Over-the-Counter Estrogen: Safety & Effectiveness

Key Takeaways 

• You can find over-the-counter (OTC) estrogen in a few forms: phytoestrogens from foods or supplements, creams, and some herbal remedies.

• OTC estrogen supplements aren’t tested for safety or effectiveness, and research shows mixed results for menopause symptom relief.  

• Prescription estrogen, if right for you, is an effective treatment for perimenopause and menopause symptoms like hot flashes, night sweats, and vaginal dryness. 

Taking estrogen can help with menopause symptoms like hot flashes, weight gain, and vaginal dryness. It usually comes in the form of prescription hormone replacement therapy (HRT). 

But you might have seen over-the-counter estrogen supplements and creams, too. What’s the deal there? 

Some types of over-the-counter estrogen may help to reduce menopause symptoms, but more research is needed on its safety and effectiveness.  

Read on for everything you need to know about OTC estrogen, including whether it’s safe and effective, and how it compares to prescription treatments.

Estrogen is a group of sex hormones made mostly in the ovaries. They play a role in puberty, menstrual cycle regulation, and pregnancy, and help to maintain bone density, brain function, and healthy cholesterol levels. 

During menopause, estrogen levels drop, which can lead to symptoms like: 

• Hot flashes and night sweats (vasomotor symptoms) 

• Mood swings

• Sleep issues 

• Vaginal dryness

• Weight gain 

Taking estrogen can top up low levels in your body and reduce some of these symptoms. 

This not only improves your quality of life, but it can also lower your risk of serious health issues, like bone weakness (osteoporosis) and cardiovascular disease. 

Estrogen usually comes in the form of hormone replacement therapy (HRT), for which you need a prescription. But you’ll also find some estrogen supplements and products available over the counter.

There are a few different types of over-the-counter estrogen, including phytoestrogens, estrogen creams, and herbal supplements.   

Here’s a closer look. 

Phytoestrogens 

Phytoestrogens are estrogen-like compounds that come from plants. They’re structurally similar to the hormone estradiol — a type of estrogen — and show up in foods like: 

• Soybeans

• Red clover

• Flaxseeds

• Nuts

• Coffee

• Berries 

• Apples 

You can also get phytoestrogens from supplements. 

Estrogen Creams 

Over-the-counter estrogen creams often claim to help with hot flashes, vaginal dryness, and painful sex. 

But real estrogen is only available by prescription. These OTC products haven’t been tested for hormone content, safety, or effectiveness. It’s unclear if they contain any estrogen at all — many just use hormone-supporting ingredients or plant-based phytoestrogens instead. 

Herbal Supplements 

Companies often market herbal supplements for menopause as “natural alternatives” to estrogen. But many don’t have any estrogen-like properties and can’t affect your estrogen levels in any way. 

Herbal supplements you might see marketed for menopause symptoms include: 

• Black cohosh 

• Evening primrose oil 

• Ginseng 

• Kava 

• Dong quai 

Over-the-counter estrogen may not be safe for everyone. 

The Food and Drug Administration (FDA) doesn’t regulate dietary supplements. That means it doesn’t test or approve OTC estrogen for safety. The levels of estrogen in these products are unknown, and they might even contain undisclosed or harmful ingredients. 

Phytoestrogens appear to be safe in the short term, but we don’t know much about long-term safety. And since they’re similar to estrogen, they may not be safe for women who can’t take the hormone. 

Plus, some herbal supplements come with health risks, even though they’re natural. For example: 

• Dong quai may interact with the blood thinner warfarin

• Kava is linked to a risk of serious liver disease

• Black cohosh is linked to liver damage in rare cases

The North American Menopause Society doesn’t recommend supplements, herbal remedies, or soy products to treat hot flashes and night sweats. 

Estrogen is a powerful hormone that comes with health risks for some women. A provider won’t prescribe it if you have a history of certain types of cancers, for example. 

The key difference is that when you take prescription estrogen, a healthcare provider can look at your medical history and make sure it’s right for you. You also take it under their supervision. 

The TL;DR? Just because you can easily get it over the counter doesn’t mean OTC estrogen is safe. Speak to a healthcare professional about any estrogen supplements or products you’re thinking about taking. They can give you personalized advice on potential drug interactions or health risks.

Some research shows that certain types of OTC estrogen can help with perimenopause and menopause symptoms. 

For example, a 2014 review found that phytoestrogens helped reduce the number of hot flashes women experienced during menopause.

More research from 2016 showed that these plant estrogens — whether from your diet or a supplement — could also help with hot flashes and vaginal dryness. But they don’t do much for night sweats. 

And when it comes to popular herbal supplements like black cohosh, evening primrose, or dong quai, the science just isn’t there yet. There’s not enough evidence to say they actually work for menopause symptoms.

The bottom line is that results are mixed, and we need more research to know which OTC estrogen options really help with symptoms like sleep problems, mood changes, or low libido.

The main alternative to over-the-counter estrogen is prescription estrogen, which comes in the form of pills, patches, creams, sprays, gels, and vaginal rings. You need a prescription for these.

Prescription estrogen can improve perimenopause and menopause symptoms, like: 

• Hot flashes 

• Night sweats

• Vaginal dryness

• Pain during sex  

• Weight gain

• Sleep problems 

Different treatments deliver different doses of estrogen and target different symptoms. Vaginal creams and rings, for example, can help with painful sex and vaginal dryness. 

And HRT — which usually combines estrogen and another hormone called progesterone — is FDA-approved to treat severe hot flashes and night sweats, and prevent bone thinning.  

Your provider might suggest:

• Combined estrogen and progesterone HRT

• Progesterone-only HRT, if you’re in perimenopause or if you can’t take estrogen

• Estrogen-only HRT, usually if you’ve had a surgery to remove your uterus (a hysterectomy), and therefore don’t have a risk of uterine cancer 

Estrogen can thicken the lining of the uterus, which can lead to an increased risk of uterine cancer. Providers often prescribe progesterone alongside estrogen to help prevent this from happening. 

If you’re under 60 or are within 10 years of starting menopause, HRT could offer more benefits than risks, according to the North American Menopause Society.

Of course, you don’t need to navigate this alone. A healthcare provider can determine if HRT is right for you and help you decide which type of treatment is right for you.

Over-the-counter estrogen supplements and products could help with perimenopause and menopause symptoms, but more research is needed on safety and effectiveness. Plus, the FDA doesn’t regulate OTC supplements like they do prescription medications.

Prescription estrogen therapy may better treat perimenopause and menopause symptoms like hot flashes, vaginal dryness, and trouble sleeping. 

To learn more, connect with a healthcare provider who can determine if HRT is right for you and, if so, which type is best for your needs. 

Is OTC Estrogen Safe to Use?

The FDA doesn’t regulate supplements, and estrogen isn’t safe for women with some health conditions. Speak to your healthcare provider before taking OTC estrogen.  

Can Low Estrogen Cause Weight Gain?

Yes, low estrogen can cause weight gain. It can increase hunger, decrease how many calories your body burns, and change fat distribution to promote more belly fat. 

Can I Get Estrogen Pills Over the Counter? 

No, you can’t get estrogen pills over the counter. You can get supplements over the counter that are made with estrogen-like compounds, but true estrogen pills are prescription-only.