Oral vs. Vaginal Estrogen: Safer Choice? Doctor Explains

Oral vs. Vaginal Estrogen: Which Is Safer? 0:00

If you've ever If you've ever wondered which is wondered which is wondered which is safer: safer: safer: oral estrogen oral estrogen oral estrogen or vaginal estrogen, the honest or vaginal estrogen, the honest or vaginal estrogen, the honest answer is that answer is that answer is that you're asking the you're asking the you're asking the wrong wrong wrong question. And because of this question. And because of this question. And because of this confusion, many confusion, many confusion, many women after 40 are women after 40 are women after 40 are either afraid of certain either afraid of certain either afraid of certain treatments or treatments or treatments or use use use the wrong ones because the wrong ones because the wrong ones because they don't help.

they don't help. they don't help. So in this video, I'm going to So in this video, I'm going to So in this video, I'm going to show you the real show you the real show you the real difference between these difference between these difference between these two types of two types of two types of estrogen. Which one estrogen. Which one estrogen. Which one is generally considered is generally considered is generally considered less risky? And less risky? And less risky? And how exactly do you know how exactly do you know how exactly do you know which one is which one is which one is right for you? I am Dr.

right for you? I am Dr. right for you? I am Dr. Jen, a Jen, a dual- dual- boarded OB-GYN and boarded OB-GYN and boarded OB-GYN and integrative integrative integrative medicine physician. Here's a look medicine physician. Here's a look medicine physician. Here's a look that radically changes the that radically changes the that radically changes the entire conversation. entire conversation. entire conversation. Oral and Oral and Oral and vaginal estrogen are vaginal estrogen are not two versions of the same not two versions of the same treatment. They treatment. They perform completely perform completely perform completely different tasks. And they

Systemic vs. Local Estrogen Explained 0:42

different tasks. And they different tasks. And they are actually dosed are actually dosed are actually dosed very, very very, very differently. So once differently. So once differently. So once you you you understand that, the understand that, the understand that, the security issue almost always security issue almost always security issue almost always resolves resolves resolves itself. And you'll see itself. And you'll see itself. And you'll see why the option why the option why the option most women most women most women fear is actually the fear is actually the fear is actually the safest of the safest of the safest of the two. Here is the main two. Here is the main two. Here is the main idea that reveals idea that reveals idea that reveals the essence: it all comes down the essence: it all comes down the essence: it all comes down to the concept of to the concept of to the concept of systemic influence systemic influence systemic influence versus local.

versus local. Therefore, oral Therefore, oral estrogen is systemic. estrogen is systemic. estrogen is systemic. You swallow a pill, You swallow a pill, You swallow a pill, it is absorbed it is absorbed it is absorbed through the intestines and through the intestines and through the intestines and distributed throughout the distributed throughout the distributed throughout the body, treating body, treating body, treating general symptoms. general symptoms. general symptoms. Such as hot flashes, Such as hot flashes, Such as hot flashes, night sweats, night sweats, night sweats, sleep problems, and sleep problems, and sleep problems, and mood swings.

mood swings. mood swings. Vaginal estrogen Vaginal estrogen is local. It acts is local. It acts is local. It acts very locally and in very locally and in very locally and in very low doses. very low doses. very low doses. These are creams, pills, These are creams, pills, These are creams, pills, rings. These are medications that rings. These are medications that rings. These are medications that you inject internally. you inject internally. you inject internally. You place it You place it You place it exactly where it is needed, exactly where it is needed, exactly where it is needed, where the problem is. Whether it's

How Oral Estrogen Works 1:30

where the problem is. Whether it's where the problem is. Whether it's the vagina, the bladder, the the vagina, the bladder, the the vagina, the bladder, the urethra—all of these urethra—all of these urethra—all of these tissues are affected by tissues are affected by tissues are affected by vaginal estrogen vaginal estrogen . This is what we . This is what we . This is what we call call call genitourinary genitourinary genitourinary syndrome of menopause, syndrome of menopause, syndrome of menopause, GMS. That is, everything GMS. That is, everything GMS. That is, everything related to the intimate related to the intimate related to the intimate area. And this moment is area. And this moment is area. And this moment is the most important for the most important for the most important for safety. When you safety. When you safety. When you ingest estrogen ingest estrogen ingest estrogen orally, it has to orally, it has to orally, it has to pass through the liver.

pass through the liver. pass through the liver. It reaches the rest of the It reaches the rest of the It reaches the rest of the body after an body after an body after an initial initial initial passage through passage through passage through the liver. It is this the liver. It is this the liver. It is this initial passage initial passage initial passage through the liver that is the through the liver that is the through the liver that is the source of systemic source of systemic source of systemic risk. Vaginal risk. Vaginal risk. Vaginal estrogen, because estrogen, because estrogen, because the dose is very small and it the dose is very small and it the dose is very small and it only acts on local only acts on local only acts on local tissues, hardly tissues, hardly tissues, hardly increases the level of increases the level of increases the level of estrogen in the blood.

estrogen in the blood. estrogen in the blood. Therefore, it is not Therefore, it is not Therefore, it is not considered systemic considered systemic . The same . The same . The same hormone, but a completely hormone, but a completely hormone, but a completely different effect. It different effect. It different effect. It depends on the fabrics depends on the fabrics depends on the fabrics you you you are using it for. This are using it for. This are using it for. This simple fact lies at the simple fact lies at the simple fact lies at the heart of the heart of the heart of the security issue. Oral

How Vaginal Estrogen Works 2:15

security issue. Oral security issue. Oral estrogen, the systemic estrogen, the systemic estrogen, the systemic option, and let's be option, and let's be option, and let's be honest, honest, honest, oral estrogen is oral estrogen is oral estrogen is actually very, very actually very, very actually very, very safe, many safe, many safe, many women can women can women can use it, it's use it, it's use it, it's very beneficial and very beneficial and very beneficial and inexpensive. If your inexpensive. If your inexpensive. If your main concerns are main concerns are main concerns are hot flashes, night hot flashes, night hot flashes, night sweats, sweats, sweats, sleep problems, or sleep problems, or sleep problems, or mood swings, you need mood swings, you need mood swings, you need systemic estrogen, and systemic estrogen, and systemic estrogen, and the pill can the pill can the pill can help with just help with just help with just that. This is a great that. This is a great that. This is a great option. But due to the option. But due to the option. But due to the first- first- first- pass effect through pass effect through pass effect through the liver, oral the liver, oral the liver, oral estrogen may slightly estrogen may slightly estrogen may slightly increase the risk of increase the risk of increase the risk of blood clots.

blood clots. blood clots. It can also It can also It can also raise raise raise triglyceride levels and triglyceride levels and triglyceride levels and sometimes affect sometimes affect sometimes affect gallbladder function gallbladder function gallbladder function . And for some . And for some . And for some women, such a women, such a women, such a compromise is compromise is compromise is unacceptable. So, unacceptable. So, unacceptable. So, most healthy most healthy most healthy women can women can women can take oral take oral take oral estrogen without any estrogen without any estrogen without any problems. The risk is very, problems. The risk is very, problems. The risk is very, very, very very, very very, very minimal. For minimal. For minimal. For most women, it is most women, it is most women, it is completely safe. But completely safe. But completely safe. But if you have a if you have a if you have a personal or personal or personal or family history of family history of family history of thrombosis or other

Oral Estrogen: Benefits & Potential Risks 3:05

thrombosis or other thrombosis or other risk factors, risk factors, risk factors, such as smoking such as smoking such as smoking and being over 40, and being over 40, and being over 40, you should discuss you should discuss you should discuss this with your doctor, this with your doctor, this with your doctor, as oral as oral as oral administration may not be administration may not be administration may not be suitable for you. Or you suitable for you. Or you suitable for you. Or you may need a may need a may need a full examination full examination full examination before you can before you can before you can use the use the use the oral route. These are oral route. These are oral route. These are things you things you things you need to discuss need to discuss need to discuss with your doctor, given with your doctor, given with your doctor, given your specific your specific your specific risks. But risks. But risks. But vaginal estrogen vaginal estrogen is a remedy that is is a remedy that is is a remedy that is safe for almost safe for almost safe for almost everyone. I honestly everyone. I honestly everyone. I honestly can't imagine anyone can't imagine anyone who wouldn't like it who wouldn't like it who wouldn't like it . And people are very . And people are very . And people are very nervous about it.

nervous about it. nervous about it. Honestly, this is the Honestly, this is the Honestly, this is the option that I think option that I think option that I think more women would more women would more women would feel feel feel comfortable with. Even comfortable with. Even breast cancer patients breast cancer patients can can can use use use vaginal estrogen vaginal estrogen . It treats GMS— . It treats GMS— genitourinary genitourinary genitourinary syndrome of menopause. These are syndrome of menopause. These are syndrome of menopause. These are phenomena such as phenomena such as phenomena such as vaginal dryness, vaginal dryness, vaginal dryness, burning, painful sex burning, painful sex , irritation of the vulva , irritation of the vulva , irritation of the vulva and vagina, frequent and vagina, frequent and vagina, frequent urinary tract infections, urinary tract infections, urgent urges, urgent urges, urgent urges, symptoms when you symptoms when you symptoms when you feel like you need to feel like you need to feel like you need to go to the toilet all the time go to the toilet all the time go to the toilet all the time . Because the dose is . Because the dose is . Because the dose is tiny and acts tiny and acts tiny and acts locally, it does

Who Should Be Cautious With Oral Estrogen? 4:00

locally, it does locally, it does its job its job its job without increasing without increasing without increasing hormone levels throughout the hormone levels throughout the hormone levels throughout the body. body. Major menopause guidelines recognize low-dose recognize low-dose vaginal vaginal vaginal estrogen as safe estrogen as safe estrogen as safe for almost everyone. But there is a for almost everyone. But there is a for almost everyone. But there is a caveat: because it caveat: because it caveat: because it acts locally, it will not acts locally, it will not acts locally, it will not eliminate your systemic eliminate your systemic eliminate your systemic symptoms, such as symptoms, such as symptoms, such as hot flashes. It won't hot flashes. It won't hot flashes. It won't protect your bones, it won't protect your bones, it won't protect your bones, it won't protect your brain, and it protect your brain, and it protect your brain, and it won't help with won't help with won't help with problems that are problems that are problems that are systemic in nature.

systemic in nature. systemic in nature. This is what This is what This is what most people don't most people don't most people don't tell you. tell you. tell you. There is actually a third option There is actually a third option There is actually a third option that addresses that addresses that addresses safety concerns and safety concerns and safety concerns and concerns for concerns for concerns for many women and many women and many women and provides them with the provides them with the provides them with the systemic estrogen systemic estrogen systemic estrogen they they they need. And that's what need. And that's what need. And that's what I want to I want to I want to talk about in the talk about in the talk about in the next 60 seconds.

next 60 seconds. next 60 seconds. So stay with So stay with So stay with me because this me because this me because this part might be the part might be the part might be the right choice right choice right choice for you. So, for you. So, for you. So, this third option is

Why Vaginal Estrogen Is Considered Low-Dose & Local 4:45

this third option is transdermal. transdermal. transdermal. So, it is indeed So, it is indeed So, it is indeed systemic estrogen systemic estrogen systemic estrogen for hot flashes, for hot flashes, for hot flashes, night night night sweats, and sweats, and sweats, and sleep problems, but sleep problems, but sleep problems, but the risk of thrombosis the risk of thrombosis the risk of thrombosis similar to that of similar to that of similar to that of taking the taking the taking the pill is absent from the pill is absent from the pill is absent from the transdermal transdermal transdermal options. So if options. So if options. So if you want a systemic you want a systemic you want a systemic oral option oral option oral option but can't because of the but can't because of the but can't because of the risk of thrombosis, this risk of thrombosis, this risk of thrombosis, this may be an may be an may be an even better even better even better choice for you. And some choice for you. And some choice for you. And some women simply women simply women simply choose the choose the choose the transdermal transdermal transdermal method because they don't want method because they don't want method because they don't want to remember to to remember to to remember to take medication every day.

take medication every day. take medication every day. Transdermal Transdermal Transdermal agents are essentially agents are essentially agents are essentially patches, gels, patches, gels, patches, gels, aerosols, or sprays. aerosols, or sprays. aerosols, or sprays. Because they Because they Because they are absorbed through are absorbed through are absorbed through the skin and bypass the skin and bypass the skin and bypass primary metabolism primary metabolism primary metabolism in the liver, in the liver, in the liver, transdermal transdermal transdermal estrogens do not carry the estrogens do not carry the estrogens do not carry the same risk of same risk of same risk of thrombosis as thrombosis as thrombosis as oral estrogens. When I oral estrogens. When I oral estrogens. When I say this, I mean the say this, I mean the say this, I mean the formation of formation of formation of blood clots. So blood clots. So blood clots. So for many women, the for many women, the for many women, the safest safest safest systemic choice is systemic choice is systemic choice is not pills, but a not pills, but a not pills, but a patch or gel.

patch or gel. patch or gel. Both options are

What Vaginal Estrogen Can & Can't Treat 5:35

Both options are Both options are FDA-approved, and there are FDA-approved, and there are FDA-approved, and there are many affordable many affordable many affordable options that can be options that can be options that can be purchased with purchased with purchased with insurance, and if not, there insurance, and if not, there insurance, and if not, there are also great are also great are also great combination options combination options . I . I . I will discuss this comparison in detail in will discuss this comparison in detail in will discuss this comparison in detail in another video. This is something to another video. This is something to another video. This is something to know before know before know before you get a prescription.

you get a prescription. you get a prescription. This video is about This video is about This video is about estradiol gel estradiol gel estradiol gel vs. vs. vs. transdermal transdermal transdermal gel. I also made a gel. I also made a gel. I also made a separate video about separate video about separate video about different options for different options for different options for hormone replacement hormone replacement hormone replacement therapy. Here is therapy. Here is therapy. Here is the link if you are the link if you are the link if you are interested.

interested. Transdermal gel Transdermal gel or patch does not or patch does not or patch does not burden the liver burden the liver , so you can , so you can , so you can use use use estrogen both systemically estrogen both systemically estrogen both systemically and vaginally. and vaginally. and vaginally. In fact, this very In fact, this very In fact, this very warning was warning was warning was removed by the FDA in 2023. removed by the FDA in 2023. Therefore, it is important to know Therefore, it is important to know that the systemic and

The Third Option: Transdermal Estrogen 6:15

that the systemic and that the systemic and vaginal options vaginal options vaginal options can be can be can be used used used together. It's not a choice between together. It's not a choice between together. It's not a choice between one thing or one thing or one thing or another. Many women another. Many women another. Many women use use use systemic estrogen systemic estrogen systemic estrogen for symptoms like for symptoms like for symptoms like hot flashes, night hot flashes, night hot flashes, night sweats, and sweats, and sweats, and sleep problems, but sleep problems, but sleep problems, but they also they also they also use use use low-dose low-dose low-dose vaginal estrogen vaginal estrogen vaginal estrogen for dryness, burning, for dryness, burning, for dryness, burning, pain during sex, and pain during sex, and pain during sex, and just to feel just to feel just to feel better better better , right , right , right ? When it comes to urinary ? When it comes to urinary ? When it comes to urinary symptoms, there's symptoms, there's symptoms, there's nothing worse than nothing worse than nothing worse than recurring recurring recurring urinary tract infections urinary tract infections urinary tract infections or the constant or the constant or the constant feeling of feeling of feeling of having to go to the having to go to the having to go to the bathroom. And this is a very bathroom. And this is a very bathroom. And this is a very common phenomenon. You will not common phenomenon. You will not common phenomenon. You will not overdose or overdose or overtreat overtreat overtreat from combining both from combining both from combining both remedies. Of course, you remedies. Of course, you remedies. Of course, you may experience may experience may experience side effects from side effects from side effects from either of them, and your either of them, and your either of them, and your doses may doses may doses may need to be need to be need to be adjusted, but adjusted, but adjusted, but taking two medications taking two medications taking two medications at the same time is not at the same time is not at the same time is not contraindicated.

contraindicated. contraindicated. One last thing I'll point out: The One last thing I'll point out: The One last thing I'll point out: The warning warning warning label that the FDA label that the FDA label that the FDA implemented through the implemented through the Women's Women's Health Initiative study 23 years ago Health Initiative study 23 years ago Health Initiative study 23 years ago stated that all

Can You Use Systemic & Vaginal Estrogen Together? 7:00

stated that all stated that all estrogens estrogens estrogens could potentially cause could potentially cause could potentially cause blood clots, breast cancer, and blood clots, breast cancer, and blood clots, breast cancer, and stroke. This label stroke. This label stroke. This label was removed in was removed in was removed in November 2025. I November 2025. I November 2025. I made a special made a special made a special video about it, so you video about it, so you video about it, so you can can can watch it. And the watch it. And the watch it. And the reason it was reason it was reason it was removed is because you removed is because you removed is because you can't can't can't just just just say that all say that all say that all estrogens cause estrogens cause estrogens cause these problems. This data these problems. This data these problems. This data was reviewed, and was reviewed, and was reviewed, and we realized that we realized that we realized that there are specific there are specific there are specific risks for different risks for different risks for different routes of administration and routes of administration and routes of administration and different types of different types of different types of estrogen. So this estrogen. So this estrogen. So this should be discussed should be discussed should be discussed with your doctor to with your doctor to with your doctor to find the right find the right find the right dose for you.

dose for you. The mistake caused by The mistake caused by that study that study that study scared many scared many scared many women away from a safe, women away from a safe, women away from a safe, life-saving life-saving life-saving medication, and now it is medication, and now it is medication, and now it is finally being finally being finally being properly addressed so that properly addressed so that women can safely women can safely women can safely take both take both take both systemic and

Understanding Estrogen Safety & FDA Warning Changes 7:45

systemic and systemic and vaginal estrogen vaginal estrogen without having to choose without having to choose without having to choose one over the other. So, hot flashes, one over the other. So, hot flashes, one over the other. So, hot flashes, night sweats, night sweats, night sweats, mood swings, mood swings, mood swings, bone and bone and bone and brain protection—all of these brain protection—all of these brain protection—all of these are treated with systemic are treated with systemic are treated with systemic estrogens via estrogens via estrogens via transdermal or transdermal or transdermal or oral routes. And oral routes. And oral routes. And local symptoms, local symptoms, local symptoms, such as vaginal such as vaginal such as vaginal dryness, pain during dryness, pain during dryness, pain during sex, and recurrent sex, and recurrent sex, and recurrent urinary tract infections, urinary tract infections, can be eliminated with can be eliminated with can be eliminated with low-dose low-dose low-dose vaginal vaginal vaginal estrogen. Both estrogen. Both estrogen. Both types of symptoms are types of symptoms are types of symptoms are treatable, and you can treatable, and you can treatable, and you can use use use both remedies. If both remedies. If both remedies. If you have a history of you have a history of you have a history of breast cancer or breast cancer or breast cancer or thrombosis, please thrombosis, please thrombosis, please discuss this discuss this discuss this individually with individually with individually with your doctor, your doctor, your doctor, as there are many as there are many as there are many nuances regarding your nuances regarding your nuances regarding your treatment. What does treatment. What does treatment. What does your your your oncologist think about the oncologist think about the oncologist think about the next steps in this regard?

next steps in this regard? It is important to have a good, It is important to have a good, organized organized organized treatment plan and to keep all

Choosing the Right Estrogen for Your Symptoms & Risk Profile 8:30

treatment plan and to keep all treatment plan and to keep all your doctors your doctors your doctors informed. So if you informed. So if you informed. So if you remember one thing from remember one thing from remember one thing from this video, let it this video, let it this video, let it be this. be this. be this. The safest The safest The safest estrogen is the one that estrogen is the one that estrogen is the one that matches your matches your matches your symptoms and symptoms and symptoms and risk profile. Local risk profile. Local risk profile. Local problems require problems require problems require topical estrogen, topical estrogen, topical estrogen, such as such as such as low-dose low-dose low-dose vaginal vaginal vaginal estrogen in the form of estrogen in the form of estrogen in the form of gels, creams, or gels, creams, or gels, creams, or tablets. And tablets. And tablets. And oral and oral and oral and transdermal transdermal transdermal options options options are used for are used for are used for systemic problems.

systemic problems. systemic problems. Safety is important, but it's Safety is important, but it's Safety is important, but it's important to understand that important to understand that important to understand that it's about the it's about the it's about the big picture and big picture and big picture and choosing the right choosing the right choosing the right tool. Good. tool. Good. tool. Good. Now that you know the Now that you know the Now that you know the real story behind the real story behind the real story behind the warning warning warning label on label on label on vaginal vaginal vaginal estrogen. If you estrogen. If you estrogen. If you want to explore hormone replacement therapy options in more depth, want to explore hormone replacement therapy options in more depth, watch my watch my video, " video, " video, " Hormone Replacement Therapy: A Hormone Replacement Therapy: A Hormone Replacement Therapy: A Doctor's Guide." That's it for now Doctor's Guide." That's it for now Doctor's Guide." That's it for now and I'll and I'll and I'll see you in the see you in the see you in the next video.