Discover How Estradiol 1 mg Could Impact Your Weight Loss Journey!

Medically reviewed by Carmen Pope, BPharm.

Estradiol is a synthetic form of estrogen, a crucial hormone that declines naturally, particularly after menopause. It is prescribed for various conditions, including menopause symptoms, vulvar and vaginal thinning, low estrogen levels, and osteoporosis prevention. Understanding the relationship between estradiol and weight loss involves considering its functions, potential side effects, and impact on metabolic processes.

What is Estradiol and What Does It Do?

Estradiol is a synthetic (man-made) form of estrogen hormone that works by replacing declining natural estrogen levels, particularly after menopause. It binds to estrogen receptors throughout the body, helping regulate temperature control (reducing hot flashes), maintaining vaginal tissue health, supporting bone density, and influencing various metabolic processes that depend on estrogen. Estradiol also plays a critical role in male sexual function being essential for modulating libido, erectile function, and spermatogenesis. Estradiol is commonly synthesized as a prodrug ester (for example, estradiol acetate, estradiol valerate) to improve its bioavailability.

Estradiol is used to treat menopause symptoms, vulvar/vaginal thinning, low estrogen levels, and to prevent osteoporosis. Estradiol tablet is a type of estrogen. During menopause, your body makes less estrogen, and this drop in estrogen can cause hot flashes, vaginal dryness, and bone loss. Estradiol tablet works by replacing the estrogen which can help relieve these symptoms and can protect your bones. In some cases, estradiol tablet can also be used to treat prostate cancer by blocking certain hormones that cancer cells need to grow. At higher doses, it can treat certain types of breast cancer that have spread in the body.

It may be used for the treatment of moderate to severe vasomotor symptoms (eg, hot flashes/flushes), and vulvar and vaginal atrophy associated with menopause. It may be considered for the prevention of postmenopausal osteoporosis in women at significant risk and for whom non-estrogen treatments are not appropriate.

Read also: Stopping Estradiol: Weight

Estradiol and Weight Changes: What the Studies Say

Both weight gain and weight loss have been reported by people taking estradiol tablet. But studies show that hormone therapy itself doesn’t directly cause weight changes. For the most part, weight changes during or after menopause are linked to natural hormonal shifts, aging, diet, and lifestyle. If you're concerned about your weight, talk to your prescriber.

The effect of estradiol on weight management is complex. It is important to understand how estradiol interacts with metabolic processes and other hormones.

The Role of Estrogen in Weight Management

Estrogen is one of the two primary female sex hormones. It has a role in the onset of puberty and the menstrual cycle. The ovaries, which are two small glands in the lower pelvis, are mainly responsible for the production of estrogen. The adrenal glands and fatty tissue also make estrogen in small amounts. There are three main types of estrogen:

Estrone (E1): Which the body produces after menopause
Estradiol (E2): Which females of childbearing age produce
Estriol (E3): Which the body produces during pregnancy

Some forms of estrogen have links with how the body controls weight gain. As such, any changes in their levels could then lead to changes in body weight.

Weight Gain During Menopause

Weight gain is a common side effect of menopause, affecting at least 50% of people during menopause and perimenopause. Research suggests that a person gains an average of 1.5 kilograms (kg) during perimenopause, with a total weight gain of around 10 kg by menopause.

Read also: Weight Loss Guide Andalusia, AL

One reason why people might gain weight around menopause is changing hormone levels. One form of estrogen, called estradiol, decreases at menopause. This hormone helps regulate metabolism and body weight, so lower levels may lead to weight gain.

After menopause, a person tends to gain weight around their midsection and abdomen. This type of fat is known as visceral fat.

According to a 2019 article, estrogen also helps control hunger signals, which may help prevent excess calorie consumption. When estrogen levels reduce, this can cause changes in a person’s ability to recognize hunger, which may result in overeating.

In addition to changing estrogen levels, a person may have reduced physical activity and less muscle mass, meaning they burn fewer calories during the day. These age-related factors may play a more significant role in weight gain than changes in estrogen levels.

Additional Factors Affecting Estrogen Levels

Menopause is not the only reason why a person might have low estrogen levels.

Lactation: Estrogen levels remain low after a person has given birth and while breastfeeding or nursing. This hormonal change helps encourage milk production and prevent ovulation and any further conception right away.
Ovary Removal: A person who has had both of their ovaries surgically removed will go through sudden menopause. They will no longer produce the same amount of estrogen.
Turner Syndrome: A person with the condition will usually begin estrogen replacement therapy around the time of puberty. This can help increase estrogen levels, which may help reduce weight gain. According to a 2016 study, late puberty induction may also help decrease the risk of weight gain with Turner syndrome.

Symptoms of Low Estrogen

Symptoms of low estrogen include:

Irregular or missed periods
Hot flashes
Night sweats
Insomnia
Vaginal dryness
Low libido
Moodiness or irritability
Headaches
Dry skin

It is best to contact a doctor if a person suspects they have low estrogen levels. The doctor may order a blood test to measure estrogen levels and determine if there is an estrogen imbalance.

A person can also keep track of their menstrual periods, including when they begin and end and any other symptoms or issues they are experiencing. Having this information available can help a doctor diagnose potential hormonal imbalances.

Managing Weight Gain Related to Low Estrogen

If a person gains weight due to low estrogen, then managing the underlying cause may help with managing weight gain. A person’s doctor can advise on a suitable treatment plan according to the cause.

The doctor can also advise on other ways to reach and maintain a moderate weight. Some general tips include:

Choosing fresh foods over processed options
Including whole grains and lean proteins along with plant-based fats
Staying hydrated by drinking lots of water
Avoiding soda, juice, and alcohol
Getting enough regular physical activity or exercise

Being active is also very important for managing estrogen-related weight gain. In addition to regular cardio exercise, such as jogging, swimming, or walking, people can use strength training to help build muscle and promote healthy bones.

Q&A: Estrogen and Weight

How do I stop estrogen weight gain? Treating an underlying condition may help restore estrogen levels. This might involve estrogen therapy. A person can also follow general tips for maintaining a moderate weight, such as consuming a diet rich in fresh foods and getting enough physical activity.
Will adding estrogen help me lose weight? As low estrogen levels can contribute to weight gain, estrogen therapy may help a person lose weight. A doctor may recommend estrogen if the weight gain is due to an estrogen imbalance. However, estrogen is not specifically a remedy for weight management.
Does estrogen cause belly fat? Reduced estrogen levels are typical during menopause. During this time, a person may experience weight gain around the midsection.

Semaglutide and Hormone Therapy

Hormone therapy was associated with an improved weight-loss response for postmenopausal women with overweight or obesity treated with semaglutide, according to cohort study results published in Menopause.

Postmenopausal women on hormone therapy had higher total body weight loss with semaglutide for up to 12 months vs. no hormone therapy. Cardiometabolic risk markers improved with and without hormone therapy use.

Overall, 16 postmenopausal women were on hormone therapy, of whom 50% received transdermal estradiol 0.025 mg per day to 0.1 mg per day and 50% received daily oral estradiol 0.5 mg to 1 mg.

Postmenopausal women on hormone therapy had a higher percentage of total body weight loss at 3 (7% vs. 5%; P = .01), 6 (13% vs. 9%; P = .01), 9 (15% vs. 10%; P = .02) and 12 (16% vs. 12%; P = .04) months of semaglutide treatment compared with no hormone therapy. At 12 months, more postmenopausal women using hormone therapy achieved 5% or greater (100% vs. 77.4%; P = .01) and 10% or greater (85.7% vs. 58.1%; P = .04) total body weight loss compared with no hormone therapy.

Both postmenopausal women on hormone therapy and those not on hormone therapy had improvements in cardiometabolic risk markers. From baseline to 12 months of semaglutide treatment, postmenopausal women on hormone therapy had improvements in HbA1c (P = .04), triglycerides (P = .004) and total cholesterol (P = .01). In addition, postmenopausal women not on hormone therapy had improvements in fasting glucose (P = .001), HbA1c (P = .0002) and systolic BP (P = .008) from baseline to 12 months.

Estradiol and the Gut Microbiome

The gut microbiome, which is composed primarily of the bacteria in the intestinal tract and their metabolites, has profound effects on energy metabolism28. The gut microbiome aids in digestion and absorption of macro- and micro-nutrients from food29. Gut microbiota are also essential modulators of host immune homeostasis. Protective polysaccharides produced from the break-down of dietary fibers attenuate inflammation30,31. Gut microbiota can also synthesize and metabolize neurotransmitters and hormones to alter host physiology32,33,34. Furthermore, changes in body weight have been associated with changes in gut microbial diversity in humans and rodents35.

A variety of factors, including host genetics, diet, stress, and gonadal hormones can alter the gut microbiome33,34,40,41,42. Sex differences in gut microbiota have been reported in humans and rodents41,43. In a European population, higher levels of Bacteroidetes and Prevotella were observed in men compared to women44. Male mice exhibited higher abundances of Lachnospiraceae (phylum Firmicutes) and Parabacteroides spp. (phylum Bacteroidetes) and Proteobacteria than female mice33,45. Additionally, testosterone administration to female neonatal rats decreased gut microbial diversity during adulthood, and increased the ratio of the two most abundant phyla, Firmicutes and Bacteroidetes40. The hormone-dependent changes in gut microbiota were more robust compared to the diet-induced changes in these rats40. Ovariectomy also alters gut microbial diversity in adult mice33,45,46.

Dosage and Administration

Take estradiol exactly as directed by your doctor. The dosage varies depending on what you are taking estradiol for. Do not increase or decrease the dose unless instructed to do so. You should only take estradiol for short periods when used to treat menopausal symptoms. Your doctor may add a progestin to your estradiol therapy. There is an increased risk of cancer associated with estradiol use. Keep your scheduled appointments with your doctor. You should go for a checkup at least once a year. Keep estradiol tablets out of reach of children.

Pharmacist tips for Estradiol tablet:

You can take estradiol tablet with or without food.
Pay attention to whether estradiol tablet should be taken every day or in cycles. Talk with your prescriber about the schedule that works best for you.
Take estradiol tablet at the lowest dose for the shortest amount of time needed. Your prescriber will check in every 3 to 6 months to see if you still need it.
Estradiol tablet can cause serious side effects, such as heart attacks and strokes. If your menopausal symptoms only affect your vagina (like itching, dryness, or burning), ask your prescriber about other options that might be safer for you, such as a vaginal cream.
If you have a uterus, ask your prescriber if you should also take a progestin along with estradiol tablet. Adding a progestin can help lower your risk of uterine cancer.
If you're planning on having surgery or will be on bedrest, you might need to stop taking estradiol tablet for at least 4 to 6 weeks before. This medication can raise your risk of blood clots, especially when you can’t move around much.
Let your prescriber know if you notice unusual vaginal bleeding, breast lumps, vision changes, or sudden severe headaches while taking estradiol tablet. These are rare but might be signs of serious problems.

Potential Side Effects and Risks

Bleeding changes, an increase in the incidence of vaginal candidiasis, breast pain and discharge, high blood pressure, nausea, vomiting, abdominal cramps, scalp hair loss, hirsutism, headache, mood disturbances, weight changes, fluid retention, skin changes, or an exacerbation of endometriosis.

Estrogens are associated with an increased risk of endometrial cancer. An increased risk of heart attack (myocardial infarction), stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis have been associated with estrogen use (including estradiol), with or without progestins.

With regard to osteoporosis, estradiol has been shown to prevent vertebral bone loss in postmenopausal women. However, it does not restore bone mass to premenopausal levels, and once discontinued, bone loss reverts to what it was during the immediate postmenopausal period.

Should not be used in women with undiagnosed abnormal genital bleeding, with a known or suspected history of breast cancer except in appropriate patients when used for palliation, with estrogen-dependent cancer, with active deep vein thrombosis, pulmonary embolism, or a history of these conditions.

Estrogen use is associated with a two to four-fold increased risk of gallbladder disease requiring surgery. It may also lead to severe high calcium levels in patients with breast cancer or bone metastases.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects.

Serious Health Issues

Estradiol tablet can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

Uterine (endometrial) cancer: Risk factors: Using estradiol tablet without progestin for people with a uterus | Long-term use of estradiol tablet Vaginal bleeding after menopause can be a sign of uterine (endometrial) cancer, so tell your prescriber right away if you notice any unusual bleeding. Using estrogen medications like estradiol tablet for more than a year can raise this risk. If you still have your uterus, your prescriber might add another hormone called a progestin to help lower this risk. That's because progestin balances out estrogen's effects by slowing the growth of your uterine lining.
Breast cancer: Risk factors: Personal or family history of breast cancer | Using estradiol tablet and progestin together | Long-term use of estradiol tablet Taking estrogens like estradiol tablet together with progestins can raise your risk of breast cancer. The risk goes up the longer you use this combination, so it’s best to take estradiol tablet for the shortest time needed. Call your prescriber right away if you notice breast changes such as lumps, pain, or swelling.
Blood clots and strokes: Risk factors: History of blood clots or stroke | Postmenopausal women using estrogen products | Using estradiol tablet with or without progestin | Obesity | History of lupus | InactivityEstradiol tablet can raise your risk of blood clots. This can be very serious and lead to a stroke, a blood clot in the lungs (pulmonary embolism), or a blood clot in the legs (deep vein thrombosis). Share your full medical history with your prescriber before starting estradiol tablet to help lower your risk. Call 911 or get emergency help right away if you have chest pain, pain in your legs or arms, sudden severe headaches, trouble breathing, or sudden changes in speech or vision.
Heart disease and heart attacks: Risk factors: History of heart attack | Heart disease | High blood pressure | High cholesterol | Diabetes | Obesity | Smoking tobacco Estradiol tablet shouldn't be used alone or with a progestin to try to prevent heart disease. In fact, taking estrogens like estradiol tablet can raise your risk of a heart attack. If you have any signs of a heart attack, such as chest pain, chest tightness, trouble breathing, nausea, vomiting, dizziness, sweating, or a fast heartbeat, get emergency help right away.
Dementia: Risk factors: Age over 65 | Using estradiol tablet alone or with progestin People over 65 who use estrogen products like estradiol tablet have a higher risk of developing dementia. If you or your loved ones notice memory problems, confusion, anxiety, or trouble making decisions, tell your prescriber right away.
Gallbladder and liver problems: Risk factors: History of or current liver problemsEstradiol tablet can sometimes cause gallbladder problems, and some people have needed surgery to remove their gallbladder after starting this medication. Call your prescriber or get medical help if you have stomach pain, nausea or vomiting that doesn’t go away, fever, or yellowing of your skin or eyes.Estradiol tablet is broken down by your liver, so if your liver isn't working well, you might have more side effects. You shouldn't take this medication if you currently have or have ever had liver problems, including liver issues during a past pregnancy.
Vision problems: A blood clot in the eye, called retinal vascular thrombosis, can occur in people taking estrogen products like estradiol tablet. Stop taking this medication and call your prescriber right away if you suddenly lose vision in one or both eyes, or if you notice bulging eyes, double vision, or migraines.
High triglycerides: Risk factors: History of high triglyceridesEstradiol tablet can raise your triglyceride levels, which can lead to serious problems like inflammation of the pancreas (pancreatitis). Your prescriber might order regular blood tests to watch for this while you're taking estradiol tablet. If you experience sudden stomach or back pain, nausea, vomiting, sudden weight loss, or a fast heart rate, contact your provider or seek medical care right away.
Low thyroid hormone levels (hypothyroidism): Risk factors: Low thyroid hormone levelsEstradiol tablet can change the amount of thyroid hormone in your blood. If you take medications for low thyroid hormone levels, you might need a higher dose of thyroid replacement therapy. Your prescriber might order regular blood tests to check your thyroid hormone levels.
Fluid Retention: Risk factors: History of heart or kidney problemsUsing estrogen products, like estradiol tablet, can sometimes cause your body to hold on to extra fluid, called edema. This is more likely if you have heart problems, like congestive heart failure, or kidney damage. If you notice unusual swelling in any part of your body or if you suddenly gain weight over a short period of time, let your prescriber know.
Changes in calcium levels in the blood: Risk factors: History of breast cancer | Cancer that has spread to the bonesTaking estradiol tablet can sometimes cause very high calcium in women with breast cancer that has spread to the bones. Signs of high calcium include feeling very thirsty, stomach pain, nausea, vomiting, constipation, bone pain, muscle weakness, or confusion. Tell your prescriber if you have any of these symptoms because you might have to stop taking this medication.Take estradiol tablet carefully if you have low parathyroid hormone levels (hypoparathyroidism). This condition affects the glands in the back of your neck and lowers your calcium levels. Let your prescriber know if you have signs of low calcium, such as burning or tingling of your fingers, toes, or lips, muscle pain and cramps, or confusion.
Worsening of other health conditions: Risk factors: History of asthma or diabetes | History of lupus | History of seizures or migraines | Taking other medications that can cause seizuresIf you have certain conditions, such as asthma or diabetes, talk to your prescriber before taking estradiol tablet. Estrogen products can sometimes make these conditions worse by raising your blood sugar or triggering asthma attacks.

Important Monitoring

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly and does not cause unwanted effects. These visits may be every 3 to 6 months. Pelvic exam, breast exam, and mammogram (breast x-ray) may be needed to check for unwanted effects, unless your doctor tells you otherwise. Be sure to keep all appointments.

Considerations for Specific Populations

It is unlikely that a postmenopausal woman may become pregnant. But, you should know that using this medicine while you are pregnant could harm your unborn baby. If you think you have become pregnant while using the medicine, tell your doctor right away.

Using this medicine over a long period of time may increase your risk of breast cancer or endometrial cancer. Talk with your doctor about this risk. Do not use this medicine if you have had your uterus (womb) removed (hysterectomy). Check with your doctor immediately if you experience abnormal vaginal bleeding.

Using this medicine may increase your risk of dementia, especially in women 65 years of age and older.

Using this medicine may increase your risk for having blood clots, strokes, or heart attacks. This risk may continue even after you stop using the medicine. Your risk for these serious problems is even greater if you have high blood pressure, high cholesterol in your blood, diabetes, or if you are overweight or smoke cigarettes. Contact your doctor immediately if you experience chest pain, confusion, difficulty speaking, double vision, headaches, an inability to move arms, legs or facial muscle, or an inability to speak.

Surgical and Emergency Procedures

Tell the medical doctor or dentist in charge that you are using this medicine before any kind of surgery (including dental surgery) or emergency treatment. Your doctor will decide whether you should continue using this medicine.

Interactions with Medical Tests

This medicine may also affect the results of certain medical tests.

Vision Changes

Check with your doctor immediately if severe headache or sudden loss of vision or any other change in vision occurs while you are using this medicine. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).

Drug Interactions

Medicines that interact with estradiol may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with estradiol. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Note that this list is not all-inclusive and includes only common medications that may interact with estradiol.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.

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