Estrogen Therapy (ET)
Oral (pills or tablets)
Enjuvia contains plant-based, rather than animal-based, estrogen. Risks and benefits are thought to be the same for both types of estrogen.
Transdermal (patch placed on the skin that releases estrogen continuously)
Vaginal ring (inserted high into the vagina; releases estrogen continuously for 3 months)
Skin cream (applied daily to the legs, thighs, or calves)
Skin gel (applied daily to an arm from wrist to shoulder)
How It Works
Estrogen therapy (ET) increases the estrogen level in your body. Estrogen impacts multiple systems of the body.
When given through an estrogen patch, vaginal ring, or skin cream or gel (transdermal estrogen), estrogen enters the bloodstream directly, without passing through the liver. The estrogen in pills must be processed by the liver before entering the bloodstream, which puts stress on an impaired liver.
Low-dose vaginal estrogen affects only the urinary and genital area. For more information, see Low-Dose Vaginal Estrogen for Dryness and Atrophy.
Why It Is Used
Women in their 20s, 30s, and 40s who experience early menopause after having their ovaries removed (oophorectomy) or because of other medical reasons typically take ET to reduce their risk of early bone loss and osteoporosis. Historically, women have continued using ET for years beyond menopause. Some women now discontinue ET around the age of menopause.
Women with a uterus who take estrogen also need the hormone progestin to prevent the estrogen from overgrowing the uterine lining, which can lead to endometrial (uterine) cancer. Estrogen-progestin is called hormone therapy (HT).
Do not use estrogen treatment if you:
How Well It Works
Systemic estrogen therapy (ET) affects your entire body and reverses the effect of low estrogen. Systemic ET may:
Low-dose estrogen. Researchers are studying the effects of low-dose estrogen therapy. Low-dose estrogen may keep bones strong and may relieve hot flash symptoms.3 But the long-term risks of taking low-dose estrogen are not yet known.
Side effects that can occur with all forms of estrogen but are more common with oral estrogen (and less common with a patch, cream, gel, or vaginal ring) include:
Some of these side effects, such as headaches, nausea, fluid retention, weight gain, and breast tenderness, may go away after a few weeks of use.
The estrogen patch (transdermal estrogen) may cause skin irritation.
An estrogen ring must be replaced every 3 months. If the ring falls out at any time during the 3-month treatment period, you may rinse it with lukewarm water and reinsert it.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
Risks of estrogen therapy
Estrogen therapy (ET) may increase the risk of health problems in a small number of women. This increase in risk depends on your age, your personal risk, and when ET is started.2 Talk with your doctor about these risks. Using ET may increase your risk of:
If you are taking ET after early menopause caused by a surgical hysterectomy, talk with your doctor about long-term ET risks and benefits.
Direct sunlight or high heat can increase, then decrease, the amount of hormone released from a patch. This can give you a big dose at the time and leave less hormone for the patch to release later in the week. Avoid direct sunlight on the hormone patch. Also avoid using a tanning bed, heating pad, electric blanket, hot tub, or sauna while you are using a hormone patch.
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