What is oestrogen gel?
Oestrogen gels are absorbed directly through the skin (transdermal). One example brand is Oestrogel pump pack. They contain 17 beta-Oestradiol, the main type of natural oestrogen in the body (making them body identical). Oestrogen gels can be used as part of Hormone Replacement Therapy (HRT) to improve menopausal symptoms. Additionally, they have many health benefits including reducing risk of heart disease, osteoporosis, diabetes, and cognitive decline.
What if I have a womb?
If you have a womb (uterus), you will need to take progestogens (usually in the form of an oral or vaginal tablet, or a hormonal coil), in addition to oestrogen. This is because oestrogen helps manage symptoms, and progestogens helps protect your womb lining. If you take oestrogen alone, this can cause the womb lining to thicken, and can increase the risk of womb cancer. By taking a progestogen, this will keep the womb lining thin.
How do I use oestrogen gel pumps?
These are a pump action gel preparation that deliver 64 pumps per bottle. Most women start with one or two pumps per day (and may need up to 4 pumps, the maximum standard dose). It can be common for younger women to need higher doses.
§ Application should be on intact skin on the outer arm or inner thigh, avoiding breast and genital areas. If applying more than one pump, do not overlap each application site. When using more than two pumps, you may wish to divide the doses between morning and night to avoid messiness.
§ The gel should be rubbed in, and hands washed immediately with soap and water. Allow around 5 minutes to dry before wearing clothes, and around 30 minutes before applying creams (moisturisers or sun creams), bathing, or exercising.
§ Most women find that oestrogen gels are not greasy, do not stain clothes, and have no odour.
What are the advantages of using oestrogen gels?
The benefits of oestrogen gels come from being transdermal (absorbed through the skin) and being body-identical, which make them favourable to oral synthetic oestrogen tablets:
§ There is no increased risk of blood clots or stroke with transdermal preparations. This contrasts with oral oestrogens, which pass through the liver and activate the clotting factors, resulting in a small increased risk of blood clots and strokes. Transdermal oestrogen is a safe preparation used in women with migraines. As there is a small risk of stroke associated with migraines, oral HRT is not recommended in these women.
§ You may find that you need to increase/decrease your dose of oestrogen according to your needs- This is easy to do with transdermal patches, gels, or sprays.
§ Transdermal oestrogen does not affect your libido. Oral oestrogen can increase levels of sex hormone binding globulin which in turn reduces the amount of free testosterone in your blood stream. This can worsen symptoms of low testosterone such as low sexual desire (libido) and energy.
What are the side effects?
Common side effects of oestrogen treatments include breast tenderness, nausea, and bloating. Most side effects settle and improve within 3 months. Some women find star flower oil can improve breast tenderness. We suggest starting with 1000mg daily for 3 months (available from over-the-counter pharmacies).
Starting oestrogen HRT or increasing the dose can also cause changes to your bleeding pattern. This should settle within 3-6 months. If you get bleeding outside of this timeframe, it is important you seek advice from your doctor.
What if I forget my dose?
Forgetting a dose may increase the likelihood of breakthrough bleeding and spotting. You might find it helpful to set a daily reminder. If you forget to use the gel, use it as soon as you remember, and then use it as you normal the next day. If you only remember to take your gel near the time you would be due the next dose, just wait and apply the next dose. Do not use a double dose to make up for a forgotten dose.
For more support with your menopause symptoms, book an appointment with our accredited menopause specialist
