Estriol (E3) and Estradiol (E2)

Who May Benefit from Estriol and Estradiol Therapy?

Vaginal dryness or urogenital discomfort

Women experiencing vaginal dryness, irritation, or discomfort related to low estrogen levels may benefit from estriol and estradiol cream, which may provide both the stronger receptor activity of estradiol and the gentler, short‑acting support of estriol. This combination may offer more balanced local estrogen effects than relying on either hormone alone.

Postmenopausal women needing broader estrogen support

Those experiencing multiple low‑estrogen symptoms—such as hot flashes, night sweats, mood changes, and disrupted sleep—may benefit from using estriol and estradiol together. This paired approach reflects the complementary nature often discussed between the two estrogens, potentially offering both the potency and the gentler modulation needed for broader symptom support.

Women sensitive to stronger estrogens

Some women who do not tolerate full‑strength estradiol may benefit from a combination therapy where estriol moderates the overall estrogenic effect. In these cases, estriol and estradiol  may offer support while reducing the intensity associated with stronger estrogens.

Localized estrogen effects

Because estriol has lower potency and shorter‑acting activity, combining it with estradiol in a topical form may provide localized benefits with less emphasis on systemic hormone levels. This makes combined estriol and estradiol formulations potentially useful when targeted, tissue‑specific support is desired.

What are bioidentical hormones?

Bioidentical hormones, predominantly isolated from plant materials, have the exact chemical and molecular structure as hormones made in the human body. Bioidentical steroid hormones like estriol and estradiol are designed to bind to the same receptors and undergo similar enzymatic breakdown. Dose and delivery route are essential to activity, which is why compounded bioidentical hormone replacement therapy (BHRT) offers distinctive options that maximize therapeutic use.

Access clinical studies on Estriol and Estradiol

• Lephart ED, Naftolin F. Menopause and the Skin: Old Favorites and New Innovations in Cosmeceuticals for Estrogen-Deficient Skin. Dermatol Ther (Heidelb). 2021 Feb;11(1):53-69. doi: 10.1007/s13555-020-00468-7. Epub 2020 Nov 26. PMID: 33242128; PMCID: PMC7859014.
• Kamp E, Ashraf M, Musbahi E, DeGiovanni C. Menopause, skin and common dermatoses. Part 1: hair disorders. Clin Exp Dermatol. 2022 Dec;47(12):2110-2116. doi: 10.1111/ced.15327. Epub 2022 Oct 28.
• Samaras N, Papadopoulou MA, Samaras D, Ongaro F. Off-label use of hormones as an antiaging strategy: a review. Clin Interv Aging. 2014 Jul 23;9:1175-86. 
• Comhaire F.  Hormone replacement therapy and longevity.  Andrologia, 2016; 48(1):65-8.
• Avila M, Bansal A, Culberson J, Peiris AN. The Role of Sex Hormones in Multiple Sclerosis. Eur Neurol. 2018;80(1-2):93-99. 
• Schwartz E, Morelli V, Holtorf K. Hormone replacement therapy in the geriatric patient: current state of the evidence and questions for the future–estrogen, progesterone, testosterone, and thyroid hormone augmentation in geriatric clinical practice: part 2. Clin Geriatr Med. 2011 Nov;27(4):561-75. doi: 10.1016/j.cger.2011.07.004. PMID: 22062441.
• Riepl M. Compounding to Prevent and Treat Dysbiosis of the Human Vaginal Microbiome. Int J Pharm Compd. 2018 Nov-Dec;22(6):456-465.
• Loflin BJ, Westmoreland K, Williams NT. Vulvodynia: A Review of the Literature. J Pharm Technol. 2019 Feb;35(1):11-24. 
• Gava G, Orsili I, Alvisi S, Mancini I, Seracchioli R, Meriggiola MC. Cognition, Mood and Sleep in Menopausal Transition: The Role of Menopause Hormone Therapy. Medicina (Kaunas). 2019 Oct 1;55(10):668. 
• Ruiz AD, Daniels KR, Barner JC, Carson JJ, Frei CR. Effectiveness of compounded bioidentical hormone replacement therapy: an observational cohort study. BMC Womens Health. 2011 Jun 8;11:27. 
• Gandhi J, Chen A, Dagur G, Suh Y, Smith N, Cali B, Khan SA. Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management. Am J Obstet Gynecol. 2016 Dec;215(6):704-711. 
• Faubion SS, Sood R, Kapoor E. Genitourinary Syndrome of Menopause: Management Strategies for the Clinician. Mayo Clin Proc. 2017 Dec;92(12):1842-1849.
• Ali ES, Mangold C, Peiris AN. Estriol: emerging clinical benefits. Menopause. 2017 Sep;24(9):1081-1085.  

Access package inserts for Estriol and Estradiol