Estrogen, Explained: What It Does, How It’s Used, and Why It Matters More Than We Were Ever Told

For years, estrogen was treated like something dangerous — something to fear, avoid, or whisper about.

But estrogen is not the villain of women’s health. It is foundational.

Understanding estrogen — how it works, how it’s delivered, and how it can be used thoughtfully — gives women agency over how they feel in their bodies as we age. And agency changes everything.

This post is about estrogen specifically: the hormone, the forms, the dosing realities, and the quiet ways it supports comfort, vitality, and confidence.

What Estrogen Actually Does

Estrogen isn’t just about reproduction. It affects nearly every system in the body, including:

• Temperature regulation (hello, hot flashes)

• Sleep and circadian rhythm

• Mood, motivation, and emotional resilience

• Cognitive clarity

• Bone density

• Skin elasticity

• Joint lubrication

• Cardiovascular health

• Vaginal and urinary tissue health

• Libido and sexual comfort

As estrogen declines — whether gradually through menopause or abruptly after oophorectomy — these systems feel the change.

Symptoms aren’t “in your head.”

They are physiologic.

The Different Forms of Estrogen (And How They Compare)

1. Transdermal Estrogen Patches

Often considered the most balanced option for many women.

Why they’re favored:

• Deliver estrogen steadily through the skin

• Bypass the liver (no first-pass metabolism)

• Lower risk of blood clots compared to oral estrogen

• Stable hormone levels

• Easy dosing (changed once or twice weekly)

For many women, patches offer the best mix of effectiveness, safety, and real-life adherence.

Turns out my Omnipod has more than one job. Every 3½ days when it alerts me that it’s time to change my insulin pod, it also reminds me to change my estrogen patch. A built-in hormone accountability partner. A true T1D bonus — proof that when you find a rhythm that works for your life, consistency becomes easy.

2. Transdermal Estrogen Gel or Spray

Biologically equivalent to patches — when used consistently.

Pros:

• Same safety advantages as patches

• Effective symptom relief

Cons (and real life matters):

• Must be applied daily

• Can feel messy

• Requires drying time

• Easy to forget

• Risk of transferring medication to others if skin contact occurs too soon

I’ve used estrogen gel. It worked — but remembering to apply it nightly was harder than I expected. Consistency matters with hormones, and for me, the patch fit my life better.

3. Oral Estrogen

Still effective, but increasingly used with more caution.

What to know:

• Goes through the liver first

• Can increase clotting factors

• Higher risk of blood clots and stroke compared to transdermal estrogen

• May slightly improve HDL cholesterol, though this isn’t usually clinically significant

Oral estrogen still has a place for some women, particularly younger, low-risk patients — but many clinicians now prefer transdermal routes when possible.

Dosing Matters: More Is Not Better

One of the least talked-about truths of estrogen therapy is this:

You can have too much estrogen.

When I first started estrogen — first with gel and later with patches after my oophorectomy — my dose was too high. Instead of feeling better, I developed swelling in my lower legs and felt sluggish and heavy.

Edema. Fatigue. A sense that something wasn’t right.

Lowering my dose made all the difference. The swelling resolved. My energy improved. My body felt balanced again.

This is an important reminder:

Finding the right estrogen dose often takes time, patience, and honest conversations with your healthcare provider. For many women, a lower dose works best.

Hormone therapy isn’t about pushing levels higher — it’s about finding the dose that supports your physiology.

Vaginal Estrogen: Local, Powerful, and Underused

Vaginal estrogen deserves its own spotlight.

As estrogen declines, the vaginal lining becomes thinner, drier, and less elastic — a condition often called genitourinary syndrome of menopause (GSM). This can cause:

• Vaginal dryness or burning

• Pain with intercourse

• Urinary urgency

• Recurrent UTIs

• Avoidance of intimacy

• Chronic discomfort — even without sexual activity

Vaginal estrogen directly treats the tissue itself.

Important truths:

• It is local therapy, not systemic

• Systemic absorption is minimal

• It is considered safe for most women

• It is effective regardless of sexual activity

This is about your comfort — not a partner’s.

Vaginal Estradiol Dosing

Dosing is fairly standard.

A common approach:

• Initial phase: nightly use for 1–2 weeks

• Maintenance: 2–3 nights per week

Some women benefit from more frequent use, especially if symptoms persist. Others do well long-term at two nights per week. This is individualized — and worth discussing with your provider.

What matters most is consistency.

Make it easy.

Leave it where you’ll see it.

If the label embarrasses you, cover it with washi tape. The goal is to use it — not hide it.

Estrogen Is About You

Whether you have a partner or don’t.

Whether intimacy is active or, like me, not part of your life right now.

Whether you feel bold or tender or somewhere in between.

Estrogen therapy — systemic or vaginal — is not about vanity or youth.

It’s about comfort, function, and quality of life.

You deserve to feel good in your body.

You deserve honest information.

And you deserve care that adapts to you — not the other way around.

🍯Honey Note

If estrogen feels confusing or intimidating, take a breath. You don’t have to know everything at once. You only need to start listening to your body — and trusting that what you feel is real and worthy of care.

This is not about fixing yourself.

It’s about supporting yourself.

Comforted. Confident. Completely unapologetic.

🍯 Honey

🌶️P.S. Taking estrogen — systemic or vaginal — doesn’t make you “high maintenance.”

It makes you informed.

And a woman who knows how to care for her body?

That’s not just healthy — that’s powerful.