A review of estrogens used in menopausal hormone therapy

Estrogen therapy reflects a nuanced approach informed by receptor selectivity, pharmacologic diversity, and timing of initiation. Estradiol-based and transdermal formulations remain preferred for systemic therapy, while low-dose vaginal estrogen is first line for urogenital symptoms. Novel estrogens and deeper mechanistic insights continue to refine therapeutic options, supporting more targeted and safer use of estrogen across the menopausal transition.