Estrogel® for menopausal hormone therapy

• EstroGel has the oestrogen hormone estradiol: The hormone is absorbed into your bloodstream and can work in hormone receptors in different parts of the body including the uterus (womb), bladder, heart, bones, skin, muscles and brain. It's applied to the skin on the arms, shoulders or mid-inner thighs. It should NOT be applied to the vulval region or breasts.
• Ovestin vaginal cream has the oestrogen hormone estriol: It's designed to work mainly in the vagina, bladder and pelvic floor. It helps improve vaginal dryness as well as urinary symptoms and pelvic floor problems. The oestrogen levels in your blood aren't raised significantly, which minimises the effect of oestrogen in other areas such as the breast or uterus. It does not need to be used with any progestogen even in women who still have a uterus. It can be used alone or with MHT. Read more about Ovestin vaginal cream.

Estrogel comes in a container with a metered dose pump

• A metered dose pump means that each pump gives the same amount of gel and the same dose.
• One pump gives 1.25 g of gel containing 0.75 mg of oestradiol.
• In Aotearoa New Zealand, Estrogel is available in the 0.06% strength.

Dose

• The usual dose is 1 or 2 pumps, as recommended by your doctor. Apply the gel once daily in the morning or evening, at about the same time each day.
• Your doctor may adjust your dose depending on your response to treatment, up to a maximum of 4 pumps in 24 hours.
• Read more below about how to apply Estrogel.

If you miss a dose

• If you forget to apply a dose and it is more than 12 hours until your next dose, apply it as soon as you remember.
• If it's less than 12 hours until your next dose, then skip the missed dose and apply the next dose at the usual time. Don't apply a double dose to make up for a forgotten dose.
• If you forget a dose you may have breakthrough bleeding or spotting.

Wash your hands with soap and water before and after applying Estrogel® .

Your doctor will tell you how many pumps of the gel you need to get the correct dose for you.

Using the pump for the first time

• When using the Estrogel pump for the first time, you'll need to prepare it for use.
• Remove the cap and press the plunger down a few times, until the gel comes out. 
• Don't use the first dose of the gel from the pump. Collecting this on a tissue and throw away the used tissues carefully to avoid transfer to other adults, children or pets.
• Your pump is now ready to use.
• Note: You will only need to do this the first time you open a new pump.

Apply Estrogel to the skin on your shoulders, arms or inner thighs

• Apply Estrogel as a thin layer to a large area of your skin on your arms, from shoulder to wrist, or mid-inner thighs.
• Apply the gel to clean, dry skin. Try to use the gel at about the same time each day.
• If your dose is 2 or more pumps of gel, then apply the other doses to another suitable area. 
• It's not necessary to massage in the gel.
• Allow the gel to dry completely for 5 minutes before dressing.
• Don't apply the gel to your breast or genitals, or to inflamed, broken or irritated skin.
• Bathing or swimming: Wait at least 1 hour after gel application before you have a bath, shower or swim.
• Don't apply over sunscreen or body lotion.  You can apply body lotion and sunscreen over Estrogel after waiting at least one hour after application.
  
  

Image credit: Healthify He Puna Waiora

Avoid oestrogen transfer to other people

Oestrogen may be transferred to others through skin-to-skin contact where you applied the gel. To avoid transfer to others, it's important to:

• wash your hands straight after applying the gel
• put on clothing over the area once the gel has dried on your skin
• wear gloves if you're helping to apply oestrogen gel to another person.

It's okay to have skin-to-skin contact with others where there is no Estrogel.

Video: Estrogel – how to apply

The following video has instructions on how to apply Estrogel.

MHT is safe to use for most people if started in their 50s or for the first 10 years after the onset of menopause.

If you had an early menopause (before 45 years) you should continue treatment at least until the average age of menopause (51 years).

When assessing the risks of MHT, remember that they're not the same for everyone. Your healthcare provider will be able to discuss your individual risk with you.

• Risks vary based on how old you are, when you start MHT and how long you take it for.
• Short-term use in early menopause has fewer risks than when it's started later in menopause.
• Risks generally increase as you get older.

MHT and cancer risk

Women are often concerned about the risk of cancer when using MHT. If you're concerned, talk to your healthcare provider about your situation.

Here is some guidance.

• Breast cancer: Fear of breast cancer is a major reason why women don't use MHT. Postmenopausal women are more likely to die from heart disease or stroke than breast cancer. Overall 1 in 8 women will develop breast cancer during their lifetime. Studies suggest there's either no, or minimal risk of breast cancer when using oestrogen-only MHT. There is a greater risk of breast cancer from two alcoholic drinks daily or being significantly overweight. Breast cancer risk is lower with oestrogen-only MHT compared with oestrogen plus progestogen. The risk increases the longer you take MHT and decreases after stopping it. Some types of progestogens such as Utrogestan have lower risk. Read more about breast cancer risk(external link).
• Endometrial cancer: Oestrogen-only MHT increases the risk if you have a uterus, because oestrogen stimulates the endometrial lining. That’s why progestogen is added to protect your uterus. Combined MHT (oestrogen + progestogen) protects against endometrial cancer, when used continuously.
• Ovarian cancer: There is a very low risk that MHT increases the risk of ovarian cancer. The absolute risk of ovarian cancer associated with MHT use is low, with about 1 additional case per 1,000 women using MHT for 5 years.

MHT after treatment for cancer

Women often have concerns about starting MHT after having cancer treatment. Your suitability to start MHT depends on the type of tumour you have.

• Cervical, vaginal and vulval cancers: Using MHT is generally suitable if you’ve had these cancers, as they're not considered hormone responsive cancers. This means these types of cancers don't rely on hormones (such as oestrogen or progesterone) to grow or spread.
• Endometrial cancer: MHT is reasonable for those who have had surgery (removal of uterus and both ovaries) for low-risk endometrial cancer to use oestrogen replacement, with either the patch, gel or tablets. Progesterone is rarely required – your gynaecologist will advise you. Note: You will not need progestogen because your uterus has been removed.
• Ovarian cancer: MHT treatment depends on whether you have had surgery to remove your uterus. In some types of ovarian cancers, MHT can be considered after weighing up the risk and benefits. It's important you discuss this with your gynaecology oncologist before starting MHT
• Breast cancer: For women who have had hormone receptor-positive breast cancer, MHT is not usually recommended. Non-hormonal treatments are preferred.

Every person is different and the length of time you'll have menopausal symptoms is unknown.

• If you had an early menopause (before 45 years) you should continue treatment at least until the average age of menopause (51 years).
• It’s important to have regular check-ups with your doctor to assess whether ongoing oestrogen is right for you.
• Most people stop taking it after a few years, when their symptoms resolve. It's usually best to reduce menopausal hormone therapy gradually rather than stopping it suddenly. This may reduce the risk of menopause symptoms returning.
• Current research suggests that oestrogen can be taken long term and there is no recommended ‘stop’ time, however after five years of MHT or after your mid 50’s, the pros and cons of MHT should be discussed with your healthcare provider.

Like all medicines, oestrogen gel can cause side effects, although not everyone gets them. If you're concerned about any symptoms you think might be related to your medicine, talk to your healthcare provider. The following information offers some guidance but doesn't include all possible side effects.

Common side effects

Tell your healthcare provider if they bother you.

• Headaches.
• Breast tenderness or pain.
• Feeling sick (nausea).
• Mood changes.
• Weight changes.

Tell your healthcare provider immediately or phone Healthline free on 0800 611 116 if these occur

• Signs of deep vein thrombosis (DVT) such as pain, redness or swelling in one of your legs, usually in your calf.
• Signs of problems with your liver such as tummy pain, your skin and eyes turning a yellow colour, itchy skin, dark coloured pee, pale coloured poo.
• A lump or changes in your breasts, especially dimpling of the skin, changes in the nipple or any lumps you can see or feel.
• Any changes in vaginal bleeding after you have been taking oestrogen for more than a few months.

Phone 111 for an ambulance or go to your nearest accident and emergency (A&E) clinic if these occur

• Signs of an allergic reaction such as itchy skin, and rash, swollen lips or tongue, problems breathing, like a tight chest or shortness of breath.

Read more about medicines and side effects and reporting a reaction you think might be a side effect.