Estradiol Side Effects: Facts You Need To Know
Widely prescribed to relieve the symptoms of menopause and other conditions including some cancers, estradiol is one of the estrogen class of sex steroids. Although this hormone, like other estrogens, is produced by the body, levels fall dramatically during perimenopause, causing hot flashes and vaginal dryness and irritation. Although estrogen therapy helps women cope with the discomforts of menopause, estradiol side effects can be severe.
During the reproductive years, a woman’s body produces high levels of estrogens as her system readies for either menstruation or pregnancy. These estrogens, consisting of estradiol, estriol and estrone, manage signals that trigger various phases of the reproductive cycle. This class of hormone drives the development of secondary sex characteristics, beginning at puberty, supports tissue growth in the reproductive organs and helps to sustain pregnancy.
Although low levels of estrogen occur in women who have undergone an oophorectomy (removal of the ovaries), the most common cause of reduced levels of these hormones is the gradual cycling down of reproductive hormones during menopause. As estrogen levels begin to fall during perimenopause, women begin to experience the typical symptoms of menopause: hot flashes, mood swings, vaginal dryness, and sleep disruption. Although the relationship between the types of estrogens produced by the body and the menopausal symptoms they cause is complex, supplementation with estrogens and other hormones can relieve many of these symptoms.
Hormone therapy is a hotly debated topic. The use of estrogen supplements can relieve the discomforts of menopause, some of which can be severe enough to interfere with daily functioning. But studies demonstrate that these preparations pose significant risks, and many researchers warn that long-term use can have serious consequences for overall health.
Estrogen therapy takes many forms, but all must be obtained by prescription and use must be monitored by a physician. These compounds can be taken orally, in forms such as estradiol acetate or valerate under the brand names Estrace and Estrofem.
Estrogen therapy is also available as a transdermal preparation under brand names such as Alora, Climara or Menostar. As an ointment, it is marketed as Divigel, Elestrin, Estrogel or, in vaginal form, Estrace. The hormone can also be delivered in a vaginal ring (Estring or Femring), and in injection form. Because of estradiol side effects when used alone, these compounds are often combined with a progestin.
Although estrogen therapy can reduce or eliminate menopausal symptoms, severe side effects can occur, including increased risk of breast, uterine or ovarian cancer. Like other hormone supplements, estradiol can also raise the risk of blood clots, stroke or heart attack in individuals with certain preexisting conditions or a family history of certain diseases.
Women should not take estrogen products in any form if they have a history of abnormal vaginal bleeding, breast, uterine or any hormone-dependent cancers, or a history of heart disease. In particular, a history of blood clots in the lung or lower body raises risk of complications.
A family history of some health conditions can also preclude the use of estrogen therapies, particularly for long periods of time. Women with family histories of blood clots, heart, kidney or liver disease, as well as those suffering from lupus, gallbladder disease, seizure disorders or migraine may also run a greater risk of complications from hormone replacement.
Allergies to medications or food dyes can also raise risk of side effects, as does a history of smoking, or obesity. Since one side effect of this treatment, it should never be taken during pregnancy. And, since it can be passed through breast milk, physicians caution that it can harm a nursing baby as well.
For those who choose to take estrogen products, careful monitoring during use can minimize the risk of estradiol side effects. Experts from the National Institutes of Health and other public health agencies recommend regular physical examinations and mammograms during a course of hormone therapy, and follow-ups with the prescribing physician every three to six months. Estrogen products should not be taken in amounts larger than prescribed, or used for longer periods of time.
Because of its association with blood clots and cardiovascular disease, estrogen use should be discontinued during medical testing or surgery, or if bed rest is required. And, because of an increased risk of heart attack or stroke, users should never smoke during estrogen therapies.
One way to mitigate the potential for estrogen-caused cancers, especially uterine cancer, is to take progestin in combination with these hormones. Some preparations, such as Activella and Cyclo-Progynova, include this additional hormone.
Progestin is a synthetic formulation with effects similar to another naturally occurring hormone, progesterone. Progesterone, produced by the ovaries and adrenal glands, plays an important role in supporting the health of the reproductive system as a whole and, during pregnancy, the endometrium. For women who still have a uterus, progestin taken with estrogens can be a safer option than taking them alone.
For healthy women without a personal or family history of serious cardiovascular disease, cancer or other disorders, estrogen therapy may be an effective short-term treatment for a variety of menopause-related complaints. But because estradiol side effects include very serious health conditions such as cancer, stroke and heart attack, it’s important to weigh benefits and risks in order to make an informed decision about taking estradiol, and to work closely with a healthcare professional to ensure the safest course of treatment.