Public record
Estradiol: the public record
Each table is computed from the named federal dataset as of its data date; the method is under each one.
Label
FDA label facts for estradiol
The FDA label read for estradiol (Vivelle-Dot, application NDA020538) was last revised on 2026-10-30. It carries a boxed warning headed "WARNING: ENDOMETRIAL CANCER WITH UNOPPOSED ESTROGEN IN WOMEN WITH A UTERUS". Of the 4 population sections checked, 4 are present: pregnancy, lactation, pediatric use, geriatric use.
| Measure | Value | Note |
|---|---|---|
| Label revision date | 2026-10-30 | |
| Label read | Vivelle-Dot | NDA020538, brand-name application |
| Boxed warning | Yes | heading as printed: "WARNING: ENDOMETRIAL CANCER WITH UNOPPOSED ESTROGEN IN WOMEN WITH A UTERUS" |
| Pregnancy section | Present | |
| Lactation section | Present | |
| Pediatric use section | Present | |
| Geriatric use section | Present |
How this was calculated
Selected the most recently revised prescription label for this single ingredient from an original manufacturer, preferring a brand-name application. Checked which sections exist and quoted headings and sentences exactly as printed.
One label: the newest prescription label for single-ingredient estradiol from an original manufacturer
Read from one label. Labels for other brands, strengths or forms of the same ingredient can differ. A missing section heading does not mean there is no guidance. Read the full label before relying on it.
Approvals
FDA approval history for estradiol
The earliest FDA approval on file for a estradiol product is 1975-07-23. Drugs@FDA lists 65 applications for it and 437 approved supplements, the most recent on 2026-10-30.
| Measure | Value | Note |
|---|---|---|
| Earliest FDA approval on file | 1975-07-23 | |
| Applications with an approval on file | 65 | |
| New drug applications (NDA) | 22 | |
| Generic applications (ANDA) | 43 | |
| Approved supplements | 437 | label, manufacturing and efficacy changes |
| Most recent supplement approval | 2026-10-30 | |
| Sponsoring companies | 44 |
How this was calculated
Selected applications with a product whose only active ingredient is this substance, then counted approved original and supplemental submissions. The earliest approved original submission is the first approval.
Applications with a single-ingredient estradiol product in Drugs@FDA, all sponsors and strengths
Older approvals can be missing dates, and tentative approvals are not counted. An approved application does not mean the product is currently marketed.
Patents and generics
Patents and generic approvals for estradiol
The FDA Orange Book lists 41 approved generic applications for estradiol, the first approved on 1984-01-31. 24 listed patents on specific brand products have not yet expired, the last on 2034-02-02; generics of other versions are already approved.
| Measure | Value | Note |
|---|---|---|
| Brand-name applications (NDA) | 20 | |
| Approved generic applications (ANDA) | 41 | first approved 1984-01-31 |
| Companies with a generic not marked discontinued | 19 | |
| Listed patents not yet expired | 24 | |
| Latest listed patent expiry | 2034-02-02 | on any product; may cover only one brand formulation |
| Earliest approval date on file | before 1982 | |
| Products not marked discontinued | 121 of 170 |
How this was calculated
Selected Orange Book products whose only active ingredient is this substance, then counted applications by type and the distinct patents and exclusivities listed against them. Expired patents are left out.
All single-ingredient estradiol products in the Orange Book, every brand and strength, files dated 2026-10-09
An approved generic or an expired patent does not show that a generic is on sale. Launch timing also depends on litigation, settlements and supply. Biologics and compounded products are not in the Orange Book.
Medicare Part D
Medicare Part D claims for estradiol by age group
Of 5,130,549 Medicare Part D claims for estradiol in 2024, 4,443,430 (86.6%) were for enrollees aged 65 and over and 687,119 were for enrollees under 65.
| Measure | Value | Note |
|---|---|---|
| All Part D claims, 2024 | 5,130,549 | |
| Claims for enrollees aged 65 and over | 4,443,430 | |
| Claims for enrollees under 65 | 687,119 | mostly people who qualify through disability |
| Share of claims for enrollees aged 65 and over | 86.6% | share of claims, not of patients |
How this was calculated
Summed the national rows for every brand and generic row with this generic name. Claims under 65 are total claims minus claims for enrollees 65 and over.
National Part D claims for single-ingredient estradiol products, 2024, split at age 65
Medicare mostly covers people 65 and over, so this split describes Medicare enrollees and not use in the general population.
Medicare Part D
Medicare Part D claims for estradiol by state
California had the most Medicare Part D claims for estradiol in 2024 (640,273), followed by Texas (390,081) and Florida (342,985). Prescribers in 59 states and territories wrote 5,129,996 claims in all.
| Measure | Value | Note |
|---|---|---|
| All states and territories, 2024 | 5,129,996 claims | |
| States and territories with reported claims | 59 | |
| California | 640,273 claims | $63.5M gross drug cost |
| Texas | 390,081 claims | $25.4M gross drug cost |
| Florida | 342,985 claims | $23.4M gross drug cost |
| New York | 246,054 claims | $26.8M gross drug cost |
| North Carolina | 182,223 claims | $13.0M gross drug cost |
How this was calculated
Summed claims and drug cost by prescriber state over every brand and generic row with this generic name. Combination products excluded. Rows CMS suppressed for small counts are left out.
Part D claims for single-ingredient estradiol products by the prescriber's state, 2024
State counts follow population size and where the prescriber practises. They are not per-person rates and do not show any state's coverage rules.
Medicare Part D
Medicare Part D spending on estradiol
Medicare Part D spending on estradiol products was $398.7M in 2024 across 5,132,890 claims, compared with $417.8M in 2023 (-4.6%). Average spending per claim was $77.68, before rebates.
| Measure | Value | Note |
|---|---|---|
| Total spending, 2024 | $398.7M | |
| Total spending, 2023 | $417.8M | |
| Change in spending, 2023 to 2024 | -4.6% | |
| Claims (prescription fills), 2024 | 5,132,890 | |
| Average spending per claim, 2024 | $77.68 | |
| Estradiol*: spending, 2024 | $218.2M | 4,055,858 claims |
| Estring: spending, 2024 | $49.2M | 90,750 claims |
| Estradiol (Twice Weekly): spending, 2024 | $30.6M | 319,673 claims |
How this was calculated
Summed total spending and claims over every brand and generic row with this generic name in the CMS file, using the Overall manufacturer rows. Combination products excluded. Average per claim is spending divided by claims.
Every single-ingredient estradiol product in Part D (Estradiol*, Estring, Estradiol (Twice Weekly)), 2024.
Gross drug cost before manufacturer rebates, so net cost is lower. Part D excludes some uses by law (for example erectile dysfunction, weight loss and hair growth), so claims reflect covered uses only. Compounded products are not included.
Medicaid
Medicaid prescriptions for estradiol by state
State Medicaid programmes paid for 1,646,048 estradiol prescriptions in 2025, with $82.4M reimbursed before rebates. California reported the most (244,801), followed by New York (119,511) and Oregon (99,444); 52 states and territories reported any.
| Measure | Value | Note |
|---|---|---|
| Prescriptions paid by Medicaid, 2025 | 1,646,048 | |
| Total reimbursed before rebates, 2025 | $82.4M | |
| States and territories reporting | 52 | with at least one count CMS did not suppress |
| California | 244,801 prescriptions | $16.8M reimbursed |
| New York | 119,511 prescriptions | $6.7M reimbursed |
| Oregon | 99,444 prescriptions | $3.9M reimbursed |
| Washington | 76,777 prescriptions | $3.3M reimbursed |
| Ohio | 73,723 prescriptions | $2.5M reimbursed |
How this was calculated
Matched each Medicaid product code to the FDA NDC Directory by labeler and product code, kept finished single-ingredient products, then summed prescriptions and reimbursement by state. National roll-up and suppressed rows dropped.
All single-ingredient estradiol products in the FDA NDC Directory, fee-for-service and managed care, 2025
Counts under 11 are suppressed by CMS and left out, so totals are a floor. Amounts are before rebates. Differences between states reflect programme size and coverage rules. Compounded products are not included.
Pharmacy cost
Pharmacy acquisition cost (NADAC) for estradiol
Retail pharmacies paid an average of $5.50 per unit for ESTRADIOL 10 MCG VAGINAL INSRT as of 2026-11-11, compared with $7.00 twelve months earlier (-21.5%). This is a pharmacy purchase cost, not a patient price.
| Measure | Value | Note |
|---|---|---|
| ESTRADIOL 10 MCG VAGINAL INSRT | $5.50 per unit | 12 months earlier $7.00 (-21.5%) |
| ESTRADIOL 1 MG TABLET | $0.0632 per unit | 12 months earlier $0.0702 (-10.0%) |
| ESTRADIOL 0.025 MG PATCH(2/WK) | $8.01 per unit | 12 months earlier $6.30 (+27.2%) |
| ESTRADIOL 0.0375 MG PATCH(2/WK) | $8.26 per unit | 12 months earlier $7.01 (+17.7%) |
| ESTRADIOL 0.05 MG PATCH (2/WK) | $8.61 per unit | 12 months earlier $7.51 (+14.7%) |
| ESTRADIOL 0.075 MG PATCH(2/WK) | $8.23 per unit | 12 months earlier $6.86 (+20.1%) |
How this was calculated
Matched NADAC product codes to the FDA NDC Directory, kept finished single-ingredient products, and listed the product descriptions with the most package codes. The earlier price is the same package code in the file one year before.
Generic versions of estradiol in the weekly NADAC file of 2026-11-11, compared with the file of 2025-11-12
NADAC is the average invoice price retail pharmacies pay, from a voluntary survey. It leaves out rebates, dispensing fees and markups, and it is not what a patient or insurer pays. Compounded products are not surveyed.
Adverse event reports
FDA adverse event reports naming application site skin reactions and estradiol
Through 2026-10-28, FDA had received 2,936 adverse event reports for estradiol that name application site skin reactions, out of 75,081 reports for the drug in all. 2,666 of these reports concerned female patients and 8 male patients.
| Measure | Value | Note |
|---|---|---|
| Reports naming application site skin reactions | 2,936 | |
| All reports for estradiol | 75,081 | |
| Share of this drug's reports naming it | 3.9% | share of reports received, not of people taking the drug |
| Of those: female patients | 2,666 | reflects who takes the drug and who files reports |
| Of those: male patients | 8 | |
| Of those: sex not recorded | 262 |
How this was calculated
Counted FAERS reports listing this active substance and at least one of these reaction terms: application site irritation, application site erythema, application site pruritus, application site rash. A report can name several reactions and several drugs. Counts by year use the date FDA received the report.
Reports with estradiol as a single-ingredient active substance (any brand), 4 MedDRA terms for application site skin reactions
FAERS reports are unverified and do not prove the drug caused the event. Reporting rises with use, publicity and lawsuits, so these counts cannot give rates or risks and cannot be compared between drugs.
Adverse event reports
FDA adverse event reports naming blood clots and estradiol
Through 2026-10-28, FDA had received 481 adverse event reports for estradiol that name blood clots (deep vein thrombosis or pulmonary embolism), out of 75,081 reports for the drug in all. 399 of these reports concerned female patients and 41 male patients.
| Measure | Value | Note |
|---|---|---|
| Reports naming blood clots (deep vein thrombosis or pulmonary embolism) | 481 | |
| All reports for estradiol | 75,081 | |
| Share of this drug's reports naming it | 0.6% | share of reports received, not of people taking the drug |
| Of those: female patients | 399 | reflects who takes the drug and who files reports |
| Of those: male patients | 41 | |
| Of those: sex not recorded | 41 |
How this was calculated
Counted FAERS reports listing this active substance and at least one of these reaction terms: deep vein thrombosis, pulmonary embolism. A report can name several reactions and several drugs. Counts by year use the date FDA received the report.
Reports with estradiol as a single-ingredient active substance (any brand), 2 MedDRA terms for blood clots
FAERS reports are unverified and do not prove the drug caused the event. Reporting rises with use, publicity and lawsuits, so these counts cannot give rates or risks and cannot be compared between drugs.
Adverse event reports
FDA adverse event reports naming breast tenderness or pain and estradiol
Through 2026-10-28, FDA had received 713 adverse event reports for estradiol that name breast tenderness or pain, out of 75,081 reports for the drug in all. 657 of these reports concerned female patients and 1 male patients.
| Measure | Value | Note |
|---|---|---|
| Reports naming breast tenderness or pain | 713 | |
| All reports for estradiol | 75,081 | |
| Share of this drug's reports naming it | 0.9% | share of reports received, not of people taking the drug |
| Of those: female patients | 657 | reflects who takes the drug and who files reports |
| Of those: male patients | 1 | |
| Of those: sex not recorded | 55 |
How this was calculated
Counted FAERS reports listing this active substance and at least one of these reaction terms: breast tenderness, breast pain. A report can name several reactions and several drugs. Counts by year use the date FDA received the report.
Reports where FDA recorded estradiol as a single-ingredient active substance (any brand, any route or form), MedDRA terms breast tenderness, breast pain
FAERS reports are unverified and do not prove the drug caused the event. Reporting rises with use, publicity and lawsuits, so these counts cannot give rates or risks and cannot be compared between drugs.
Adverse event reports
FDA adverse event reports naming headache and estradiol
Through 2026-10-28, FDA had received 4,641 adverse event reports for estradiol that name headache, out of 75,081 reports for the drug in all. 4,245 of these reports concerned female patients and 41 male patients.
| Measure | Value | Note |
|---|---|---|
| Reports naming headache | 4,641 | |
| All reports for estradiol | 75,081 | |
| Share of this drug's reports naming it | 6.2% | share of reports received, not of people taking the drug |
| Of those: female patients | 4,245 | reflects who takes the drug and who files reports |
| Of those: male patients | 41 | |
| Of those: sex not recorded | 355 |
How this was calculated
Counted FAERS reports listing this active substance and at least one of these reaction terms: headache. A report can name several reactions and several drugs. Counts by year use the date FDA received the report.
Reports where FDA recorded estradiol as a single-ingredient active substance (any brand, any route or form), MedDRA term headache
FAERS reports are unverified and do not prove the drug caused the event. Reporting rises with use, publicity and lawsuits, so these counts cannot give rates or risks and cannot be compared between drugs.
Adverse event reports
FDA adverse event reports naming unexpected vaginal or uterine bleeding and estradiol
Through 2026-10-28, FDA had received 1,198 adverse event reports for estradiol that name unexpected vaginal or uterine bleeding, out of 75,081 reports for the drug in all. 1,084 of these reports concerned female patients and 0 male patients.
| Measure | Value | Note |
|---|---|---|
| Reports naming unexpected vaginal or uterine bleeding | 1,198 | |
| All reports for estradiol | 75,081 | |
| Share of this drug's reports naming it | 1.6% | share of reports received, not of people taking the drug |
| Of those: female patients | 1,084 | reflects who takes the drug and who files reports |
| Of those: male patients | 0 | |
| Of those: sex not recorded | 114 |
How this was calculated
Counted FAERS reports listing this active substance and at least one of these reaction terms: vaginal haemorrhage, intermenstrual bleeding, uterine haemorrhage. A report can name several reactions and several drugs. Counts by year use the date FDA received the report.
Reports with estradiol as a single-ingredient active substance (any brand), 3 MedDRA terms for unexpected vaginal or uterine bleeding
FAERS reports are unverified and do not prove the drug caused the event. Reporting rises with use, publicity and lawsuits, so these counts cannot give rates or risks and cannot be compared between drugs.
Adverse event reports
Most reported events in FDA adverse event reports for estradiol
Through 2026-10-28, FDA had received 75,081 adverse event reports for estradiol, 28,845 of them marked serious by the reporter. The symptom terms named most often were headache (4,641), fatigue (4,124) and nausea (4,084).
| Measure | Value | Note |
|---|---|---|
| All reports received | 75,081 | |
| Reports the reporter marked serious | 28,845 | death, hospitalisation, disability or similar outcome |
| Headache | 4,641 reports | |
| Fatigue | 4,124 reports | |
| Nausea | 4,084 reports | |
| Hot flush | 2,985 reports | |
| Pain | 2,980 reports |
How this was calculated
Counted FAERS reports listing this active substance, then the reaction terms named most often. A report can name several reactions, and a term can describe the illness being treated and not an effect of the drug. Terms about product use or complaints rather than symptoms (for example drug ineffective) were left out of the list.
Reports where FDA recorded estradiol as a single-ingredient active substance (any brand, any route or form), all years to 2026-10-28
FAERS reports are unverified and do not prove the drug caused the event. Reporting rises with use, publicity and lawsuits, so these counts cannot give rates or risks and cannot be compared between drugs.
Recalls
FDA drug recalls naming estradiol
FDA enforcement reports list 22 drug recall entries naming estradiol from 2015 to 2026-10-07. 0 of them are for compounded or other unlisted products and 22 for products FDA lists under a label. The most common stated reason was other reasons (8 of 22).
| Measure | Value | Note |
|---|---|---|
| Recall entries on record | 22 | |
| For products FDA lists under an approved or registered label | 22 | |
| For compounded or other unlisted products | 0 | matched by the name in the product description |
| Class I (most serious) | 0 | |
| Class II | 18 | |
| Class III | 4 | |
| Most recent recall reported | 2026-10-07 | |
| Most common stated reason | other reasons | 8 of 22 entries |
How this was calculated
Counted enforcement report entries matched by FDA's listed active substance, or by the name in the product description where FDA lists none. Reasons were grouped by keywords in FDA's stated reason.
Recalls of single-ingredient estradiol products, plus compounded or unlisted products whose description names it
Each recall covers specific lots from one firm and is not a statement about every product with this ingredient. One event can appear as several entries, one per product.
Clinical studies
Registered clinical studies of estradiol
ClinicalTrials.gov lists 2,024 registered studies that name estradiol as an intervention as of 2026-11-11. Of these, 207 are recruiting, 1,146 are completed and 358 are phase 3 studies.
| Measure | Value |
|---|---|
| Registered studies | 2,024 |
| Recruiting now | 207 |
| Not yet recruiting | 59 |
| Completed | 1,146 |
| Terminated, withdrawn or suspended | 244 |
| Phase 3 (including phase 2/3) | 358 |
| Phase 2 (including phase 1/2) | 538 |
| Phase 1 | 383 |
How this was calculated
Searched the ClinicalTrials.gov intervention field for the name, downloaded every matching record and counted by overall status and phase. Combined phases are counted under the higher phase. Phase not applicable covers observational, device and behavioural studies.
Studies whose intervention field matches estradiol, any condition, any country, all statuses
A registered study is not a result. Counts include studies where the drug is a comparator or background treatment, and studies that never finished or reported.
Population data
How estradiol is distributed in US adults
In the 2021 to 2023 US national health survey, the median estradiol was 23.0 pg/mL in men aged 20 to 39 and 74.5 pg/mL in women aged 20 to 39. Half of people in each group fall below the median; the row notes give the range covering the middle 90%.
| Measure | Value | Note |
|---|---|---|
| Men 20 to 39, median | 23.0 pg/mL | middle 90% of people: 10.8 to 41.7; 608 people tested |
| Men 40 to 59, median | 24.6 pg/mL | middle 90% of people: 11.6 to 42.1; 711 people tested |
| Men 60 and over, median | 23.6 pg/mL | middle 90% of people: 8.9 to 43.3; 1,184 people tested |
| Women 20 to 39, median | 74.5 pg/mL | middle 90% of people: 5.5 to 420; 787 people tested |
| Women 40 to 59, median | 19.4 pg/mL | middle 90% of people: 1.2 to 246; 900 people tested |
| Women 60 and over, median | 4.3 pg/mL | middle 90% of people: 1.2 to 20.5; 1,342 people tested |
How this was calculated
Computed survey-weighted 5th, 50th and 95th percentiles from the CDC public file by sex and age band, using the sample weight WTPH2YR. Groups with fewer than 50 people are left out.
US adults aged 20 and over who gave a sample in NHANES 2021 to 2023, CDC variable LBXEST (Estradiol (pg/mL))
These are population distributions, not clinical reference ranges or treatment targets. They include people with and without health conditions and people on medication. Laboratories differ in method and units.
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