Oestrogel

Oestrogel is a transdermal oestrogen gel containing estradiol, the principal oestrogen produced by the ovaries.

It is applied to the skin daily and delivers oestrogen through the dermis into the bloodstream, providing relief from menopausal vasomotor symptoms such as hot flushes, night sweats, and urogenital atrophy.

Transdermal estradiol bypasses first-pass hepatic metabolism, which means it has a more favourable effect on hepatic clotting factors compared with oral oestrogen preparations.

Epidemiological data suggest that transdermal oestrogen at standard doses does not significantly increase the risk of venous thromboembolism, making it a preferred option for women with elevated VTE risk factors.

Who Is Oestrogel For?

Oestrogel is suitable for postmenopausal women with an intact uterus (when combined with a progestogen) or women who have had a hysterectomy (oestrogen alone).

It is particularly useful for women who prefer a gel over tablets or patches, and for those with gastrointestinal conditions that affect oral absorption.

The gel is applied once daily to the skin of the arms, shoulders, or inner thighs and dries within a few minutes without leaving a residue.

How to Apply Oestrogel

Apply the gel once daily, preferably at the same time each day. Pump one to two doses (as prescribed) onto the inside of the arm, shoulder, or inner thigh.

Spread thinly over a large area and allow to dry for two to five minutes before dressing. Do not apply to the breasts or face.

After Application

Wash your hands after applying. Avoid bathing, showering, or swimming for at least one hour to ensure absorption. Avoid applying sunscreen, lotion, or other products to the same area.

Progestogen Protection

Women with an intact uterus must also take a progestogen (e.g., dydrogesterone, micronised progesterone, or a levonorgestrel IUS) to protect the endometrium from unopposed oestrogen stimulation.

Standard Dose

• 1 pump (1.25 g gel = 0.75 mg estradiol) applied daily
• May increase to 2 pumps (1.5 mg estradiol) if symptoms are not adequately controlled

Dose Adjustment

• Start at the lowest effective dose
• Titrate based on symptom response and tolerability
• Review at least annually

Progestogen Addition (Intact Uterus)

• At least 12-14 days per 28-day cycle (sequential) or continuously

Hepatic and Renal Impairment

• Contraindicated in active liver disease
• No dose adjustment for renal impairment

Elderly

• No dose adjustment; use the lowest effective dose

Common (up to 1 in 10 women)

• Breast tenderness
• Headache
• Application site reactions (redness, itching)
• Abdominal pain or bloating

Uncommon (up to 1 in 100 women)

• Nausea
• Mood changes
• Leg cramps
• Weight changes

Rare (up to 1 in 1,000 women)

• Venous thromboembolism (lower risk than oral oestrogen)
• Gallbladder disease

Very Rare (fewer than 1 in 10,000 women)

• Breast cancer (with long-term combined HRT use beyond 5 years)
• Stroke

Transdermal oestrogen is generally better tolerated than oral preparations, with fewer gastrointestinal side effects and a more favourable VTE risk profile.

Endometrial Protection

Women with a uterus must use a progestogen alongside Oestrogel to prevent endometrial hyperplasia. Oestrogen-only therapy in women with a uterus significantly increases the risk of endometrial cancer.

Transfer to Others

Avoid skin-to-skin contact with others on the application area until the gel has dried.

In particular, prevent prolonged contact with children, as inadvertent oestrogen transfer can cause early sexual development.

Thromboembolism

While transdermal oestrogen has a lower VTE risk than oral preparations, the risk is not zero. Report sudden leg swelling, chest pain, or breathlessness immediately.

Breast Screening

Continue attending routine mammography appointments. Report any breast lumps, skin changes, or nipple discharge promptly.

Annual Review

Reassess the need for HRT at least once a year.

Do not use Oestrogel if you have:

• Known or suspected breast cancer (current or past)
• Known or suspected oestrogen-dependent malignancy
• Undiagnosed abnormal vaginal bleeding
• Untreated endometrial hyperplasia
• Active or recent venous or arterial thromboembolism
• Active liver disease
• Porphyria
• Hypersensitivity to estradiol or any excipient in the gel