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Estriol; Oestriol; Tri-Estrogen

Proposed Uses: Menopausal Symptoms; Osteoporosis

Several forms of estrogen occur naturally in a woman's body. The ovary produces a form named estradiol, which is converted into another important estrogen called estrone. Estriol is yet another form of estrogen metabolized from estradiol, weaker than the other two, but still active.

The estrogen tablets prescribed for menopausal symptoms usually contain estradiol, estrone, or a combination of the two. Some alternative medicine physicians have popularized the use of estriol as an alternative, and there is no doubt that estriol is also effective for symptoms of menopause. However, despite claims that it is safer than other forms of estrogen, the balance of evidence suggests that, in fact, estriol presents precisely the same risks.

Therapeutic Dosages
The usual dose of estriol is 2 to 8 mg taken once daily. Estriol is also commonly sold in combination with other forms of estrogen.

Therapeutic Uses
Like more common forms of estrogen, estriol is used for the treatment of menopausal symptoms. Double-blind, placebo-controlled studies, and other controlled trials have found oral or vaginal estriol effective for symptoms of menopause, including hot flashes, night sweats, insomnia, vaginal dryness, and recurrent urinary tract infections; estriol may also help prevent osteoporosis.

Estriol might cause less vaginal bleeding as a side effect than other forms of estrogen, although this has not been definitively established.

Some alternative practitioners claim that estriol actually fights cancer, as opposed to estrogen, which increases risk of some cancers. However, this claim is based on exaggerated interpretations of very weak studies.  It is more likely that estriol increases cancer risk in much the same way as other forms of estrogen.

Safety Issues
Like other forms of estrogen, oral estriol stimulates the growth of uterine tissue. This leads to risk of uterine cancer. For this reason, to protect the uterus estriol, like other forms of estrogen, needs to be balanced with progesterone. Additionally, one study suggests that estriol is less likely to affect the uterus when taken in a once-daily dose rather than in multiple daily doses.

However, the uterus isn't the only organ at risk of cancer. Test tube studies suggest that estriol is just as likely to cause breast cancer as any other form of estrogen. 20 While this preliminary evidence doesn't constitute proof, it does raise alarm bells. Until proven otherwise, estriol must be regarded as increasing breast cancer risk.

As with other forms of estrogen, vaginal estriol preparations are safer than oral preparations.

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