Estradiol in medicines
This resource on estradiol (a type of oestrogen) is for the Muslim community (including patients, carers, parents and members of the public). Healthcare professionals may also find this resource useful when supporting people with gathering and understanding information about their medicine(s).
It highlights the issues of oestrogen use in medicines that you should be aware of. There is also a table to help you understand which oestrogen is halāl or harām, according to each of the four Sunni schools of thought.
What is estradiol?
Estradiol is a form of oestrogen, a female sex hormone.1 Estradiol is mainly synthetically derived.
Conjugated oestrogen is another type of oestrogen. Conjugated oestrogen is animal-derived and extracted from the urine of pregnant mares (female horses or other equine).2
Estradiol is mainly synthetically derived
Conjugated oestrogen is mainly animal-derived
How estradiol is used in medicines
Estradiol (oestrogen) is used as:
- Hormone replacement therapy (HRT) to treat the symptoms of menopause (e.g. hot flushes and vaginal dryness) and prevent osteoporosis in women. Estradiol (oestrogen) HRT is available in different formulations such as tablets, patches, gels and sprays
- Oral contraceptives to regulate the menstrual cycle and prevent pregnancy
- Treatment of hormonal disorders related to oestrogen deficiency, such as hypogonadism and delayed puberty.
Conjugated oestrogen is used as hormone replacement therapy (HRT) to treat the symptoms of menopause. It is available as an oral tablet, for example, as Premarin.3
Hormone replacement therapy (HRT)
How the use of estradiol in medicines affects the Muslim community
Estradiol is mainly synthetically derived and is considered halāl.
However, the Muslim community needs to be aware that another type of oestrogen, conjugated oestrogen, is derived from animal urine. Urine is considered harām, legally impure (najis) and repulsive by the majority of Islamic scholars due to its origin from urine. Conjugated oestrogen is mainly used in HRT medicines.
It is important for the Muslim community to:
- Check if your medicine contains oestrogen (estradiol or conjugated oestrogen) and clarify the source (animal or synthetic)
- Check for halāl–certification.
To find out this information, see section on How do I find out if a medicine contains estradiol or conjugated oestrogen?. You could also speak to your local pharmacist for advice and support. You may also need to directly contact the manufacturer of your medicine if you want to check for the source of oestrogen and for halāl-certification (manufacturers may have limited information).
Is all oestrogen halāl or harām?
The table below summarises the rulings of animal oestrogen and synthetically derived oestrogen according to the four Sunni schools4:
| Source | Ḥanafī | Mālikī | Shāfiʿī | Ḥanbalī |
|---|---|---|---|---|
| Animal urine derived conjugated oestrogen | ❌Harām to consume. Urine is considered legally impure (najis). | ❌Harām to consume. Urine is considered repulsive, even though it is considered legally pure (ṭāhir). | ❌Harām to consume. Urine is considered legally impure (najis). | ❌Harām to consume. Urine is considered repulsive, even though it is considered legally pure (ṭāhir) |
| Synthetically derived oestrogen e.g. estradiol | ✅ Halāl | ✅ Halāl | ✅ Halāl | ✅ Halāl |
In summary, oestrogens that are derived from animal urine such as conjugated oestrogen, are considered harām and legally impure (najis) according to the four schools of thought. However, oestrogens that are synthetically derived such as estradiol, are considered halāl according to the four schools of thought.
Halāl alternatives and substitutes
If you are seeking halāl products, look for halāl-certified, plant-based, or synthetic alternatives (where available and possible).
Alternative synthetically derived oestrogen for use in HRT is available e.g., from:
- Plant-based sources (wild yam, soy)
- Synthetic sources using biotechnological methods (recombinant DNA technology) – e.g. synthetic estradiol which is bioidentical to natural human estradiol.1
How do I find out if a medicine contains estradiol or conjugated oestrogen?
You can check if a medicine contains synthetically derived estradiol (an oestrogen) or animal derived conjugated oestrogen using the relevant product patient information leaflet (PIL) or summary of product characteristics (SPC) which is available on the electronic medicines compendium (emc) website. You may also find our resource on ‘How to find out if a medicine contains harām ingredients or excipients’ useful. If you are still unsure if your medicine contains estradiol or conjugated oestrogen, speak to your local healthcare professional such as your local pharmacist.
It is important to remember that even if a medicine contains a harām ingredient or excipient, it does not always mean it is prohibited to take. If you find out a medicine contains harām ingredients or excipients from harām sources, then see our guide on ‘What to do if a medicine contains harām ingredients or excipients’. The guide includes the conditions of when it is acceptable to take a medicine that contains harām ingredients or excipients from harām sources. It may also help you make informed decisions on the next steps in discussions with your healthcare professional. If you are still not sure if it is permissible to take your medicine, then speak to your local Imam or trusted Islamic scholar (ideally who has relevant knowledge and expertise in the Fiqh of medicines).
Summary
- Synthetic-derived estradiol (oestrogen) is halāl and widely accepted in all Sunni schools as a halāl alternative
- Conjugated oestrogen (e.g. Premarin) is animal-derived and considered harām, legally impure (najis) and repulsive by the majority of Islamic scholars due to its origin from urine
- If you are on HRT, you can check if the medicine you are taking contains synthetically derived estradiol (oestrogen) or conjugated oestrogen using the PIL or SPC. If you are unsure, then speak to your local pharmacist
- If you are unsure if your medicine is permissible to take, then speak to your local Imam or trusted Islamic scholar (ideally who has relevant knowledge and expertise in the Fiqh of medicines)
- If you are seeking halāl products, look for look for halāl-certified, plant-based, or synthetically derived oestrogen (e.g. estradiol) over an animal derived conjugated oestrogen (e.g. Premarin) (where available and possible).
References and further reading
- NHS (2023). About oestrogen tablets, patches, gel and spray. [online] nhs.uk. Available at: https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/oestrogen-tablets-patches-gel-and-spray/about-oestrogen-tablets-patches-gel-and-spray/ ↩︎
- Lippert TH, Mueck AO, Seeger H. Is the use of conjugated equine oestrogens in hormone replacement therapy still appropriate? Br J Clin Pharmacol. 2000 May;49(5):489-90. Accessed 1.3.2025 from: https://pmc.ncbi.nlm.nih.gov/articles/PMC2014957/ ↩︎
- British National Formulary (n.d.). BNF is only available in the UK. [online] NICE. Available at: https://bnf.nice.org.uk/drugs/conjugated-oestrogens-equine/. ↩︎
- Islamic Perspective on Animal-Derived Estradiol (Premarin) and Synthetic Estradiol by Shaykh Dr Rafaqat Rashid ↩︎