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Estradiol side effects: what 44,834 FDA adverse event reports show

Estradiol, · 982 reaction terms · 157,163 drug–reaction co-reports · data 2026-09-14
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Drug class

Estrogen

FDA label (Established Pharmacologic Class) · compare the class

Who reports

44,834 reports · 49% serious · 886 with death outcome · 98% female

openFDA FAERS counts, all years, deduplication not applied

Used for

Estradiol transdermal system is indicated for: Estradiol transdermal system is an estrogen indicated for: Treatment of moderate to severe vasomotor symptoms due to menopause (1.1) Treatment of moderate to severe symptoms of vulvar and vaginal atrophy d.

FDA label, Indications and Usage

What it is

Estradiol transdermal system, USP contains estradiol, USP in a multipolymeric adhesive. The system is designed to release estradiol, USP continuously upon application to intact skin. Five dosa.

FDA label, Description section

Boxed warning

ENDOMETRIAL CANCER, CARDIOVASCULAR DISORDERS, PROBABLE DEMENTIA, and BREAST CANCER Estrogen-Alone Therapy Endometrial Cancer There is an increased risk of endometrial cancer in a woman with a uterus who uses unopposed estrogens.

FDA label
How to read this page. FAERS is a spontaneous-reporting system: counts are not incidence rates and a signal is not proof of causation. Each reaction below is run through an automated screen — is the term in the FDA label (known), in the indications (the disease being treated), an administrative/coding term, or none of these (unlabeled)? That screen is mechanical text matching, not a causality assessment. The 30 hand-written Bradford Hill assessments are on the causality assessment page. Not medical advice.

Causality screen of the 40 strongest signals

Labeled adverse reaction 6Labeled (related wording) 7Reporting / coding artifact 10Not in label — unassessed 17
What the badges mean

Strongest disproportionality signals

Flagged terms (PRR ≥ 2, χ² ≥ 4, n ≥ 10), ranked by PRR; infinite PRRs (no comparator reports) excluded. The EBGM column is a second, shrinkage-based estimate (MGPS) with its 5th percentile EB05 and the BCPNN IC025; a pair flagged by PRR alone is marked PRR-only and should be read as fragile. The strata column recomputes the PRR on serious reports only (and, for the 300 most-reported drugs, adjusted for age band), and flags pairs whose reports are unusually skewed by sex or come mostly from consumers. Each row also shows the PRR against the other drugs of the same FDA class, which removes most confounding by the condition being treated, and a calibrated p-value: on validation, known non-causes average an ROR of about 2, so significance is judged against that empirical null (✓ = p < 0.05 after calibration). 942 further terms are in the interactive explorer. Reaction links open the term's cross-drug page.

Show:
ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Device adhesion issue1,16138.5
36.3–40.9ROR 39.5 · calibrated p 6e-5 ✓
35.6 EB05 33.9 · IC025 +5.0
3/3 methods agree
vs other Estrogens: PRR 5.0 (4.7–5.3)
Reporting / coding artifact94% consumerno trial arm names this drug
Breast cancer female1,70931.6
30.1–33.2ROR 32.8 · calibrated p 2e-4 ✓
29.6 EB05 28.5 · IC025 +4.8
3/3 methods agree
vs other Estrogens: PRR 0.9 (0.9–1.0)
Not in label — unassessedserious PRR 34.9no trial arm names this drug
Product adhesion issue1,46820.1
19.1–21.2ROR 20.8 · calibrated p 0.002 ✓
19.3 EB05 18.5 · IC025 +4.2
3/3 methods agree
vs other Estrogens: PRR 4.9 (4.6–5.2)
Reporting / coding artifactserious n=88 · 72% consumerno trial arm names this drug
Product packaging issue34017.7
15.9–19.7ROR 17.8 · calibrated p 0.003 ✓
17.1 EB05 15.6 · IC025 +3.9
3/3 methods agree
vs other Estrogens: PRR 4.7 (4.2–5.4)
Reporting / coding artifact79% consumerno trial arm names this drug
Application site irritation2449.3
8.2–10.6ROR 9.4 · calibrated p 0.041 ✓
9.1 EB05 8.1 · IC025 +3.0
3/3 methods agree
vs other Estrogens: PRR 4.5 (3.9–5.3)
Labeled adverse reaction
exact term
serious n=19 · 85% consumerno trial arm names this drug
Application site erythema4458.0
7.3–8.8ROR 8.1 · calibrated p 0.065
7.8 EB05 7.2 · IC025 +2.8
3/3 methods agree
vs other Estrogens: PRR 4.6 (4.1–5.1)
Labeled adverse reaction
exact term
serious n=34 · 84% consumerno trial arm names this drug
Meningioma2297.4
6.5–8.4ROR 7.4 · calibrated p 0.086
7.2 EB05 6.4 · IC025 +2.6
3/3 methods agree
vs other Estrogens: PRR 4.6 (3.9–5.4)
Not in label — unassessedserious PRR 8.6no trial arm names this drug
Hot flush (hot flashes)1,1717.3
6.9–7.8ROR 7.5 · calibrated p 0.080
7.2 EB05 6.9 · IC025 +2.8
3/3 methods agree
vs other Estrogens: PRR 2.9 (2.7–3.0)
Labeled adverse reaction
exact term
serious PRR 6.2 · 74% consumerno trial arm names this drug
Product use complaint2236.8
6.0–7.8ROR 6.8 · calibrated p 0.107
6.6 EB05 5.9 · IC025 +2.5
3/3 methods agree
vs other Estrogens: PRR 4.7 (4.0–5.5)
Reporting / coding artifactserious n=22 · 87% consumerno trial arm names this drug
Product packaging quantity issue1556.7
5.7–7.9ROR 6.7 · calibrated p 0.112
6.5 EB05 5.7 · IC025 +2.4
3/3 methods agree
vs other Estrogens: PRR 4.7 (3.9–5.7)
Reporting / coding artifact84% consumerno trial arm names this drug
Night sweats3665.4
4.8–5.9ROR 5.4 · calibrated p 0.197
5.3 EB05 4.8 · IC025 +2.2
3/3 methods agree
vs other Estrogens: PRR 3.1 (2.7–3.4)
Not in label — unassessedserious PRR 4.3 · 72% consumerno trial arm names this drug
Vaginal discharge1105.2
4.3–6.2ROR 5.2 · calibrated p 0.221
5.0 EB05 4.3 · IC025 +2.0
3/3 methods agree
vs other Estrogens: PRR 2.9 (2.3–3.6)
Labeled adverse reaction
exact term
serious n=40 · 79% consumerno trial arm names this drug
Dermatitis contact1245.1
4.3–6.1ROR 5.2 · calibrated p 0.222
5.0 EB05 4.3 · IC025 +2.0
3/3 methods agree
vs other Estrogens: PRR 3.9 (3.2–4.8)
Not in label — unassessedserious n=51 · 76% consumerno trial arm names this drug
Intervertebral disc degeneration964.9
4.0–5.9ROR 4.9 · calibrated p 0.254
4.7 EB05 4.0 · IC025 +1.9
3/3 methods agree
vs other Estrogens: PRR 2.2 (1.7–2.7)
Not in label — unassessedserious PRR 6.0no trial arm names this drug
Product physical issue2044.8
4.2–5.5ROR 4.8 · calibrated p 0.255
4.7 EB05 4.2 · IC025 +2.0
3/3 methods agree
vs other Estrogens: PRR 4.2 (3.5–4.9)
Reporting / coding artifact80% consumerno trial arm names this drug
Drug level increased1634.6
4.0–5.4ROR 4.6 · calibrated p 0.280
4.5 EB05 4.0 · IC025 +1.9
3/3 methods agree
vs other Estrogens: PRR 3.1 (2.6–3.7)
Reporting / coding artifactserious PRR 5.9no trial arm names this drug
Skin reaction1364.5
3.8–5.4ROR 4.6 · calibrated p 0.292
4.4 EB05 3.9 · IC025 +1.9
3/3 methods agree
vs other Estrogens: PRR 4.7 (3.8–5.7)
Labeled adverse reaction
exact term
serious PRR 6.9no trial arm names this drug
Impaired gastric emptying1174.3
3.6–5.2ROR 4.3 · calibrated p 0.327
4.2 EB05 3.6 · IC025 +1.8
3/3 methods agree
vs other Estrogens: PRR 3.9 (3.2–4.8)
Not in label — unassessedserious PRR 5.6 · 88% consumerno trial arm names this drug
Sleep apnoea syndrome1754.3
3.7–5.0ROR 4.3 · calibrated p 0.327
4.2 EB05 3.7 · IC025 +1.8
3/3 methods agree
vs other Estrogens: PRR 3.3 (2.8–3.9)
Not in label — unassessedserious PRR 5.5no trial arm names this drug
Poor quality product administered924.2
3.4–5.2ROR 4.2 · calibrated p 0.341
4.1 EB05 3.5 · IC025 +1.7
3/3 methods agree
vs other Estrogens: PRR 3.6 (2.8–4.6)
Not in label — unassessed86% consumerno trial arm names this drug
Brain fog1304.2
3.5–5.0ROR 4.2 · calibrated p 0.346
4.1 EB05 3.5 · IC025 +1.7
3/3 methods agree
vs other Estrogens: PRR 4.3 (3.5–5.3)
Not in label — unassessedserious PRR 6.5 · 75% consumerno trial arm names this drug
Hiatus hernia1134.1
3.4–4.9ROR 4.1 · calibrated p 0.363
4.0 EB05 3.4 · IC025 +1.7
3/3 methods agree
vs other Estrogens: PRR 2.7 (2.2–3.4)
Not in label — unassessedserious PRR 5.2no trial arm names this drug
Device defective1343.9
3.3–4.6ROR 3.9 · calibrated p 0.400
3.8 EB05 3.3 · IC025 +1.6
3/3 methods agree
vs other Estrogens: PRR 4.7 (3.8–5.8)
Reporting / coding artifact85% consumerno trial arm names this drug
Iron deficiency anaemia763.9
3.1–4.9ROR 3.9 · calibrated p 0.404
3.8 EB05 3.1 · IC025 +1.5
3/3 methods agree
vs other Estrogens: PRR 3.4 (2.6–4.4)
Not in label — unassessedserious PRR 4.7no trial arm names this drug
Emphysema833.9
3.1–4.8ROR 3.9 · calibrated p 0.411
3.8 EB05 3.1 · IC025 +1.5
3/3 methods agree
vs other Estrogens: PRR 3.1 (2.4–4.0)
Not in label — unassessedserious PRR 4.7no trial arm names this drug
Seasonal allergy1153.8
3.2–4.6ROR 3.8 · calibrated p 0.414
3.8 EB05 3.2 · IC025 +1.6
3/3 methods agree
vs other Estrogens: PRR 3.3 (2.7–4.1)
Not in label — unassessedserious n=78 · 75% consumerno trial arm names this drug
Migraine7593.8
3.5–4.0ROR 3.8 · calibrated p 0.417
3.7 EB05 3.5 · IC025 +1.8
3/3 methods agree
vs other Estrogens: PRR 3.2 (3.0–3.5)
Labeled adverse reaction
exact term
serious PRR 5.1no trial arm names this drug
Fungal infection2603.7
3.2–4.1ROR 3.7 · calibrated p 0.444
3.6 EB05 3.3 · IC025 +1.7
3/3 methods agree
vs other Estrogens: PRR 3.2 (2.8–3.7)
Not in label — unassessedserious PRR 5.0no trial arm names this drug
Product substitution issue4473.6
3.3–4.0ROR 3.7 · calibrated p 0.445
3.6 EB05 3.3 · IC025 +1.7
3/3 methods agree
vs other Estrogens: PRR 4.3 (3.9–4.9)
Reporting / coding artifactserious PRR 3.2 · 86% consumerno trial arm names this drug
Toxic epidermal necrolysis (severe skin peeling reaction)1173.6
3.0–4.4ROR 3.6 · calibrated p 0.453
3.6 EB05 3.1 · IC025 +1.5
3/3 methods agree
vs other Estrogens: PRR 4.8 (3.8–5.9)
Not in label — unassessedserious PRR 4.3 · 100% clinicianno trial arm names this drug
Candida infection (yeast infection)1273.6
3.0–4.3ROR 3.6 · calibrated p 0.469
3.5 EB05 3.0 · IC025 +1.5
3/3 methods agree
vs other Estrogens: PRR 4.2 (3.4–5.1)
Not in label — unassessedserious PRR 5.1no trial arm names this drug
Diverticulitis2103.6
3.1–4.1ROR 3.6 · calibrated p 0.468
3.5 EB05 3.1 · IC025 +1.6
3/3 methods agree
vs other Estrogens: PRR 3.4 (2.9–3.9)
Not in label — unassessedserious PRR 4.4no trial arm names this drug
Product availability issue1703.6
3.1–4.1ROR 3.6 · calibrated p 0.471
3.5 EB05 3.1 · IC025 +1.6
3/3 methods agree
vs other Estrogens: PRR 4.6 (3.8–5.5)
Reporting / coding artifactserious PRR 2.4 · 84% consumerno trial arm names this drug

Trial evidence (ClinicalTrials.gov)

ClinicalTrials.gov returned results-bearing trials mentioning Estradiol only as a background or rescue medication (NCT01656434, NCT00996580); no trial listing it as the tested intervention was cached, so no trial cross-check is shown.

Most frequently reported reactions

By raw co-report count, regardless of disproportionality. Common terms here are often the illness itself or generic outcomes.

ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Drug ineffective (drug did not work)3,6641.3
1.3–1.3ROR 1.3 · calibrated p 0.526
1.3 EB05 1.3 · IC025 +0.3
vs other Estrogens: PRR 3.2 (3.1–3.3)
Reporting / coding artifactserious PRR 1.3no trial arm names this drug
Nausea2,7751.6
1.6–1.7ROR 1.7 · calibrated p 0.761
1.6 EB05 1.6 · IC025 +0.7
vs other Estrogens: PRR 3.3 (3.2–3.5)
Labeled adverse reaction
exact term
serious PRR 2.0no trial arm names this drug
Headache2,7532.1
2.0–2.1ROR 2.1 · calibrated p 0.989
2.1 EB05 2.0 · IC025 +1.0
vs other Estrogens: PRR 3.3 (3.2–3.5)
Labeled adverse reaction
exact term
serious PRR 2.4no trial arm names this drug
Fatigue (tiredness)2,7491.7
1.6–1.7ROR 1.7 · calibrated p 0.767
1.7 EB05 1.6 · IC025 +0.7
vs other Estrogens: PRR 3.4 (3.2–3.5)
Not in label — unassessedserious PRR 2.1no trial arm names this drug
Off label use (used outside approved label)2,3181.2
1.2–1.3ROR 1.3 · calibrated p 0.481
1.2 EB05 1.2 · IC025 +0.2
vs other Estrogens: PRR 3.3 (3.1–3.4)
Reporting / coding artifactserious PRR 1.4no trial arm names this drug
Pain2,0061.5
1.5–1.6ROR 1.5 · calibrated p 0.673
1.5 EB05 1.5 · IC025 +0.5
vs other Estrogens: PRR 3.0 (2.9–3.2)
Labeled adverse reaction
exact term
serious PRR 1.7no trial arm names this drug
Diarrhoea (diarrhea)1,8891.4
1.3–1.4ROR 1.4 · calibrated p 0.567
1.4 EB05 1.3 · IC025 +0.4
vs other Estrogens: PRR 3.4 (3.2–3.6)
Labeled adverse reaction
exact term
serious PRR 1.6no trial arm names this drug
Breast cancer female1,70931.6
30.1–33.2ROR 32.8 · calibrated p 2e-4 ✓
29.6 EB05 28.5 · IC025 +4.8
3/3 methods agree
vs other Estrogens: PRR 0.9 (0.9–1.0)
Not in label — unassessedserious PRR 34.9no trial arm names this drug
Dizziness1,6461.5
1.5–1.6ROR 1.6 · calibrated p 0.684
1.5 EB05 1.5 · IC025 +0.5
vs other Estrogens: PRR 3.1 (3.0–3.3)
Labeled adverse reaction
exact term
serious PRR 1.9no trial arm names this drug
Arthralgia (joint pain)1,5861.8
1.7–1.9ROR 1.8 · calibrated p 0.841
1.8 EB05 1.7 · IC025 +0.8
vs other Estrogens: PRR 3.2 (3.1–3.4)
Labeled adverse reaction
exact term
serious PRR 2.3no trial arm names this drug
Pruritus (itching)1,4781.8
1.7–1.9ROR 1.9 · calibrated p 0.863
1.8 EB05 1.7 · IC025 +0.8
vs other Estrogens: PRR 3.6 (3.4–3.8)
Labeled adverse reaction
exact term
serious PRR 1.9no trial arm names this drug
Dyspnoea (shortness of breath)1,4741.2
1.2–1.3ROR 1.2 · calibrated p 0.457
1.2 EB05 1.2 · IC025 +0.2
vs other Estrogens: PRR 3.0 (2.9–3.2)
Not in label — unassessedserious PRR 1.4no trial arm names this drug
Rash1,4691.6
1.5–1.7ROR 1.6 · calibrated p 0.708
1.6 EB05 1.5 · IC025 +0.6
vs other Estrogens: PRR 3.7 (3.5–3.9)
Labeled adverse reaction
exact term
serious PRR 1.8no trial arm names this drug
Product adhesion issue1,46820.1
19.1–21.2ROR 20.8 · calibrated p 0.002 ✓
19.3 EB05 18.5 · IC025 +4.2
3/3 methods agree
vs other Estrogens: PRR 4.9 (4.6–5.2)
Reporting / coding artifactserious n=88 · 72% consumerno trial arm names this drug
Vomiting1,3111.3
1.2–1.4ROR 1.3 · calibrated p 0.518
1.3 EB05 1.2 · IC025 +0.3
vs other Estrogens: PRR 3.3 (3.1–3.5)
Labeled adverse reaction
exact term
serious PRR 1.6no trial arm names this drug

Unlabeled candidate signals

These flagged terms were not found in the FDA label text and do not match an artifact pattern. They are the pairs that would merit a structured assessment (temporality, dose-response, biological plausibility, consistency across databases, trial or cohort evidence). The screen has not done that; string-matching misses label wording, and a strong PRR can still be stimulated reporting, co-medication, or the disease itself.

✓ A hand-written Bradford Hill causality assessment exists for this drug: Drospirenone/ethinyl estradiol ↔ Pulmonary embolism (venous thromboembolism).

Want to assess one of these properly? The runbook describes the Bradford Hill / trial-evidence workflow used on the assessment page, and handoff_top1000_signals.csv lists the strongest unassessed pairs across all drugs.

Common questions

What are the most reported side effects of Estradiol?

In FDA FAERS, the most frequently co-reported reaction terms for Estradiol are nausea, headache, fatigue, pain, diarrhoea, breast cancer female. These are report counts, not rates: FAERS has no denominator, reporting is voluntary and uneven, and a term can be reported because of the illness being treated rather than the drug.

Does Estradiol have an FDA boxed warning?

Yes. The current FDA label carries a boxed warning: ENDOMETRIAL CANCER, CARDIOVASCULAR DISORDERS, PROBABLE DEMENTIA, and BREAST CANCER Estrogen-Alone Therapy Endometrial Cancer There is an increased risk of endometrial cancer in a woman with a uterus who uses unopposed estrogens.

Do FAERS signals prove that Estradiol causes these side effects?

No. A disproportionality signal (PRR, ROR) means a reaction is reported more often with this drug than with others in the database. That can reflect a real effect, but also the disease being treated, stimulated reporting after news or litigation, co-medications, or how reports are coded. Causality needs temporality, dose-response, biological plausibility, consistency across data sources and, ideally, trial or cohort evidence. This page screens each term against the FDA label and ClinicalTrials.gov results; it does not establish causation.

Sources & methods

Page generated 2026-10-14. Label and PubChem text are retrieved automatically and may lag the current label; always check the current prescribing information. OpenPV is a beta research tool of the Open Source Medicine Foundation.