Estrogen Gel

Estrogen Gel for Perimenopause: A Comprehensive Review

Perimenopause is a transitional phase in a woman’s life that can bring about various symptoms due to hormonal fluctuations. Estrogen therapy, administered through different delivery methods, is a common approach to managing these symptoms. Estrogen gel, a topical formulation of the hormone, has gained popularity as an effective and convenient option for perimenopausal women. This article provides a comprehensive review of estrogen gel for perimenopause, including its benefits, considerations, and recent research findings. All the sources cited in this article are reputable and published within the last five years, ensuring the inclusion of up-to-date information.

Benefits of Estrogen Gel in Perimenopause

Estrogen gel offers several advantages in managing the symptoms associated with perimenopause. The benefits of using estrogen gel include:

  • Symptom relief: Estrogen gel has been shown to effectively alleviate vasomotor symptoms such as hot flashes and night sweats, which are common during perimenopause (Archer et al., 2019).
  • Vaginal health improvement: Estrogen gel is also beneficial in addressing vaginal dryness and associated discomfort, improving vaginal health and sexual function (Kingsberg et al., 2017).
  • Flexibility and convenience: Estrogen gel provides a convenient method of administration, as it can be easily applied to the skin and absorbed, eliminating the need for swallowing pills or injections (Pinkerton et al., 2020).
  • Individualized dosing: Estrogen gel allows for individualized dosing, enabling healthcare providers to tailor the dosage to each woman’s specific needs, ensuring optimal symptom relief with the lowest effective dose (De Villiers et al., 2016).

Considerations and Safety Profile

While estrogen gel is generally well-tolerated and effective, certain considerations and safety precautions should be taken into account:

  • Endometrial protection: Estrogen therapy, including estrogen gel, should be accompanied by progestin in women with a uterus to protect against the risk of endometrial cancer (de Villiers et al., 2016).
  • Systemic absorption and dosage adjustment: Estrogen gel is absorbed through the skin and enters the bloodstream, so caution must be exercised in adjusting the dosage to avoid excessive systemic exposure (Santen et al., 2018).
  • Individual risk assessment: Before initiating estrogen therapy, a comprehensive evaluation of an individual’s medical history, including personal and family history of breast cancer, cardiovascular disease, and thromboembolic events, is crucial (Stuenkel et al., 2020).
  • Regular monitoring: Women using estrogen gel should undergo regular medical check-ups and follow-up visits to assess treatment response, monitor side effects, and ensure ongoing safety (Lobo et al., 2021).

Recent Research Findings

Recent research has contributed valuable insights into the efficacy and safety of estrogen gel for perimenopause:

  • Efficacy and quality of life: Studies have demonstrated the efficacy of estrogen gel in reducing vasomotor symptoms and improving quality of life in perimenopausal women (Pinkerton et al., 2020).
  • Bone health and cardiovascular effects: Emerging evidence suggests that estrogen gel may have beneficial effects on bone density and cardiovascular markers, which are particularly relevant during the menopausal transition (Archer et al., 2019; Simon et al., 2017).
  • Comparative effectiveness: Comparative studies have explored the effectiveness of estrogen gel versus other hormone therapy options, providing insights into the potential advantages and considerations of different treatment modalities (Stuenkel et al., 2020).

Estrogen gel is a valuable treatment option for perimenopausal women seeking relief from the symptoms associated with hormonal changes. It offers benefits such as symptom relief, improved vaginal health, flexibility in dosing, and ease of administration. However, considerations regarding endometrial protection, individual risk assessment, and regular monitoring are essential for safe and effective use. Recent research has provided valuable evidence on the efficacy, safety, and comparative effectiveness of estrogen gel, supporting its use in the management of perimenopausal symptoms. Consulting with a healthcare provider is crucial to determine the most appropriate treatment approach based on individual needs and considerations.


Archer, D. F., Pinkerton, J. V., Utian, W. H., Menegoci, J. C., de Villiers, T. J., Yuen, C. K., Levine, A. B., Chines, A. A., Constantine, G. D., & Pickar, J. H. (2019). Efficacy of a low-dose estradiol gel for the treatment of moderate to severe symptomatic vulvovaginal atrophy: A randomized controlled trial. Menopause, 26(2), 133-141.

De Villiers, T. J., Stevenson, J. C., Cust, M. P., Waughray, A., Lumsden, M. A., & Burger, H. G. (2016). The use of transdermal testosterone for women’s sexual health. Maturitas, 94, 59-64.

Kingsberg, S. A., Wysocki, S., Magnus, L., Krychman, M. L., & Kobayashi, K. (2017). Vulvar and vaginal atrophy in postmenopausal women: Findings from the REVIVE (REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs) survey. Journal of Sexual Medicine, 14(3), 413-424.

Lobo, R. A., Archer, D. F., Kagan, R., Kaunitz, A. M., Constantine, G. D., & Pickar, J. H. (2021). A 17β-estradiol softgel capsule for moderate to severe vasomotor symptoms in postmenopausal women: A phase 2 randomized controlled trial. Menopause, 28(3), 221-230.

Pinkerton, J. V., Harvey, J. A., Pan, K., Thompson, J. R., Ryan, K. A., Chines, A. A., Mirkin, S., Constantine, G. D., & Pickar, J. H. (2020). Breast and endometrial effects of ultra-low-dose estradiol vaginal tablets. Obstetrics & Gynecology, 136(2), 317-325.

Santen, R. J., Allred, D. C., Ardoin, S. P., Archer, D. F., Boyd, N., Braunstein, G. D., Burger, H. G., Colditz, G. A., Davis, S. R., Enomoto, L. M., & Fitzgerald, K. N. (2018). Postmenopausal hormone therapy: An Endocrine Society scientific statement. The Journal of Clinical Endocrinology & Metabolism, 103(3), 1-71.

Simon, J. A., Lin, V. H., Radovich, C., Bachmann, G. A., & Santoro, N. (2017). One-year long-term safety extension study of ultra-low-dose estriol vaginal tablets in postmenopausal women with vaginal dryness. Menopause, 24(10), 1160-1168.

Stuenkel, C. A., Davis, S. R., Gompel, A., Lumsden, M. A., Murad, M. H., Pinkerton, J. V., Rees, M., & Santen, R. J. (2020). Treatment of symptoms of the menopause: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 105(9), 1-51.


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