To Your Good Health: Low-risk estradiol treatment comes with FDA-boxed warning

I’m a 70-year-old woman who has suffered with vaginal dryness ever since I went through menopause. My doctor has prescribed estradiol 0.01% hormone cream to help with the symptoms. The side effects and warnings are worrisome, even though my doctor assures me that it’s safe to use. I value your opinion and would appreciate your thoughts.

The Food and Drug Administration requires boxed warnings, which are the highest level of concern, on systemic estrogen like pills. Until November 2025, the same warnings existed on topical treatments like creams and gels.

In my opinion, the risks of estrogen cream like the estradiol that you have been prescribed are low. I agree with removing the boxed warning since it can scare women from using these helpful, low-risk treatments for their symptoms of low estrogen, including vaginal dryness or painful sex.

As always, I do recommend that anyone who is prescribed estrogen and has a history of an estrogen-sensitive tumor — such as breast cancer — should discuss this treatment with their oncologist prior to starting it. For most healthy menopausal women, topical estradiol is an excellent and very safe choice.

I’ve read that millions of people have parasites and aren’t even aware of it. How do I cleanse myself safely? I’m hesitant to use animal medications like fenbendazole or ivermectin. I drink clove tea daily, but I don’t believe that it’s sufficient because it doesn’t cross the blood-brain barrier. What are your thoughts since this is one of your fields of study?

It is probably true that millions of people in the United States alone have undiagnosed parasitic infections. The most common of these are intestinal parasites, such as Blastocystis or Strongyloides.

While it may be unpleasant to think about intestinal parasites, we generally don’t recommend treatment in asymptomatic people, even if it’s been diagnosed.

Microorganisms are categorized into three groups: beneficial ones, like the healthy bacteria that are found in our intestines by the trillions; harmful, or pathogenic, ones that cause disease; and commensals, which neither help nor hurt us much.

For most people, protozoans like Blastocystis are commensals, so there is no need to treat them. There are very few instances of when an asymptomatic parasite needs to be treated, and it is quite rare among people who are born in the United States.

Clove tea is a traditional herbal medicine to treat some parasites, but it is not particularly effective; I don’t recommend it as a treatment.

The most common symptoms of intestinal parasites are diarrhea, abdominal pain, bloating, gas, anal itching and weight loss.

Parasites are not a common cause of these symptoms in the United States, but persistent symptoms deserve a thorough evaluation, not home remedies and certainly not powerful antiparasitic medicine — unless it’s been prescribed after a firm diagnosis.

Ivermectin is used in both animals and humans for parasitic infections. Although fenbendazole isn’t approved for humans, similar medicines like albendazole can be used for humans in cases where a parasite is in need of treatment. Infectious disease doctors are the experts in the treatment of parasitic infections.