EstroGel®

At menopause and during the time leading up to it (peri-menopause), your ovaries start to make less oestrogen. A decrease in oestrogen levels can cause symptoms such as hot flushes, vaginal dryness, mood and sleep changes. Using hormone therapy to replace oestrogen can help to relieve some of the symptoms of menopause and can make a big difference to the enjoyment of life for some people. Read more about the types and stages of menopause and the signs of menopause.

If you still have your uterus, your menopausal hormone therapy will include both oestrogen and progesterone, so EstroGel will be used together with a progestogen. This is because oestrogen alone can overstimulate the cells lining your uterus, causing an increased risk of cancer of the uterus lining. Taking progesterone alongside oestrogen helps to prevent this.

When do I start using EstroGel?

• If you are already using another type of oestrogen therapy, where you have a period, finish your usual oestrogen pack before you start using EstroGel.
• If you have never used any other MHT medicines or you are switching to EstroGel from a period-free MHT product, you can start using EstroGel on any day.

Estrogel is different to oestrogen vaginal cream (Ovestin cream)

• 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.

Oestrogen gender affirming hormone therapy (E-GAHT) is used by some transgender and non-binary people to help align their body with their gender. E-GAHT has 2 types of medicines – a form of oestrogen and a medicine to block testosterone. Both are needed unless you've had surgical removal of your testicles (in which case a testosterone blocker isn't usually needed).

• E-GAHT can be used by trans women or non-binary people for gender feminising effects such as breast development, softer skin and reduced oiliness, decreased muscle mass and strength, less body hair, etc
• The oestrogen gel is applied to your skin and absorbed. It may work as well as tablets but have fewer side effects. Read more about E-GAHT.

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

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

Oestrogen gel, patches or tablets are not suitable for everyone. To make sure they're safe for you, tell your healthcare provider if you: 

• are pregnant or breastfeeding
• have ever had breast cancer, are having tests for breast cancer, or are considered high risk due to family history
• have ever had any other type of cancer
• have ever had a blood clot in a vein (thrombosis), such as in your legs (deep vein thrombosis) or lungs (pulmonary embolism)
• have ever had angina or a heart attack
• have vaginal bleeding with no known cause
• have thrombophilia, a condition that increases the risk of blood clots
• have liver problems
• have migraines or severe headaches.

Common side effects

Some people may have headaches, breast tenderness or pain, feel sick (nausea), experience mood changes and weight changes. If these things happen to you, contact your doctor for advice.

Serious side effects

Serious side effects from oestrogen gel are rare.

Get immediate medical advice if you get these symptoms:

• Pain, redness or swelling in one of your legs, usually in your calf. This could be a sign of deep vein thrombosis (DVT).
• Tummy pain, your skin and eyes turning a yellow colour, itchy skin, dark coloured pee, pale coloured poo. These could be signs of problems with your liver.
• A sudden rash or signs of anaphylaxis, such as swelling of your face or lips. 

Speak to your GP if you get the following symptoms:

• 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.