Estrogel is a skin gel containing oestrogen which is exactly the same as your own body makes (body-identical). It is released slowly straight into the blood stream (which is different to tablets which get metabolised by the liver before reaching your bloodstream). You can therefore use a lower dose and avoid some of the side effects of oestrogen tablets.
Estrogel can be used during perimenopause and after menopause to replace your body’s falling oestrogen levels. It is an excellent treatment for many of the symptoms of menopause caused by low oestrogen eg flushes, vaginal dryness, bladder problems, sleep problems, irritability and depression. Estrogel also helps to prevent osteoporosis, diabetes, depression, cardiac disease and may even prevent even dementia.
If you have a uterus, you will need to take some form of progesterone with your Estrogel to protect your uterine lining. This will be cyclically every month if you are perimenopausal, continuously if you are postmenopausal, or in the form of a Mirena IUD.
How to use Estrogel
Estrogel is a gel that you apply to clean, dry skin. Your doctor will prescribe the number of pumps to apply each day.
Using your new pump pack for the first time-
- Remove the cap from the pump pack.
- Press the plunger down a few times until the gel comes out.
- Do not use this first dose of gel from your Pump Pack. This dose should be discarded.
- Your Pump Pack is now ready to use.
Depress the pump fully into one hand then apply the gel, leaving it on the skin to dry (do not rub in).
This will take a few minutes.
Apply to the SAME AREA OF SKIN EVERY TIME as the oestrogen will build up under the skin like a reservoir.
- 1 pump – 1 upper arm (or whole outer arm if your arm is very small)
- 2 pumps – 1 to each upper arm (or both whole outer arms)
- 3 -4 pumps – both upper and lower outer arms (or
arms and inner thighs).
You can also apply Estrogel to the front/ inner thighs as an alternative to your arms.
Use Estrogel every day at about the same time. Make sure you let it dry and wash your hands after applying it. (Don’t apply it to your breasts or genitals).
Your doctor may ask you to use Estrogel differently depending on your symptoms eg use additional oestrogen (another patch or vaginally) each day or on some days.
It is common to have to adjust your dosage according to your response. It takes a few months to settle into your right dose and you may also need to change doses and treatments as you journey through menopause. Vaginal bleeding in particular is common in the first few months.
Risks of using Oestrogen
Thrombosis
Risk of blood clots is NOT increased when using Estrogel.
A thrombosis is the formation of a blood clot which may block a blood vessel.
A thrombosis sometimes occurs in the deep veins of the legs (deep venous thrombosis). If this blood clot breaks away from the veins where it is formed, it may reach and block the arteries of the lungs, causing a so-called “pulmonary embolism”. Deep venous thrombosis is a rare occurrence. It can develop whether or not you are taking oestrogen. The risk is higher in oestrogen-users than in non-users. The increased risk has been seen with tablet or oral oestrogen use (including the contraceptive pill) and not when used through the skin.
Breast cancer
Some females using HRT will be diagnosed with breast cancer slightly more often than those not using HRT. The studies showing this were using old style formulations in certain groups of females and the risk is very small. There is no increased risk of dying from breast cancer nor any increased risk of dying from any cause (all cause mortality).
It is not clear whether this is caused by the HRT. It may be that the women were examined more often because they were on HRT, or that early cancers grew more quickly.
Studies show that about one extra case of breast cancer in 1000 women is diagnosed when women use combined HRT – oestrogen AND progesterone (old style non-body-identical formulations of progesterone). Studies show that women using oestrogen alone (without progesterone) have lower rates of breast cancer diagnosis – also about one less diagnosis in 1000 women.
Please talk to your doctor about how these risks weigh up against the benefits for you personally.
Reasons not to start Estrogel
Allergies to Estrogel
Unexplained vaginal bleeding
Severe liver disease
You are pregnant or breast feeding
Speak with your doctor about any risks because you have…
Blood clots
Stroke
Heart attack
Cancer
Migraines
Side effects of Estrogel
Side effects are uncommon and you may not experience any. Most are not serious and will settle over a few months.
Headache, vivid dreams, breakthrough vaginal bleeding or spotting, any significant change in your period, acne, breast pain or tenderness, changes in mood libido or sleep, constipation, irritation from the gel.
Stop taking Estrogel and seek medical advice if…
- Migraines are getting worse
- The skin or eyes are becoming yellow
- Pain in your calves or chest, sudden shortness of breath indicating possible clots*
- Severe headache, vomiting, dizziness, changes in vision, speech, numbness, weakness of an arm or leg*
* go to emergency as these need immediate assessment.
