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Bioidentical Estrogen
(Estradiol) Therapy

Relieve hot flashes. Support long-term heart, brain, and bone health.
Bioidentical estradiol restores the most biologically active form of estrogen to improve sleep, mood, temperature stability, and support cardiovascular, cognitive, and skeletal health.
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Two forms of Estradiol medication: a topical cream and oral Tablets.
Two forms of Estradiol medication: a topical cream and oral Tablets.

What does estrogen replacement do for your body?

Estradiol medication: a couple of oral Tablets.
Relieves hot flashes, night sweats, and vaginal dryness
Improves skin elasticity, hair growth, and nail strength
Supports cardiovascular health and healthy cholesterol levels
Supports bone strength and reduces osteoporosis risk
Relieves hot flashes, night sweats, and vaginal dryness
Supports cardiovascular health and healthy cholesterol levels
Improves skin elasticity, hair growth, and nail strength
Supports bone strength and reduces osteoporosis risk

What is bioidentical estrogen (estradiol) treatment?

Estradiol is the most biologically active form of estrogen your body produces before menopause. It plays a critical role in sleep quality, mood stability, metabolism, cognitive clarity, bone density, skin elasticity, and cardiovascular health throughout adulthood.

As women transition through menopause, estrogen levels decline. In many women, this decline is associated with symptoms such as hot flashes, night sweats, vaginal dryness, poor sleep, joint discomfort, and brain fog.

Bioidentical estradiol therapy restores estrogen after menopause using a molecule identical to your body’s natural hormone. Dosing is personalized to your symptoms, health profile, and hormone levels, with ongoing 60-day follow-ups to ensure precise, medically guided care.
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Two mature women with blonde hair wearing black tops pose together in front of a wooden room divider.
Two mature women with blonde hair wearing black tops pose together in front of a wooden room divider.
Two forms of Estradiol medication: a topical cream and oral Tablets.

Bioidentical estrogen (estradiol) therapy – treatment options

All Fem Excel estradiol prescriptions are bioidentical, plant-derived, US-made, and easy to use.

Estrogen cream (transdermal estradiol) Applied daily to support steady absorption and consistent hormone levels. Helps relieve hot flashes, improve sleep and mood, and support heart, bone, and brain health. Commonly prescribed alongside progesterone to support hormone balance and uterine protection.

Oral estrogen (micronised estradiol) Taken daily for systemic support. Reduces vasomotor symptoms, improves sleep and mood, and supports cardiovascular, skeletal, and cognitive health. Oral estradiol has also been shown to improve cholesterol profiles and reduce lipoprotein(a), a marker associated with cardiovascular risk.

Vaginal estrogen suppositories or cream (optional add-on) Used locally to restore vaginal tissue health, improve natural moisture, and reduce urinary symptoms. Can be safely combined with systemic estradiol therapy for complete relief.

Benefits of bioidentical estrogen (estradiol) therapy

Restore energy and vitality

Supports metabolic efficiency, resilience, and overall wellbeing.

Stronger bones

Helps prevent bone loss associated with menopause and reduces fracture risk.

Protect your heart

Supports vascular health, improves lipid profiles, and contributes to long-term cardiovascular protection.

Support brain and memory

Supports cerebral blood flow, neurotransmitter balance, and cognitive function.

Better sleep

Supports temperature regulation and nervous system balance for deeper, more restorative sleep.

Healthier skin, hair, and nails

Supports collagen production, skin hydration and elasticity, and hair and nail quality.

How it works

Our in-house team specializes in hormone optimization and takes the time to understand your symptoms, goals, and history. Doctor-led hormone therapy is the key to real symptom relief, healthy aging, and results that last.
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Start with your story.
Share your symptoms and health history through our online assessment.

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Happy provider speaking to patient over video chat
Meet your hormone expert.
Connect online with a licensed provider to discuss your symptoms and goals. If prescribed, treatment can start right away.
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Fem Excel At-Home Hormone Test Kit
Get deeper insights.
After your consult, we’ll send you a simple at-home hormone test kit to measure key biomarkers and fine-tune your care.
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Fem Excel Estradiol Medications
Personalized, ongoing support.

Once your lab results are in, your provider will review your progress and adjust your treatment as needed. We check in every 60 days, and you’ll receive comprehensive blood tests every six months to keep your care truly personalized.


Thousands of women are already experiencing the benefits.
Start your free assessment today.
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85%
report improvement within 2 months*
96%
report improvement within 6 months*
100,000+ patients treated*
Among America’s fastest-growing companies. Voted Top Hormone Provider of 2024 and Hormone Provider of the Year 2025.
*Data taken from 32,795 members responding to symptoms reviews with their Excel Medical providers
Dr. Lorna, a woman with long blonde hair, posing in a white lab coat with her arms crossed.
“Bioidentical estradiol is one of the most powerful tools we have to protect a woman’s long-term health.

When prescribed thoughtfully and monitored consistently, it does more than relieve hot flashes and other symptoms. It helps safeguard cardiovascular health, preserve bone density, and support cognitive function for years to come.”

Lorna A. Brudie, DO, FACOG, FACOOG
Medical Director
“Bioidentical estradiol is one of the most powerful tools we have to protect a woman’s long-term health.

When prescribed thoughtfully and monitored consistently, it does more than relieve hot flashes and other symptoms. It helps safeguard cardiovascular health, preserve bone density, and support cognitive function for years to come.”
Lorna A. Brudie, DO, FACOG, FACOOG

Medical Director

What our patients say

When your hormones are off, everything feels harder. But with the right care and optimized hormones, everything changes.

Women come to Fem Excel feeling tired, foggy, frustrated, and unheard. They stay because they feel energized, clear-minded, unburdened, and back in control.

These are their stories, not just of better health, but of lives transformed.
When your hormones are off, everything feels harder. But with the right care and optimized hormones, everything changes.

Women come to Fem Excel feeling tired, foggy, frustrated, and unheard. They stay because they feel energized, clear-minded, unburdened, and back in control.

These are their stories, not just of better health, but of lives transformed.

Very knowledgeable & professional

“Very knowledgeable & professional. Details about the whole process and the medications that I may be taking. I was very happy to have a caring one on one with the NP. It is the help I was waiting for in the convenience of my own quiet setting.”

Araka

Possibly the best healthcare experience I’ve ever had

“I walked away from this appointment actually feeling satisfied with the results I received. For once I left an appointment with all my questions answered instead of having more questions than answers. The provider was very thorough, informative, and helpful. This was one of the better healthcare appointments I have ever had. Thank you Ms. Tara for the wonderful experience.”

Alicia

Caring and thorough

“I really liked ease and convenience having a virtual appointment. Kel made me feel comfortable immediately and explained everything thoroughly. She is a good listener and has an empathetic spirit about her. I feel encouraged that together we will resolve any challenges I am having.”

Renée

I had been struggling since I hit menopause…

“I had been struggling since I hit menopause a year ago. My doctors couldn’t help. It was terrible, I was struggling with no hope for any help. Then I tried Fem Excel. They HAVE CHANGED MY LIFE! I have energy, I sleep well I feel so good, it’s unbelievable and the doctors were so efficient and I just felt understood. I am so glad I got a hold of this company. Thank you so much!”

Lisa

Real Reviews, Actor Portrayal shown

Related symptoms

Night sweats

Waking up drenched or restless during the night may point to a hormone imbalance. Our treatment helps regulate temperature and improve deep, uninterrupted sleep.

Anxiety

Racing thoughts, irritability, or unexpected anxiety often increase during perimenopause. We treat the hormonal imbalances that affect your mood, not just the symptoms.

Hormonal irritability or mood swings

If you feel more irritable, reactive, or emotionally off, it may be due to fluctuating hormones. We stabilise mood by treating the underlying hormonal imbalance.

Joint pain or stiffness in menopause

Estrogen decline can lead to joint pain, stiffness, and reduced flexibility. We treat the hormonal root to relieve pain and support joint health as you age.

Low libido

If your desire has disappeared, hormones may be the reason. We help restore healthy testosterone and estrogen levels so you can feel like yourself again.

Persistent fatigue

If you feel constantly drained, even after rest, low thyroid, testosterone, or progesterone could be the cause. We treat all three to help restore lasting energy.

Memory issues or brain fog

Trouble with focus, recall, or mental clarity becomes more common after menopause. Our protocol supports cognition by balancing estrogen, testosterone, progesterone and thyroid function.

Dry, thinning skin

Estrogen plays a major role in skin hydration and elasticity. We restore healthy hormone levels to improve skin texture and slow visible aging.

Vaginal dryness or discomfort

Pain with intimacy, irritation, or ongoing dryness are not just part of getting older. We treat the cause using bioidentical estradiol to restore comfort and tissue health.

Bone loss or muscle weakness

Low estrogen and testosterone can lead to declining strength and increasing fracture risk. We help protect your bones and muscles through hormone optimization.

Hot flashes

Sudden waves of heat, flushing, or sweating that leave you uncomfortable and distracted are a classic sign of estrogen decline. We use bioidentical progesterone to bring fast, lasting relief.

Belly fat and slowed metabolism

Weight gain after menopause is often hormonal. We treat thyroid dysfunction and estrogen loss to support healthy weight and metabolic balance.

Bladder sensitivity or urinary urgency

If you’re urinating more often or feel sudden urgency, it may be caused by low estrogen affecting your bladder. We use hormone therapy to restore balance and improve urinary function.

Sleep disruption or early waking

If you’re struggling to fall asleep, stay asleep, or wake up too early, shifting hormones may be to blame. We restore balance to support deeper, more restful sleep.

All symptoms
Waking up drenched or restless during the night may point to a hormone imbalance. Our treatment helps regulate temperature and improve deep, uninterrupted sleep.
Racing thoughts, irritability, or unexpected anxiety often increase during perimenopause. We treat the hormonal imbalances that affect your mood, not just the symptoms.
If you feel more irritable, reactive, or emotionally off, it may be due to fluctuating hormones. We stabilise mood by treating the underlying hormonal imbalance.
Estrogen decline can lead to joint pain, stiffness, and reduced flexibility. We treat the hormonal root to relieve pain and support joint health as you age.
If your desire has disappeared, hormones may be the reason. We help restore healthy testosterone and estrogen levels so you can feel like yourself again.
If you feel constantly drained, even after rest, low thyroid, testosterone, or progesterone could be the cause. We treat all three to help restore lasting energy.
Trouble with focus, recall, or mental clarity becomes more common after menopause. Our protocol supports cognition by balancing estrogen, testosterone, progesterone and thyroid function.
Estrogen plays a major role in skin hydration and elasticity. We restore healthy hormone levels to improve skin texture and slow visible aging.

Pain with intimacy, irritation, or ongoing dryness are not just part of getting older. We treat the cause using bioidentical estradiol to restore comfort and tissue health.

Low estrogen and testosterone can lead to declining strength and increasing fracture risk. We help protect your bones and muscles through hormone optimization.
Sudden waves of heat, flushing, or sweating that leave you uncomfortable and distracted are a classic sign of estrogen decline. We use bioidentical progesterone to bring fast, lasting relief.
Weight gain after menopause is often hormonal. We treat thyroid dysfunction and estrogen loss to support healthy weight and metabolic balance.
If you’re urinating more often or feel sudden urgency, it may be caused by low estrogen affecting your bladder. We use hormone therapy to restore balance and improve urinary function.
If you’re struggling to fall asleep, stay asleep, or wake up too early, shifting hormones may be to blame. We restore balance to support deeper, more restful sleep.

The Excel Advantage™ membership

$99/month

Get dedicated physician support, regular monitoring, and personalized adjustments so your hormone therapy evolves with you.

  • Access to all treatments
  • Begin care within days
In-house specialists
Trained directly in the Excel Advantage™ protocol.
Integrated treatment
Hormones, metabolic support, and advanced therapies.
Symptom-driven care
Treatment guided by symptoms, not lab numbers alone.
Member access & pricing
Access to advanced treatments with preferred pricing.
Precision monitoring
Regular labs with personalized treatment adjustments.
60-day follow-ups
Provider reviews to refine and optimize treatment.
No commitment required • Cancel anytime • Medications not included

Medically Reviewed

This page was medically reviewed by Peter Fotinos, MD, Chief Medical Officer, and Lorna A. Brudie, DO, FACOG, FACS, Medical Director, Excel Medical. Dr Fotinos and Dr Brudie have nearly 50 years of combined clinical experience in hormone optimization and preventive medicine.
Last reviewed: October 2025
Teal seal: Medically Reviewed by Excel Medical Clinical Team on 22/01/2026.

References

  1. Lobo RA, Archer DF, Kagan R, et al. A 17β-estradiol–progesterone oral capsule for vasomotor symptoms due to menopause: a randomized controlled trial (REPLENISH). Menopause. 2017;24(4):409–416.
    PubMed: https://pubmed.ncbi.nlm.nih.gov/29889748/
    DOI: https://doi.org/10.1097/GME.0000000000001041
  2. Hodis HN, Mack WJ, Henderson VW, et al; ELITE Research Group. Vascular effects of early versus late postmenopausal treatment with estradiol. N Engl J Med. 2016;374(13):1221–1231.
    PubMed: https://pubmed.ncbi.nlm.nih.gov/27028912/
    DOI: https://doi.org/10.1056/NEJMoa1505241
  3. Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women’s Health Initiative randomized trials. JAMA. 2013;310(13):1353–1368.
    PubMed: https://pubmed.ncbi.nlm.nih.gov/24084921/
    DOI: https://doi.org/10.1001/jama.2013.278040
  4. Schierbeck LL, Rejnmark L, Tofteng CL, et al. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ. 2012;345:e6409.
    PubMed: https://pubmed.ncbi.nlm.nih.gov/23048011/
    DOI: https://doi.org/10.1136/bmj.e6409
  5. Mikkola TS, Tuomikoski P, Lyytinen H, et al. Estradiol-based postmenopausal hormone therapy and risk of cardiovascular and all-cause mortality. Menopause. 2014;21(10):1127–1131.
    PubMed: https://pubmed.ncbi.nlm.nih.gov/25803671/
  6. Canonico M, Oger E, Plu-Bureau G, et al. Hormone therapy and venous thromboembolism among postmenopausal women: impact of the route of estrogen administration and progestogens. Circulation. 2007;115(7):840–845.
    PubMed: https://pubmed.ncbi.nlm.nih.gov/17309934/
    DOI: https://doi.org/10.1161/CIRCULATIONAHA.106.642280
  7. Vinogradova Y, Coupland C, Hippisley-Cox J. Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ. 2019;364:k4810.
    PubMed: https://pubmed.ncbi.nlm.nih.gov/30626577/
    DOI: https://doi.org/10.1136/bmj.k4810
  8. Simon JA, Goldstein I, Kim NN, et al. Local vaginal estradiol for the treatment of vaginal atrophy. Menopause. 2020;27(3):282–289.
    DOI: https://doi.org/10.1097/GME.0000000000001465
  9. Sherwin BB. Estrogen and cognitive functioning in women. Endocr Rev. 2003;24(2):133–151.
    PubMed: https://pubmed.ncbi.nlm.nih.gov/12700177/
    DOI: https://doi.org/10.1210/er.2001-0016
  10. Wang K, et al. Menopausal hormone therapy use and long-term all-cause and cause-specific mortality. Int J Cancer. 2020;147(5):1367–1376.
    PubMed: https://pubmed.ncbi.nlm.nih.gov/31957967/
    DOI: https://doi.org/10.1002/ijc.32821
  11. Cauley JA, Robbins J, Chen Z, et al. Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women’s Health Initiative randomized trial. JAMA. 2003;290(13):1729–1738.
    PubMed: https://pubmed.ncbi.nlm.nih.gov/14519707/
    DOI: https://doi.org/10.1001/jama.290.13.1729
  12. Stuenkel CA, Davis SR, Gompel A, et al. Treatment of symptoms of the menopause: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(11):3975–4011.
    PubMed: https://pubmed.ncbi.nlm.nih.gov/26444994/
    DOI: https://doi.org/10.1210/jc.2015-2236

Frequently asked questions

More FAQ
Estrogen is a family of hormones (mainly estradiol, estrone, and estriol) that support menstrual cycles, bone health, brain function, and more. Estradiol is the most potent and biologically active estrogen before menopause and is the standard form used in most modern menopause therapies.
Estradiol can reduce hot flashes, night sweats, sleep disruption, vaginal dryness, and painful intercourse, and it helps prevent menopause‑related bone loss. Many women also notice improvements in mood, energy, and overall quality of life when bothersome vasomotor and genitourinary symptoms are controlled.
For most healthy women within 10 years of menopause, the overall benefit‑risk profile of systemic estradiol is favorable when used at the lowest effective dose and reviewed regularly. Safety depends on your age, time since menopause, personal and family history, other medicines, and whether you use estradiol alone or with progesterone.
If you still have a uterus and you are using systemic estradiol (patch, oral, high‑dose gel), a progestogen (usually micronized progesterone) is typically added to protect the uterine lining and lower the risk of endometrial cancer. If you have had a hysterectomy, you usually do not need progesterone with estradiol.
Yes. Low‑dose vaginal estradiol is used mainly for local symptoms such as vaginal dryness, burning, discomfort with sex, and recurrent urinary symptoms. At these doses, systemic absorption is low, so a progestogen is generally not required, but women with a uterus should still be periodically reviewed by their clinician.
Good candidates are typically women with moderate to severe menopause symptoms who are younger than 60 or within about 10 years of their final period and who do not have contraindications such as certain cancers, active liver disease, recent stroke, heart attack, or unexplained vaginal bleeding. Women with early or premature menopause often benefit from estradiol therapy at least until the average age of natural menopause for bone, cardiovascular, and cognitive protection.
There is no single “right” duration for estradiol therapy. Treatment does not need to be routinely stopped at age 60 or 65. Current clinical guidelines support continuing therapy for as long as the benefits outweigh the risks, provided you are reviewed regularly and monitored appropriately.

Some women use estradiol for a few years to manage menopausal symptoms. Others continue long term, including into their 70s or beyond, for ongoing symptom relief, bone protection, cardiovascular support, and quality of life. The decision is individualized and should be based on a personalized risk–benefit discussion with your clinician, along with regular follow-up to ensure the therapy remains appropriate for your health profile.
Estradiol is available in several forms:
  • Transdermal preparations (patches, gels, creams)
  • Oral tablets or capsules
  • Low-dose vaginal creams, tablets, or rings
Transdermal estradiol is often preferred in women with elevated cardiovascular or clotting risk because it avoids first-pass metabolism in the liver and is associated with a lower risk of venous thromboembolism compared with oral estrogen in observational studies.
Common side effects include breast tenderness, bloating, mild nausea, headache, or light irregular bleeding in the first months, especially while adjusting doses or adding progesterone. Most effects are dose‑dependent and improve with time or with small dose or regimen adjustments guided by your provider.
Estradiol helps slow bone loss and lowers fracture risk when started around the time of menopause, which is one reason it’s considered for women at higher osteoporosis risk. For appropriately selected women under 60 or within 10 years of menopause, estradiol may also support a more favorable cardiovascular risk profile, but it is not prescribed solely as a heart‑disease prevention drug.
More FAQ