Written by Dr. Specialist Stine Andreasen
Specialist in Gynecology and Obstetrics, PhD in Obstetrics in 2015 and more than 15 years of clinical practice in Obstetrics and Gynecology
Estrogen comes in several forms: tablets, patches, gels, sprays and local vaginal products. The right choice depends on which symptoms you want to treat, your individual risk factors and your personal preferences. The biggest difference is between estrogen that works throughout the body (systemic) and estrogen that works only locally in the vagina.
Key takeaways
- Tablets, patches, gels and sprays are systemic estrogen and treat hot flashes and night sweats.
- Estrogen taken by mouth passes through the liver and carries a higher risk of blood clots than estrogen absorbed through the skin.
- Low-dose vaginal estrogen treats vaginal and urinary symptoms, with minimal absorption into the bloodstream. It does not treat hot flashes.
Estrogen tablets, patches or gel: which is best?
There is no single best option. The choice depends on your symptoms, your risk factors and your preferences.
Estrogen tablets (oral estrogen)
Tablets are taken daily and provide systemic treatment for menopause symptoms. They suit women who want a familiar, straightforward treatment. Oral estrogen passes through the liver before entering the bloodstream. This affects certain clotting factors and is associated with a higher risk of venous blood clots than estrogen absorbed through the skin. Tablets may therefore be less suitable if you have an increased risk of thrombosis or certain cardiovascular risk factors.
Estrogen patches, gels and sprays (transdermal estrogen)
Transdermal estrogen is absorbed through the skin and provides systemic treatment without passing through the liver first. Patches are usually changed once or twice a week, while gels and sprays are generally applied daily. After an individual medical assessment, transdermal estrogen is often preferred for women with risk factors such as obesity, migraine or an increased risk of venous thrombosis.
Potential advantages:
Effective relief of hot flashes and night sweats
More stable estrogen delivery with some formulations
Lower risk of venous blood clots than oral estrogen
Less effect on clotting factors produced by the liver
Potential disadvantages:
Skin irritation from patches
Needing to apply it regularly
Gel or spray can transfer to another person before it has dried or been absorbed
What is vaginal estrogen?
Low-dose vaginal estrogen is used specifically to treat symptoms caused by low estrogen in the vaginal and nearby urinary tissues. It comes as vaginal tablets, creams, pessaries and vaginal rings. Unlike systemic HRT, it acts mainly locally, with minimal absorption into the bloodstream.
Who is vaginal estrogen for?
It is particularly suitable if you experience:
Vaginal dryness, burning or irritation
Pain or discomfort during sex
Recurrent urinary tract infections linked to menopause
If your symptoms are limited to the vaginal and urinary area, local treatment may be enough on its own, without systemic HRT.
What can vaginal estrogen help with?
Better vaginal moisture and tissue elasticity
Less discomfort during sex
Relief from vaginal dryness and irritation
Fewer recurrent urinary tract infections in selected postmenopausal women
It can be used long term when needed, with appropriate clinical follow-up. Vaginal estrogen does not treat hot flashes or night sweats effectively.
Do you need progesterone with vaginal estrogen?
Generally not, even if you still have a uterus, because the amount of estrogen reaching the rest of the body is minimal.
[MÅ SKRIVES AV FAGPERSON:] Can I use vaginal estrogen after breast cancer?
Low-dose vaginal estrogen may be considered for women who have previously had breast cancer and experience vaginal dryness, discomfort, or painful intercourse, particularly when non-hormonal treatments such as vaginal moisturizers and lubricants have not provided sufficient relief. Unlike systemic hormone therapy, low-dose vaginal estrogen acts mainly locally, with minimal absorption into the bloodstream. Current evidence is generally reassuring and has not demonstrated an overall increased risk of breast cancer recurrence, although long-term safety data remain limited. Extra caution is recommended for women receiving aromatase inhibitors, as even small increases in estrogen levels may be relevant. The decision should be individualized and ideally made in consultation with the treating oncologist, taking into account the type of breast cancer, ongoing treatment, symptom severity, and personal preferences.
What are the side effects of estrogen?
Most women tolerate estrogen well. Some get side effects, particularly in the first months:
Breast tenderness
Nausea
Headaches
Bloating
Vaginal spotting or irregular bleeding
Skin irritation with patches, gels or sprays
These often improve as the body adjusts. Changing the dose, product or route can help.
Does the type of estrogen affect the risk?
Yes. Estrogen taken by mouth passes through the liver and increases the risk of venous blood clots compared with estrogen absorbed through the skin. This is why patches, gels and sprays are often preferred for women with an increased risk of thrombosis, obesity or migraine.
→ Read more about the overall benefits and risks of HRT
Do you need progesterone with estrogen?
If you have a uterus and use systemic estrogen, you generally also need progesterone or another progestogen to protect the endometrium. Low-dose vaginal estrogen is the exception.
Read more → Progesterone in HRT
This article is general information and not a substitute for medical advice. Talk to your doctor about whether hormone therapy is right for you.
FAQ – Estrogen HRT
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Estrogen absorbed through the skin carries a lower risk of venous blood clots than estrogen taken by mouth. Which option suits you depends on your individual risk factors.
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Yes. Gel or spray can transfer to another person through skin contact before it has dried or been absorbed.
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No. Low-dose vaginal estrogen acts mainly locally and does not effectively treat hot flashes or night sweats.
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It can reduce how often recurrent urinary tract infections occur in selected postmenopausal women.
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It can be used long term when needed, with appropriate clinical follow-up.