Description
How it works
Estradiol is a form of oestrogen, the main female sex hormone. Around the menopause, natural oestrogen levels fall, which can lead to symptoms such as:
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Hot flushes and night sweats
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Sleep disturbance and mood changes
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Vaginal dryness or discomfort
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Joint or muscle aches
Oestrogel delivers estradiol through the skin into the bloodstream, bypassing the digestive system. This:
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Replaces the missing oestrogen, helping to restore more stable hormone levels
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Relieves vasomotor symptoms (e.g. hot flushes, sweats)
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Helps protect bone density and can help prevent osteoporosis in postmenopausal women at high risk of fractures who cannot take, or should not take, other osteoporosis medicines
Transdermal (through-the-skin) delivery avoids “first-pass” metabolism in the liver and tends to produce more stable estradiol levels than many oral preparations.
Who it may be suitable for
Oestrogel may be suitable for:
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Postmenopausal women with moderate to severe oestrogen deficiency symptoms affecting quality of life
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Postmenopausal women at high risk of future fractures who are intolerant of, or contraindicated for, other medicines used to prevent osteoporosis
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Women with or without a uterus (womb), but the regimen is different:
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Without a uterus: oestrogen-only gel is usually sufficient
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With a uterus: a progestogen should be added for at least 12–14 days each month to protect the womb lining
Treatment should only be started for symptoms that significantly affect daily life, and should be reviewed at least once a year to confirm that benefits continue to outweigh the risks.
Who should not use Oestrogel
Do not use Oestrogel if you:
- Have current, past, or suspected breast cancer
- Have a known or suspected oestrogen-dependent tumour (e.g. womb cancer)
- Have unexplained vaginal bleeding
- Have untreated endometrial hyperplasia (thickened womb lining)
- Have ever had a venous blood clot (DVT or pulmonary embolism)
- Have a known thrombophilic disorder (e.g. protein C, protein S, antithrombin deficiency)
- Have active or recent arterial disease such as angina or heart attack
- Have acute liver disease, or a history of liver disease with abnormal liver tests
- Have porphyria
- Are pregnant or breastfeeding
Oestrogel is for postmenopausal women only and is not used in pregnancy or lactation.
Use with extra care (medical supervision)
Closer monitoring is usually needed if you have, or have had:
- Fibroids (leiomyoma) or endometriosis
- Strong family history of breast cancer
- Risk factors for blood clots (obesity, prolonged immobility, major surgery, SLE, cancer)
- High blood pressure
- Liver problems (including liver adenoma)
- Diabetes, with or without vascular disease
- Gallstones
- Migraine or severe headaches
- Systemic lupus erythematosus (SLE)
- A history of endometrial hyperplasia
- Epilepsy, asthma, otosclerosis
- Markedly raised triglycerides
Treatment should be stopped and reviewed immediately if you develop jaundice, a significant blood pressure rise, a new migraine-type headache, or become pregnant.
Side Effects
Side effects are generally mild and often occur in the first months of treatment.
Commonly reported side effects include:
- Mood and nervous system
- Depression, mood swings
- Headache, migraine, dizziness or vertigo
- Digestive system
- Nausea, abdominal pain
- Bloating or flatulence, occasionally vomiting
- Skin and hair
- Itching (pruritus)
- Skin discolouration or acne
- Rash
- Reproductive system and breasts
- Breast tenderness, swelling, enlargement
- Painful or heavy periods (dysmenorrhoea, menorrhagia) in perimenopausal women
- Breakthrough bleeding or spotting
- Vaginal discharge, vaginitis or vaginal thrush
- Endometrial hyperplasia (thickening of the womb lining) if oestrogen is not balanced with a progestogen in women with a uterus
- General and metabolic
- Weight changes (gain or loss)
- Water retention, swollen ankles/legs (peripheral oedema)
- Fatigue or asthenia
- Glucose intolerance (may affect blood sugar control)
- Liver and blood vessels
- Abnormal liver function tests, cholestasis or jaundice
- High blood pressure
- Venous thromboembolic disease (blood clots in legs or lungs) – see below for risk discussion
Hormone-related long-term risks (mainly with systemic HRT) include:
- Breast cancer – risk increases with duration of HRT use; risk is generally lower with oestrogen-only than with combined oestrogen–progestogen therapy.
- Endometrial cancer – increased if oestrogen-only is used in women with a uterus without adequate progestogen protection.
- Ovarian cancer – a slightly increased risk with HRT.
- Venous blood clots (VTE) – 1.3–3 times higher relative risk compared with non-users, especially in the first year of treatment.
- A small increase in risk of ischaemic stroke with HRT use.
Stop treatment and seek urgent medical help if you notice:
- Painful swelling, warmth or redness in one leg
- Sudden chest pain, shortness of breath or coughing blood
- Sudden severe headache, especially with visual changes
- Yellowing of the skin or eyes (jaundice)
- A new breast lump
- Unexpected vaginal bleeding after being period-free for some time
Any persistent, troublesome or unusual symptoms should be reviewed by a healthcare professional.
Patient Information Leaflet
Please see HERE for the Patient Information Leaflet
Additional Info
Key facts about Oestrogel:
- Active ingredient: Estradiol, delivering 0.75 mg per pump (1.25 g gel)
- Form: Clear, colourless transdermal gel with an alcohol smell, supplied in a pump pack
- Indications:
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- Relief of oestrogen deficiency symptoms in postmenopausal women
- Prevention of osteoporosis in postmenopausal women at high fracture risk who cannot use other preventive medicines
- Use in women with a uterus: A progestogen is required for at least 12–14 days per cycle to protect the womb lining.
- Use in women without a uterus: Oestrogen-only Oestrogel is usually appropriate, unless residual endometriosis is present.
- Systemic exposure: As a transdermal product, it avoids first-pass liver metabolism and provides stable estradiol levels; systemic absorption is sufficient for HRT effect.
- Children: There is no relevant use in children; accidental transfer to children can cause breast development or other sexual changes – application sites must be kept covered and away from skin contact.
- Storage: No special storage conditions; keep in the original container, out of sight and reach of children. The product is flammable until dry.
Directions
Oestrogel is for external skin use only – it must not be swallowed.
Usual dose
For menopausal symptoms and prevention of osteoporosis:
- Each pump gives 1.25 g gel = 0.75 mg estradiol
- Usual starting dose:
- 2 pumps once daily (2.5 g gel, 1.5 mg estradiol)
- If symptoms are not adequately controlled after 1 month, the dose may be increased up to a maximum of 4 pumps once daily (5 g gel, 3 mg estradiol)
- Always use the lowest effective dose for the shortest duration needed
With a uterus: add a progestogen for at least 12–14 days every 28-day cycle to reduce the risk of endometrial hyperplasia and womb cancer.
Without a uterus: oestrogen-only Oestrogel can be used continuously, unless there is a history of endometriosis, in which case a progestogen may still be considered.
How and where to apply
- Prime the pump (first use only)
- When using a new pump pack for the first time, press the pump repeatedly until gel appears, then discard the first dose.
- Daily application
- Apply the gel once a day, at about the same time each day.
- Application sites
- Apply to clean, dry, intact skin on:
- The arms and shoulders, or
- The inner thighs
- Spread the gel in a thin, even layer over a large area (e.g. entire inside and outside of one arm from wrist to shoulder, or over the inner thigh).
- Apply to clean, dry, intact skin on:
- Important application rules
- Do not apply on or near the breasts or the vulval area.
- Do not apply to damaged or irritated skin.
- Allow the gel to dry for about 5 minutes before dressing.
- Avoid washing the application area, using other skin products, or close skin-to-skin contact (especially with a partner or child) for at least 1 hour after application, to reduce the risk of transfer.
- Wash hands with soap and water after applying the gel.
- Skin contact with others
- The gel can be transferred to others, especially children, by direct skin contact with the application area before it is fully absorbed.
- If a child’s skin touches the area, their skin should be washed with soap and water as soon as possible.
- If a child shows signs of breast development or other sexual changes, medical advice is needed.
Remember: the gel is flammable until dry; keep away from flame or high heat immediately after application.
Missed a dose?
If you forget a dose:
- If more than 12 hours remain until your next usual dose:
- Apply the missed dose as soon as you remember, then continue as normal.
- If less than 12 hours remain until your next dose:
- Skip the missed dose and apply the next dose at your usual time.
Do not apply two doses at the same time to make up for a missed application. Missing doses may increase the chance of breakthrough bleeding or spotting.
FAQs
What is Oestrogel used for?
Oestrogel is a hormone replacement therapy used to relieve postmenopausal symptoms like hot flushes and vaginal dryness and to help prevent osteoporosis in high-risk patients who cannot use other treatments.
How long does it take to work?
Most women notice relief from hot flushes and night sweats within a few weeks or the first month of treatment, while bone protection is assessed over a longer period and benefits should be reviewed annually.
Do I need to take a progestogen with Oestrogel?
If you still have your uterus you generally need to take a progestogen for at least 12 to 14 days per cycle to protect the womb lining, whereas those without a uterus typically use Oestrogel alone unless they have residual endometriosis.
Where on my body should I apply the gel? Can I use it on my breasts?
You should apply a thin layer of Oestrogel to clean dry skin on the arms, shoulders, or inner thighs, but you must never apply it to the breasts, vulval region, or any irritated skin.
Can I shower or swim after applying Oestrogel?
You should let the gel dry for five minutes and avoid washing the area or applying other skin products for at least one hour to ensure proper absorption before showering or swimming as normal.
What if my partner or child touches the application site?
If someone touches the application site you must wash their skin with soap and water immediately and you should cover the area with clothing once dry to prevent accidental transfer, especially to children.
Is Oestrogel safer than tablet HRT?
While Oestrogel avoids first-pass liver metabolism and may be advantageous for some, it still carries standard systemic HRT risks like blood clots and breast cancer, so the best treatment route should be discussed with a clinician.
How long can I stay on Oestrogel?
You should use the lowest effective dose for the shortest necessary time with an annual review by a medical professional to ensure the benefits of continuing treatment still outweigh the risks for you.
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