The main reasons women use it:

• Hot flashes and night sweats— estrogen is still the most effective treatment for these, period. Nothing else comes close
• Vaginal dryness, irritation, and painful sex— these happen because low estrogen thins and dries out vaginal tissue. A small amount of vaginal estrogen (cream, ring, or tablet inserted locally) fixes this really well, and barely enters the bloodstream, so it’s considered very safe even for women who can’t use systemic therapy
• Sleep problems— often tied directly to night sweats; when those improve, sleep usually does too
• Mood changes— some women feel anxious, irritable, or low during the menopause transition specifically because of hormone swings, not because of a separate mental health condition; estrogen can help stabilize that

Longer-term protective uses:

• Bone protection— estrogen keeps bones strong. Women who stop making estrogen lose bone density faster, which leads to fractures later in life. This is especially important for women who go through menopause early
• Early or surgical menopause— if your ovaries were removed or stopped working before age 45, your body is missing estrogen decades earlier than it should be. That significantly raises your long-term risk of heart disease, bone loss, and possibly cognitive problems. In this case, hormone therapy isn’t just about comfort — it’s genuinely protective, and most doctors consider it essential until at least age 51

What estrogen is NOT for:

Starting estrogen many years after menopause to prevent heart disease or dementia is not recommended, the evidence doesn’t support it for late starters. Timing really matters here. Starting around the time of menopause appears beneficial; starting ten or more years later does not carry the same benefits and may carry more risk.