The SAFEST Way to Use Estrogen for Menopause

Dr. Stengler: Are you using the safest form of estrogen? Millions of women are on estrogen therapy, and this can be a great thing for your health, helping to relieve menopausal symptoms and improving quality of life. But there's really only one form that has been shown to be very safe, and it's not the commonly used pill form that some doctors use.

Hi, I'm Dr. Mark Stengler. In this video, I'm going to review the safest and most effective way to use estrogen replacement therapy. This can be a lifesaver for women using hormone replacement. Estrogen therapy is a key part of menopause management, helping relieve hot flashes, night sweats, vaginal dryness, and mood changes that come from declining hormone levels. While estrogen can be taken in pill form or through the skin, such as a patch, gel, or cream, research increasingly shows that how you take estrogen makes a big difference in safety. For many women, using estrogen through the skin, known as transdermal or topical estrogen, is a safer and more natural way to restore balance.

One of the biggest differences between oral and transdermal estrogen is how the body processes it. When estrogen is swallowed in pill form, it must pass through the liver first before entering the bloodstream. This first-pass effect triggers the liver to make more clotting factors and certain inflammatory proteins. As a result, oral estrogen increases the risk of blood clots such as deep vein thrombosis and pulmonary embolism, especially in women over 50 or those with other risk factors like obesity, smoking, or a family history of clotting disorders. Transdermal estrogen, on the other hand, is a topical form absorbed directly through the skin that goes straight into the bloodstream, bypassing the liver. Because it does not stimulate liver production of clotting factors, it has not been shown to increase the risk of venous thromboembolism or blood clots. Large observational studies, including the Women's Health Initiative follow-up research and European Menopause Society data, confirm that women using estrogen patches or gels have a significantly lower risk of blood clots compared to those taking estrogen pills.

In addition to reducing clot risk, transdermal estrogen appears to have a more favorable effect on inflammation and metabolism. While oral estrogen can increase levels of C-reactive protein, an inflammatory marker linked to heart disease and whole-body inflammation, transdermal estrogen does not raise C-reactive protein and tends to maintain healthier triglyceride and blood sugar levels. It also provides more stable hormone levels throughout the day, which some women find leads to smoother symptom control and fewer mood swings.

For many women seeking hormone replacement therapy, transdermal estrogen offers the benefits of symptom relief without the risks of oral estrogen. While each woman's situation is unique and should be discussed with a healthcare provider, using estrogen through the skin is often the preferred option for safety and overall well-being. This is the form I recommend for my female patients whom I treat with hormone replacement therapy, and I've been using this therapy for over 30 years. For optimal balance, I always use natural progesterone along with transdermal estrogen — these two hormones have a balancing effect on one another. I hope you liked this video. Make sure to subscribe and like this video, and look for other videos on hormone balance — we have many videos on hormone balancing for both men and women.

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