Key takeaways:
Estradiol is a lab-made form of estrogen. It’s most often prescribed for menopausal symptoms, such as vaginal dryness or hot flashes. But it’s also FDA-approved for low estrogen levels and certain types of breast and prostate cancer.
The typical oral estradiol dosage for menopause symptoms is 1 mg to 2 mg daily on a 21-day on, 7-day off cycle. It’s also sometimes used off-label for gender-affirming hormone therapy at a dose of 2 mg to 4 mg daily.
Oral estradiol tablets are available as a lower-cost generic. GoodRx can help you save over 90% off the average retail price at certain pharmacies.
Estradiol is a lab-made version of estrogen. It has several different uses, but is most commonly prescribed to replace estrogen when levels are low, such as during menopause. It’s also taken as part of estrogen-based gender-affirming hormone therapy (GAHT), although this is considered an off-label use.
This guide will cover typical oral estradiol dosages. Keep in mind that these are general dosing recommendations. Your healthcare provider may have you take estradiol differently than discussed below.
What dosage forms does estradiol come in?
Estradiol comes in many different dosage forms, including oral tablets and vaginal cream, rings, and tablets. It also comes in topical patches, gels, and sprays that are applied to the skin. Vaginal and topical forms of estrogen are covered in separate dosage guides.
Oral estradiol is available in 0.5 mg, 1 mg, and 2 mg tablets. You can take estradiol tablets with or without food, and at any time of day — but it’s best to be consistent with when you take it.
What’s considered a low dose of estradiol?
When taking estradiol, especially as part of hormone replacement therapy, you may hear that a lower estradiol dose is better. That’s because higher doses of estradiol are more likely to cause vaginal bleeding and sore breasts. They may also carry a higher risk of uterine cancer and blood clots than lower doses.
Generally, 0.5 mg of oral estradiol daily is considered “low-dose” estradiol. And a “standard” estradiol dose is 1 mg daily. But keep in mind that the goal of estradiol treatment is to find the lowest effective dosage for your symptoms. And that varies from person to person. So it’s recommended to start with a low dose and slowly increase it until you find the lowest estradiol dosage that works for your symptoms.
What’s the typical oral estradiol dosage for adults?
The typical oral estradiol dosage depends on why you’re taking it. There are several approved uses for estradiol tablets.
Menopause symptoms (vaginal irritation, hot flashes, and night sweats)
Menopause symptoms can affect the whole body, including vasomotor symptoms such as hot flashes and night sweats. Menopause can also cause changes to the vagina, including vaginal thinning, dryness, and irritation. Painful sex can also be an issue. Estradiol tablets are approved to treat moderate to severe vasomotor as well as vaginal symptoms of menopause.
The recommended oral estradiol tablet dosage for menopause symptoms is 1 mg to 2 mg by mouth once daily for 21 days, followed by no tablets for 7 days. You’ll repeat this 28-day cycle as recommended by your prescriber.
As mentioned, the lowest effective estradiol dosage is preferred. So, your prescriber may prefer to start you on a lower estradiol dosage and increase it slowly over time based on your response. Once you start taking estradiol tablets, they’ll likely check in every 3 to 6 months to see if you still need the medication. It’s best to take estradiol for the shortest time possible.
Good to know: If you have a uterus, it’s recommended to take a progestin along with estradiol for menopause symptoms. This helps lower the risk of uterine cancer caused by estrogen treatment.
Low estrogen levels
For low estrogen levels caused by conditions other than menopause, estradiol tablets are approved to restore estrogen levels to normal. The recommended estradiol dosage for low estrogen levels is 1 mg to 2 mg by mouth once daily. The lowest effective dose is best, so your prescriber may start you at a lower dose and slowly raise it as needed.
Osteoporosis
The oral estradiol dosage for preventing osteoporosis is typically 1 mg to 2 mg once daily. An exact dose isn’t recommended by the manufacturer, as it depends on several different factors and must be tailored to the needs and medical history of the person taking it.
Good to know: Oral estradiol isn’t considered a first-choice option for preventing osteoporosis in women after they’ve gone through menopause. Other treatments, such as bisphosphonates, are a preferred option.
Breast cancer
High doses of estradiol are sometimes used to help manage the symptoms of certain types of breast cancer. The recommended estradiol dosage for breast cancer treatment is 10 mg by mouth 3 times a day for at least 3 months.
Prostate cancer
Oral estradiol tablets are also approved to help manage the symptoms of certain types of prostate cancer. The approved estradiol dosage for prostate cancer treatment is 1 mg to 2 mg by mouth 3 times a day.
Feminizing hormone therapy
Oral estradiol tablets are sometimes used as part of estrogen-based GAHT. They aren’t FDA-approved for this, so it’s considered an off-label use. The recommended oral estradiol dosage for feminizing hormone therapy is 2 mg to 4 mg daily. Your prescriber may raise the dose up to 8 mg per day based on your response.
What happens if you miss a dose of estradiol?
If you miss a dose of estradiol, take it as soon as you remember. But if it’s almost time for your next dose, skip the missed dose. It’s best not to double up on your doses, unless your healthcare provider tells you to do so.
If you’re taking estradiol tablets on a 21-day on, 7-day off cycle, and you forget to stop or restart taking them on the right day, it’s best to reach out to your medical care team or pharmacist. They’ll be able to help you get back on schedule safely.
If keeping track of your doses becomes challenging for you, consider setting a calendar alert or using a reminder app on your phone to help. You can also talk with your prescriber about other forms of estradiol that may be easier to use.
What should you do if you take too much estradiol?
If you accidentally take an extra estradiol dose, it’s unlikely to cause you serious harm. But large doses of estradiol can lead to uncomfortable symptoms such as:
Abdominal pain
Drowsiness
Fatigue
Nausea
Vomiting
Vaginal bleeding
If you or a loved one takes too much estradiol, contact a healthcare professional or call Poison Control at 1-800-222-1222. They’ll let you know what the best course of action is.
How to save on estradiol tablets
Oral estradiol tablets are only available as a lower-cost generic medication. GoodRx can help you save over 90% off the average retail price of estradiol tablets. A 30-day supply of generic estradiol tablets is as low as $9.46 with a free GoodRx discount.
The bottom line
Estradiol is a lab-made form of estrogen that’s most often prescribed for menopausal symptoms and low estrogen levels. The recommended oral estradiol dose for menopause symptoms is 1 mg to 2 mg daily, on a 21-day on, 7-day off cycle. Estradiol tablets are also taken off-label as part of estrogen-based gender-affirming hormone therapy (GAHT). The recommended estradiol dosage for GAHT is 2 mg to 4 mg by mouth daily.
Why trust our experts?
References
Ettinger, B. (2005). Vasomotor symptom relief versus unwanted effects: Role of estrogen dosage. The American Journal of Medicine.
Ettinger, B. (2007). Rationale for use of lower estrogen doses for postmenopausal hormone therapy. Maturitas.
Lees, B., et al. (2014). The prevention of osteoporosis using sequential low-dose hormone replacement therapy with estradiol-17β and dydrogesterone. Osteoporos International.
Lobo, R. A., et al. (2016). Back to the future: Hormone replacement therapy as part of a prevention strategy for women at the onset of menopause. Atherosclerosis.
Martin, K. A., et al. (2023). Treatment of menopausal symptoms with hormone therapy. UpToDate.
Preferred Pharmaceuticals Inc. (2023). Estradiol- estradiol tablet [package insert].
Stevenson, J., et al. (2023). Prevention and treatment of osteoporosis in women. Post Reproductive Health.
Thurston, R. C., et al. (2011). Vasomotor symptoms and menopause: Findings from the study of women’s health across the nation. Obstetrics and Gynecology Clinics of North America.
Tomlins, L. (2019). Prescribing for transgender patients. Australian Prescriber.
