatment for menopause symptoms. So chances are good that you’ll experience some benefit from them.

Regardless of whether you're treating hot flashes, night sweats, or vaginal symptoms, you can expect results within about 1 to 3 months. So if you’re not noticing relief after taking an estrogen supplement for 3 months, let your healthcare provider know.

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Written by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

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