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Hot Flash Medication: How Estradiol Treats Menopause Symptoms
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Menopause
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Estradiol at 1 mg: What a 12 Week Clinical Trial Revealed
In a clinical trial that studied the efficacy of oral 17beta-estradiol, varying doses were tested for their impact on moderate-to-severe hot flashes over a period of 12 weeks. The data from this study can provide helpful insight into the use of this medication.
At 4 weeks, 86% of women receiving 1 mg of estradiol had at least a 50% reduction in moderate to severe hot flashes, compared with 50% of women who received a placebo. The lower doses took longer to show significant benefit over placebo, but were still helpful.
The study also tested a higher 2 mg dose, which was also effective for hot flashes.However, higher doses of estrogen can increase the risk of side effects. Twice as many women in the 2 mg group stopped taking the drug because of side effects. This led the researchers to determine that 1 mg seemed to be the most practical starting dose. It provided good benefits with lower risks. (4)
Significant improvement in hot flashes can be seen as early as two weeks, with continued benefits observed through 12 weeks of treatment.
Estradiol Side Effects
Estradiol, like all drugs, may produce side effects. Side effects of oral estradiol include: breast tenderness, bloating, nausea and headaches. In rare cases, it can also contribute to strokes and blood clots, and can increase the risk of some breast cancers. As this study demonstrated, the common side effects like nausea and bloating may be dose dependent, with more side effects occurring in higher doses. Most side effects are often mild and may dissipate over time. (9)
Your provider can help you weigh the potential benefits and side effects based on your individual situation.
FAQs
Is estradiol FDA approved for menopause symptoms?
Yes. Several estradiol products are approved by the FDA to treat moderate to severe vasomotor symptoms (hot flashes and night sweats) due to menopause.
Do I need to take progesterone too?
If you have a uterus, it is usually advisable to use progesterone in addition to estrogen to prevent overgrowth of the uterine lining and potentially uterine cancer. Your health care provider will decide what is best for you and your individual medical situation. (5)
How long until I see results?
In this study, hot flashes started getting better at 2 weeks and were still improving at 12 weeks. The amount of improvement will depend on you and your body. Your healthcare provider can help you figure out what to expect. (4)
Who shouldn’t take estradiol?
If you’ve had conditions like estrogen dependent cancers (such as uterine or breast cancer), blood clots, uncontrolled high blood pressure (HTN) or liver disease, you likely won’t be a candidate for hormone replacement. Your provider will review your medical history before recommending this medication.
How long would I use it?
The goal is to take the lowest effective dose for the shortest amount of time. How long that is will be something your provider can talk to you about. You should speak with your provider about your individual needs.
What if I can't take hormone therapy?
There are non-hormonal prescription options that may help with hot flashes, including low dose antidepressants and other medications. The right approach depends on your unique health history and the severity of your symptoms. This is something to discuss in detail with your healthcare provider.
Check Your Eligibility
If you’re dealing with hot flashes and want to understand whether hormone therapy might be an option for you. A healthcare provider on Mochi Health’s telehealth platform can help you determine the best course of action for your needs. Check your eligibility here.
References
Freedman, R. R. (2014). Menopausal hot flashes: mechanisms, endocrinology, treatment. Journal of Steroid Biochemistry and Molecular Biology, 142, 115–120. https://doi.org/10.1016/j.jsbmb.2013.08.010
Mayo Clinic Staff. "Hot Flashes: Diagnosis & Treatment." Mayo Clinic, 4 Mar. 2025, www.mayoclinic.org/diseases-conditions/hot-flashes/diagnosis-treatment/drc-20352795.
The North American Menopause Society. (2022). The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause, 29(7), 767–794. https://doi.org/10.1097/GME.0000000000002028
Notelovitz, M., Lenihan, J. P., McDermott, M., Kerber, I. J., Nanavati, N., & Arce, J. (2000). Initial 17beta-estradiol dose for treating vasomotor symptoms. Obstetrics & Gynecology, 95(5), 726–731. https://doi.org/10.1016/s0029-7844(99)00643-2
Stute, P., Neulen, J., & Wildt, L. (2016). The impact of micronized progesterone on the endometrium: a systematic review. Climacteric, 19(4), 316–328. https://doi.org/10.1080/13697137.2016.1187123
Zhang, Z., et al. (2021). The effects of estrogens on neural circuits that control temperature. Endocrinology, 162(8), bqab087. https://doi.org/10.1210/endocr/bqab087
Cochran, C. J., Gallicchio, L., Miller, S. R., Zacur, H., & Flaws, J. A. (2008). Cigarette smoking, androgen levels, and hot flushes in midlife women. Obstetrics and gynecology, 112(5), 1037–1044. https://doi.org/10.1097/AOG.0b013e318189a8e2
Ee, C., French, S. D., Xue, C. C., Pirotta, M., & Teede, H. (2017). Acupuncture for menopausal hot flashes: clinical evidence update and its relevance to decision making. Menopause (New York, N.Y.), 24(8), 980–987. https://doi.org/10.1097/GME.0000000000000850
Lyytinen, H., Pukkala, E., & Ylikorkala, O. (2006). Breast cancer risk in postmenopausal women using estrogen-only therapy. Obstetrics and gynecology, 108(6), 1354–1360. https://doi.org/10.1097/01.AOG.0000241091.86268.6e
Disclaimer: This article is for educational purposes only and should not be considered medical advice. The information provided does not constitute recommendations for treatment. Always consult with your healthcare provider about your specific situation, symptoms, and treatment options.
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