Menopause symptoms often show up before anyone tells you what they mean. You notice something’s different, and you’re left trying to figure out what’s happening with your body in real time.

Many menopause symptoms trace back to estrogen. But what is it, exactly, and how does it relate to estradiol?

In this article, we break down the difference between estradiol and estrogen.

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Is estradiol the same as estrogen?

Estrogen is a group of sex hormones. There are three main types:

• Estrone (E1): This is a weaker type of estrogen. It becomes the main type as you progress through the menopause transition. 
• Estradiol (E2): This is the most potent type of estrogen, and it’s your body’s source of the hormone in your reproductive years. 
• Estriol (E3): Estriol is the weakest type of estrogen of the three. The body only produces it in meaningful quantities during pregnancy. 

There are other types of estrogen that your body doesn’t produce, like equilin and equilenin. But estrogen types, regardless of origin, generally have the same functions. 

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Estradiol vs. estrogen: At a glance

Here’s a side-by-side comparison of estradiol and estrogen:

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Understanding the three types of estrogen

Let’s break down each type to put estradiol in context. 

Estrone

Before menopause, fat tissues serve as estrone’s major production source. Other peripheral tissues play a role, too, like the ovaries. 

In menopause, ovarian estrogen production declines. But other tissues continue producing estrone, which is why it’s the dominant form of estrogen for postmenopausal women. 

Estradiol

Ovaries are the major production source of estradiol. In menopause, estradiol fluctuates and declines sharply—a key contributor to menopause symptoms. Then, as you progress through menopause, the body naturally produces limited amounts of estradiol due to declining ovarian function. Peripheral tissues still produce it, but in much smaller amounts. 

Estriol

If you have high levels of estriol, you might be pregnant. That’s because it’s largely tied to a precursor hormone called 16α-OH-DHEA-S. This hormone comes from the fetus. 

But estriol’s effects aren’t pregnancy-specific. Its role in pregnancy overlaps with estrone and estradiol.

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Which estrogen types do HRT products use? 

The type of estrogen depends on the HRT product. Many use estradiol, which is bioidentical to the hormone the body produces. These include Estrace®, Climara®, and Estring®. 

Others use conjugated estrogens (CE), a collection of estrogen compounds. Estrone (E1) is often the main ingredient in these mixes, but they also contain estrogens not found naturally in humans, such as equilin sulfate.

However, prescribing has shifted away from conjugated equine estrogens (CEEs) in the last couple of decades. In 2002, the Women’s Health Initiative studied more than 16,000 women taking CEEs. The data and safety monitoring board recommended researchers stop the trial due to concerns about breast cancer risk. As a result, doctors have shifted toward bioidentical formulas.

HRT medications that contain estradiol

Below are a few forms of estradiol that are FDA-approved to treat menopause symptoms. 

Estrace®

Estrace® is a type of local vaginal HRT. You apply this low-dose cream directly to vaginal tissue, which has minimal effects on the wider body. Brand-name Estrace® pills aren’t available anymore, but you can find generic versions. It’s approved to treat moderate-to-severe vulvar and vaginal atrophy.

Climara® and Vivelle Dot®

Both Climara® and Vivelle Dot® are types of transdermal HRT. You apply a patch to your lower abdomen or upper glutes, where the drug then absorbs and enters circulation. They’re FDA-approved for several indications:

• Moderate-to-severe VMS
• Moderate-to-severe vulvar and vaginal atrophy
• Postmenopausal osteoporosis prevention 

The main difference between the two is the dosing schedule. Climara® is applied once weekly, while Vivelle Dot® is used twice weekly.

Estring®

Estring®, like Estrace®, is a type of local vaginal HRT. But it comes in a different form: a ring that’s placed in the upper vagina. It’s FDA-approved for the treatment of moderate-to-severe vulvar and vaginal atrophy (VVA).

VVA refers to the inflammation, thinning, and drying of vulvar and vaginal tissues. Declining estrogen is a key contributing factor, as these tissues rely on estrogen for their proper functioning. VVA falls under the umbrella of genitourinary syndrome of menopause (GSM), which refers to a collection of genital, sexual, and urinary symptoms. 

Estrogen in HRT: What are its benefits?

For symptom relief, estrogen types mostly perform the same. One study, published in Obstetrics and Gynecology, looked at the effects of estradiol on menopause-driven VMS. It found that the following dose amounts had different impacts:

• 0.25 mg estradiol: No meaningful improvement over placebo
• 0.5 mg estradiol: Significant improvement by week 12
• 1 mg estradiol: Significant improvement by week four
• 2 mg estradiol: Significant improvement by week four

For the 1 mg group, 86% of participants experienced a significant reduction in symptoms. This rose to 91% for the 2 mg group, but more discontinued treatment due to increased side effects. 

Other estrogen types can provide VMS relief, too. For example, a 2001 study in Fertility and Sterility demonstrated that conjugated estrogens meaningfully reduced the frequency and severity of VMS. And the same is true for GSM symptoms. A 2014 review found that estradiol and conjugated estrogens both provided GSM relief.

Do different estrogen types carry distinct risks?

They might. Venous thrombosis (blood clots) is one example. A 2014 article published in JAMA Internal Medicine found that conjugated estrogens were associated with about twice the odds of venous thrombosis as estradiol. But this requires further research, and other studies have different conclusions.

FDA-approved estrogen-containing products have low absolute risk when prescribed appropriately. Before prescribing, your doctor will screen for all risks that apply to your care plan. Multiple factors influence an estrogen-containing product’s risk, like the route of administration, dose, and duration of use. 

Care for the chapter no one prepares you for

Your menopause journey is unique. A care plan that works for one person may not make sense for you. At Maven Clinic, our specialists tailor care plans to your needs and goals, reflecting what’s actually going on beneath the surface. 

Dara found the answers she had been looking for with Maven Clinic, writing: "The holistic view and approach for managing perimenopause and menopause have been life-changing!”

Find out more about how we approach hormone care.