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Estradiol oral

Updated 2 Feb 2023 | Oestrogens and HRT


Tablets containing estradiol as estradiol hemihydrate.

Drugs List

  • BEDOL 2mg tablets
  • ELLESTE-SOLO 1mg tablets
  • ELLESTE-SOLO 2mg tablets
  • estradiol 1mg tablets
  • estradiol 2mg tablets
  • ZUMENON 1mg tablets
  • ZUMENON 2mg tablets
  • Therapeutic Indications


    Menopausal symptoms
    Secondary prophylaxis of postmenopausal osteoporosis where risk of fracture

    Hormone replacement therapy (HRT) to treat oestrogen deficiency symptoms in peri and postmenopausal women.

    To prevent osteoporosis in postmenopausal women at high risk of fractures, who cannot take other drugs indicated for the prevention of osteoporosis. (2mg only)


    A progestogen should be added for 12 to 14 days each cycle for women with an intact uterus, to oppose the production of an oestrogen-stimulated hyperplasia of the endometrium. It's not recommended to add a progestogen in hysterectomised women, unless there is a previous diagnosis of endometriosis.


    Starting treatment:
    Treatment may be started on any convenient day for women who are: hysterectomised; or with established amenorrhoea; or who are experiencing long intervals between spontaneous menses; or those changing from a continuous combined HRT preparation.

    Women changing from a cyclical or continuous sequential HRT preparation should start treatment the day after completing the previous regimen.

    Women who have regular menstrual periods should start treatment on the first day of bleeding, although different brands have different recommendations - see manufacturer's information.

    Treatment of menopausal symptoms:
    Initially 1mg daily without interruption. If clinical response is inadequate, increase to 2mg daily but reduce to the lowest effective dose for maintenance therapy.

    Prevention of osteoporosis:
    2mg daily without interruption. Begin treatment as soon as possible after the onset of menopause.

    Additional Dosage Information

    Tablets should be taken continuously without a break between packs.

    Missed tablets:
    If a tablet is forgotten, it should be taken as soon as the patient remembers, therapy should then continue as before. If more than one tablet has been missed, only the most recent tablet should be taken, the patient should not take multiple doses.

    If the next tablet is taken more than 12 hours late, the missed tablets should be left in the pack and the next tablet taken at the right time.

    Missed tablets may cause breakthrough bleeding and spotting.


    Suspected hormone dependent neoplasm
    Abnormal liver function test
    Acute hepatic disorder
    Antiphospholipid syndrome
    Breast cancer
    Deep vein thrombosis
    Familial conjugated hyperbilirubinaemias
    History of breast cancer
    History of hormone dependent neoplasm
    History of thromboembolic disorder
    History of venous thromboembolism
    Hormone dependent neoplasm
    Myocardial infarction
    Pulmonary embolism
    Recent arterial thromboembolic disorder
    Thromboembolic disorder
    Thrombophilic disorder
    Uncontrolled endometrial hyperplasia
    Undiagnosed gynaecological haemorrhage

    Precautions and Warnings

    Family history of breast cancer
    Hereditary angioedema
    History of recurrent spontaneous abortion
    Patients over 65 years
    Predisposition to thromboembolic disease
    Prolonged immobilisation
    Recent anticoagulant therapy
    Recent surgery
    Recent trauma
    Severe headache
    Abnormal mammography
    Cardiac impairment
    Diabetes mellitus
    Endometrial hyperplasia
    Epileptic disorder
    Fibrocystic breast disorder
    Glucose-galactose malabsorption syndrome
    Hepatic adenoma
    Hepatic impairment
    History of chloasma
    History of endometrial hyperplasia
    History of endometriosis
    Lactose intolerance
    Post partum
    Renal impairment
    Uterine fibroids

    Risk of pancreatitis in individuals with hypertriglyceridaemia
    Add progestogen for 12-14 days each cycle for those with an intact uterus
    Assess family medical history prior to commencing treatment
    Exclude breast cancer before treatment
    Exclude oestrogen dependent neoplasm before treatment
    Not all available strengths are licensed for all indications
    Contains lactose
    Some formulations contain sunset yellow (E110); may cause allergic reaction
    Do breast & pelvic exam. before & during treatment if clinically indicated
    Exclude pregnancy prior to initiation of treatment
    Abnormal and/or irregular bleeding should be investigated
    Advise patients of risks/benefits & review need for treatment regularly
    Discontinue treatment if patient develops seizures
    Evaluate treatment at least annually
    Monitor hepatic function in patients with history of hepatic disease
    Advise patient that changes in their breasts should be reported to Dr/nurse
    Advise patient to contact a doctor if symptoms of thromboembolism develop
    Avoid immobilisation-treatment may cause increased risk of thromboembolism
    Discontinue at the onset of severe depression
    Increased risk of venous thromboembolism
    Increased risk of VTE during travel involving >5hr immobilisation
    May increase baseline risk of ovarian carcinoma
    Uterine fibroids may increase in size
    May interfere with certain laboratory measurements
    Discontinue 4 - 6 weeks before major surgery
    Advise patient to seek advice at first indications of pregnancy
    Discontinue at first signs of thrombophlebitis or thromboembolism
    Discontinue if abnormal neurological signs develop
    Discontinue if cerebrovascular disorders occur
    Discontinue if cholestasis develops
    Discontinue if first occurrence or worsening of migraine/severe headache
    Discontinue if jaundice or other evidence of hepatic impairment occurs
    Discontinue if significant rise in blood pressure occurs
    Discontinue if sudden pain in the chest occurs
    Discontinue if sudden, severe pain in stomach occurs
    Discontinue if symptoms due to endometriosis are exacerbated
    Maintain treatment at the lowest effective dose
    Maintain treatment for the shortest possible duration
    Advise patient not to take St John's wort concurrently
    Female: Not for contraception.Use non-hormonal contraception, if required
    Advise patient of increased risk of breast cancer vs benefits of HRT
    Intolerance to contact lenses may occur

    HRT should only be considered for patients whose symptoms adversely affect quality of life. An annual careful appraisal of the risks and benefits should be undertaken. When carrying out initial medical examinations of patients, ensure that investigations (including appropriate imaging tools, e.g. mammography) are carried out in accordance with currently accepted screening practices.

    For the treatment of menopausal symptoms the benefits of short-term HRT are considered to outweigh the risks in the majority of women.
    In all cases, it is good practice to use the lowest effective dose for the shortest possible time and to review the need to continue treatment at least annually.
    For postmenopausal women over 50 years who are at an increased risk of bone fracture, HRT should be used to prevent osteoporosis only in those who are intolerant of, or contraindicated for, other osteoporosis therapies.

    Physical examination should be guided by this and a knowledge of the contraindications and precautions and warnings for use of the product. Investigations including mammography should be carried out in accordance with currently accepted screening practices, modified according to the clinical needs of the individual.

    There is an increased risk of breast cancer in women currently or recently using HRT. The risk of breast cancer increases with the duration of treatment and, after stopping HRT, the risk will decrease with time. When HRT lasts for more than 5 years, the risk may persist for 10 years or more.

    Examinations to rule out endometrial abnormalities should be undertaken at regular intervals. Prolonged monotherapy with oestrogens increases the risk of endometrial hyperplasia and carcinoma in postmenopausal women unless supplemented by administration of a progestogen to protect the endometrium. Unless there is a previous diagnosis of endometriosis it is not recommended to add a progestogen in hysterectomised women.

    Pregnancy and Lactation


    Hormone replacement therapy is contraindicated during pregnancy.

    Should pregnancy occur, treatment should be discontinued immediately.

    Estradiol has been associated with cardiovascular defects, eye and ear abnormalities and hypospadias in the newborn when having been exposed to these in the womb (Briggs, 2015). However, some studies have failed to find a relationship with cardiovascular defects and non-genital malformations. Down's syndrome has also been associated with oestrogens as a group, but not for estradiol (Schaefer, 2015).

    Development alterations in the psychosexual performance of boys have been attributed to exposure to estradiol and progestogen in the womb. Males who have been exposed to estradiol and progestogen have demonstrated a trend to have less heterosexual characteristics and fewer masculine interests than males which have not been exposed to these hormones prenatally.


    Hormone replacement therapy is contraindicated during breastfeeding.

    Oestrogenic agents demonstrate lower infant weight gain, decreased milk production and decreased composition of nitrogen and protein content of human milk (Briggs, 2015). Even though the extent of these changes is low, the changes in milk production and composition may be of nutritional importance in malnourished mothers. Because of the reasons mentioned above the use of this medication during lactation should be avoided.

    Side Effects

    "Spotting" bleeding
    Abdominal cramps
    Abdominal pain
    Aggravation of porphyria
    Allergic skin reactions
    Altered thyroid hormone levels
    Back pain
    Breakthrough bleeding
    Breast enlargement
    Breast pain
    Breast tenderness
    Cervical erosion
    Change in amount of cervical secretion
    Change in carbohydrate metabolism
    Changes in libido
    Cholestatic jaundice
    Cystitis-like syndrome
    Deep vein thrombosis (DVT)
    Endometrial hyperplasia
    Erythema multiforme
    Erythema nodosum
    Exacerbation of epilepsy
    Exacerbation of varicose veins
    Fibrocystic breast changes
    Fluid retention
    Gallbladder disease
    Gastroesophageal reflux disease
    Haemolytic anaemia
    Haemorrhagic eruption
    Hypersensitivity reactions
    Increase in plasma triglyceride concentration
    Increased risk of breast cancer
    Increased risk of endometrial cancer
    Increased risk of ovarian cancer
    Increased size of uterine fibroids
    Intolerance to contact lenses
    Leg cramps
    Liver function disturbances
    Muscle cramps
    Myocardial infarction
    Pelvic pain
    Peripheral oedema
    Peripheral vascular disorders
    Premenstrual-like syndrome
    Pulmonary embolism
    Sodium retention
    Steepening of corneal curvature
    Thromboembolic disorders
    Urinary incontinence
    Vaginal candidiasis
    Vascular purpura
    Visual disturbances
    Weight changes

    Effects on Laboratory Tests

    Hormone replacement therapy, especially oestrogen-progestogen combined treatment may increase the density of mammographic images and adversely effect the detection of breast cancer.

    The use of oestrogen may also influence the laboratory results of certain endocrine tests and liver enzymes.


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: September 2022

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

    Summary of Product Characteristics: Bedol 2mg. Resource Medical Ltd. Revised April 2009.

    Summary of Product Characteristics: Elleste Solo 1mg. Meda Pharmaceutical Ltd. Revised March 2022.
    Summary of Product Characteristics: Elleste Solo 2mg. Meda Pharmaceuticals Ltd. Revised March 2022.

    Summary of Product Characteristics: Zumenon 1mg. Abbott Healthcare Products. Revised March 2022.
    Summary of Product Characteristics: Zumenon 2mg. Abbott Healthcare Products. Revised March 2022.

    NICE Evidence Services Available at: Last accessed: 31 August 2022

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Estradiol Last revised: 17 March 2021
    Last accessed: 31 August 2022

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