Estrodiol for Women 2026

“You must always be willing to truly consider evidence that contradicts your beliefs and admit the possibility that you may be wrong. Intelligence is not in knowing everything. It is the ability to challenge everything you know.”

Hormone Replacement Therapy (HRT) has been around for years (I have been involved for 25 years plus) but conventional medicine continues to be confused by the difference between synthetic hormones (like conjugated estrogen from horses’ urine) and bioidentical estradiol. Same with thyroid (t3/t4 vs levothyroxine) and progesterone vs progestin. Hope this helps with understanding.

Compiled from lectures by Dr. Neal Rouzier December 2025 and Other Studies

Studies from Part IV, Advanced HRT, World Link Medical

Purposes of Bioidentical Hormone Therapy (BHRT), Menopause and Perimenopause – And Before (yes, teenagers and young adults can have hormonal difficulties).

• Protection/reduction of risk of heart disease, diabetes, dementia, Alzheimer’s disease, cancer, loss or diminishing function.

• Increased longevity, increased joy of life, restoration of more youthful levels of hormones, energy, and skin.

• Avoidance of negative effects of menopause including hot flashes, urinary incontinence, loss of sex drive, loss of lean muscle and strength, decreased memory, osteoporosis.

• Perimenopause. Treatment of PCOS, difficult periods, sleep issues, PMS, and protection vs breast cancer and other forms.

Key Points for Bio Identical Hormones

• Estradiol: Note differences between estradiol (Bioidentical) and Synthetic equine estrogens (Prempro, and premarin).

• Estradiol (Bioidentical). Source: Lab-created to match the body's natural estrogen (from plants like soy/yams). 

• Premarin (Conjugated Equine Estrogens - CEE). Source: A mix of estrogens from pregnant mares' urine.

• Prempro is a combination hormone replacement therapy containing conjugated estrogens and medroxyprogesterone acetate (the latter is NOT progesterone but progestin). Connected to increase breast cancer risk.

• Provera (generic name: medroxyprogesterone acetate) is a prescription hormonal medication, a synthetic form of the hormone progesterone but is NOT progesterone which is naturally produced by the body. It is Progestin. See below.

(NOTE: All the points described below are supported by the appropriate study. I copied a few just to show the original slides had the papers included.

• The only drug that reduces morality of breast cancer by 50% is estradiol.

• If you have estrogen positive tumor, studies show that estradiol is apoptotic to breast cancer cells (kills them). This is featured in both cancer and obgyn journals.

• Aromatize inhibitors (estrogen blockers) increase the risk of CVD, diabetes, etc.

• Oral estradiol reverses plaque.

• Age is not a contraindication for HRT (unless use synthetic hormones like Premarin, Provera).

• All Randomized, Controlled Trials (a high-level scientific study method in medicine and research) and long-term studies, show that estradiol reduces breast cancer (BC) and even retreats BC. Study with high dose oral estradiol, reversed bc.

• Results: • Risk of CHD death was significantly reduced by 18% to 54% in HT (hormone therapy) users. • Risk of stroke death was also reduced by 18% to 39%. • Risk of all-cause mortality was reduced in HT users by 12% to 38%. • All these risk reductions were comparable in women initiating HT before age 60 years and women initiating HT at age 60 years or older.

• Conclusions: In absolute terms, the risk reductions mean nineteen fewer CHD deaths and seven fewer stroke deaths per 1,000 women using any HT for at least 10 years. Includes synthetic.

  
  

Estradiol:

• Oral estradiol lowers lipo(a), and insulin resistance.

• Higher doses of estradiol give better results for CAD, and CVD. Studies used up to 6 mg of estradiol (no harm).

• HDL levels increased. LDL decreased. Note: HDL is more predictive of CVD than LDL in women.

• Aromatize inhibitors (estrogen blockers) increase the risk of cardiovascular disease, diabetes, etc.

• Compared with women not currently using hormones, current users of esterified estrogen (estradiol) had no increase in venous thrombotic risk. In contrast, women currently taking conjugated equine estrogen had an elevated risk.

• Oral estradiol protects health in the long term -- many years.

• Women level of 100 is goal.

• If measuring FSH and on BCP, stop the BCP and wait one month for accurate serum level.

• Transdermal form of estradiol has no effect on lipids so need first pass through liver. Transdermal does nothing to help prevent atherosclerosis.

• Our findings indicate that postmenopausal status is a significant factor of high mean CIMT. These findings add to the growing evidence showing that menopause transition is a critical period for subclinical atherosclerosis development.

• Reports have correlated the use of estrogen for the treatment of menopausal symptoms with beneficial effects on the cardiovascular system. Molecular, biochemical, preclinical, and clinical studies have furnished a wealth of evidence in support of this outcome of estrogen action. Long-term WHI follow-up studies are supportive of cardio protection. (2019).

• Oral Estradiol therapy (1 mg/day) was associated with less progression of subclinical atherosclerosis (measured as CIMT) than was placebo. The Estrogen in Prevention of Atherosclerosis Trial (EPAT), which showed a reduction of atherosclerosis progression in association with postmenopausal hormone therapy.

• We did not observe a relationship between on-treatment LDL cholesterol levels and the progression of calcified coronary atherosclerosis. Over a period of 12 months, intensive atorvastatin therapy was unable to attenuate CAC progression compared with standard atorvastatin therapy. (Yeah, but E2 does!)

• Men: use oral estradiol for better lipid effect. Transdermal in men does have some lipid effect. Testosterone will convert in part to estradiol (men not  women). Many do not understand that estradiol in men helps protect against AD and  Heart Disease.

  
  

• Issue of transdermal estrogens (CEE conjugated equine estrogen) vs estradiol. Incorrect information from conventional approach.

  
  

  Concern: Transdermal estrogens can help prevent plaque rupture in first year if at risk (but not atherosclerosis). There is no risk of rupture if use estradiol - so can use oral form.

• Premarin can cause increase in cardio issues, so transdermal a better choice than Premarin during the first year of use. This risk discussed in the literature and by many non-functional medicine doctors refers to synthetic forms, e.g., Premarin.

• Avoid risk in certain women in first year by taking transdermal -- but only compared with taking Premarin. Does not protect long term. At risk for heart attack and VTE. E.g., if 80 years of age and already have established attack, use oral E2 to decrease stroke and plaque,

• Only Premarin increases VTE not oral estradiol (no increase in blood clots). VTE is Venous Thromboembolism, a serious condition involving blood clots forming in deep veins, typically in the legs. Certain women may be at risk if take oral Premarin the first year of starting this synthetic form of estrogen.

  
  

Results:

• Risk of CHD death was significantly reduced by 18% to 54% in HT users.

• Risk of stroke death was also reduced by 18% to 39%.

• Risk of all-cause mortality was reduced in HT users by 12% to 38%.

• All these risk reductions were comparable in women initiating HT before age 60 years and women initiating HT at age 60 years or older.

• Relationship of Serum Sex Steroid Levels and Bone Turnover Markers with Bone Mineral Density in Men and Women: A Key Role for Bioavailable Estrogen Estrogen level was the consistent independent predictor of BMD in both men and postmenopausal women. Age-related bone loss may be the result of E2 deficiency not just in postmenopausal women but also in men.

See articles coming soon on progesterone, testosterone in men and women, and thyroid health.

Sample from upcoming Progesterone Paper.

• P4 (bioidentical progesterone) has been shown to treat active breast cancer as well as to help prevent BC.

  See Journal Lancet. Apoptotic effect on cancer cells. ("Apoptotic" describes the process of apoptosis, or programmed cell death, a tightly controlled biological event where a cell systematically self-destructs to eliminate damaged, unnecessary, or infected cells, preventing harm and maintaining tissue health.)

• If progesterone positive tumor, stimulate PR receptor with progesterone. Kinney papers.

• Papers in Lancet Medical Journal: “kills cancer cells with progesterone.”

• Know difference between progesterone (natural to body) and progestin (used in drugs like Birth Control Pills).

Questions?