Oestrogel Pump

What is Oestrogel?

Oestrogel is a topical HRT gel containing estradiol, a form of oestrogen identical to that produced naturally by the body. It is prescribed as part of hormone replacement therapy (HRT) to help manage the symptoms of menopause.

The gel comes in a pump dispenser that releases a fixed amount of gel with each press, so every dose is consistent and measured.

What is Oestrogel Used For?

Oestrogel is prescribed as HRT for women experiencing symptoms of the menopause. Oestrogen levels fall during and after the menopause, which can cause a range of unpleasant symptoms. Oestrogel helps to relieve these by restoring oestrogen to more comfortable levels.

Symptoms it may help with include:

• Hot flushes and night sweats
• Mood changes, irritability, or low mood
• Vaginal dryness or discomfort
• Sleep disturbance
• Brain fog or difficulty concentrating

Oestrogel may also be prescribed to help prevent osteoporosis in postmenopausal women who are at increased risk of fractures when other osteoporosis medications are unsuitable or not tolerated.

How Does Oestrogel Work?

Oestrogel contains estradiol, which is absorbed through the skin and passes directly into the bloodstream. When oestrogen HRT is taken as a tablet, it passes through the digestive system and liver before entering the bloodstream, which can make oral oestrogen more susceptible to enzyme inducers. By bypassing this process, the Oestrogel pump may reduce the risk of certain side effects.

Once absorbed, estradiol binds to oestrogen receptors throughout the body, helping to restore hormonal balance. This is what helps to relieve common menopausal symptoms such as hot flushes, night sweats, and mood changes.

How Long Does Oestrogel Take to Work?

Most women begin to notice an improvement in symptoms within a few weeks of starting Oestrogel, though this varies by individual and by the symptoms being treated. According to the NHS, hot flushes and night sweats often improve within a few weeks, while other symptoms such as mood changes and vaginal dryness can take a few months.

Your doctor will usually review your treatment at one month and again at three months to check how well it is working. If symptoms have not improved after the first month, your dose may be adjusted.

How Effective is the Oestrogel Pump?

Oestrogel is considered an effective treatment for menopausal symptoms. Clinical trial evidence supports the efficacy of estradiol gel at the doses used in Oestrogel. A randomised, placebo-controlled trial published in Menopause assessed estradiol gel at 1.25g and 2.5g daily in 221 postmenopausal women over 12 weeks, finding a significant reduction in the frequency and severity of hot flushes compared with placebo. A second randomised controlled trial published in Obstetrics & Gynecology found that by weeks 3 to 5, estradiol gel reduced moderate-to-severe hot flushes by at least 7 per day compared with baseline and significantly reduced their severity and frequency compared with placebo. The medication was also found to be well-tolerated, with no unexpected side effects.

Meanwhile, the NHS states that the main benefit of HRT is that it is effective at relieving most perimenopause and menopause symptoms, including hot flushes, night sweats, and mood changes. The British Menopause Society similarly identifies HRT as the most effective intervention for managing menopausal symptoms, and supports estradiol applied through the skin as a first-choice route of administration for many women.

How to Use Oestrogel Pump

If you are new to HRT or switching from a period-free HRT treatment, you can begin using Oestrogel at your convenience. However, if you are already taking a different HRT that includes a menstrual cycle, it’s important to complete your current medicine pack before switching to Oestrogel.

How to Prime Oestrogel Pump

Before using the Oestrogel pump for the first time, it’s crucial to prime your pump. Priming ensures that the medicated gel is dispensed correctly and in the right amount.

How to Prime Oestrogel Pump

Before using the Oestrogel pump for the first time, it’s crucial to prime your pump. Priming ensures that the medicated gel is dispensed correctly and in the right amount.

To prime the pump:

1. Remove the cap from the canister
2. Remove the stopper from the spout
3. Depress the plunger a couple of times until the gel is expelled
4. Do not use this initial dose. Discard it safely using a tissue.

Oestrogel Gel: How to Apply

Once your pump is primed, it is ready to use. You should try to apply Oestrogel at the same time every day by following these instructions:

1. Remove the cap to reveal the plunger.
2. While holding the canister in one hand and readying your other hand to catch the gel, depress the plunger to expel one measure of the gel. If your doctor has prescribed more, use the amount of gel prescribed by your doctor.
3. Apply your prescribed dose of the gel once daily to clean, dry, unbroken skin on your outer arms and shoulders, or the inner thigh of both legs. Do not apply Oestrogel to the genital area or breasts.
4. Spread the gel over the area. For a 2 pump measure, apply 1 pump to each outer arm and shoulder, or each inner thigh.
5. Cover the spout with the included stopper and replace the cap.
6. Wait 5 minutes for the area to dry before covering it with clothes.
7. Always wash your hands with soap and water after using Oestrogel.

Guidelines for Using Oestrogel HRT

The following guidelines should also be followed when using Oestrogel HRT:

• You must apply the gel yourself. Do not let anyone else apply the gel on your behalf.
• Avoid skin-to-skin contact with others, particularly men and children, for at least 1 hour after application
• Do not wash or apply skincare products to the application area for 1 hour after use.
• Do not apply to damaged skin
• If the prescribed amount does not relieve your symptoms, speak to your doctor.
• Do not use more or less gel than prescribed without consulting your doctor first.
• Oestrogel contains ethanol and is flammable, so avoid heat or naked flames until the gel has dried on the skin.

How Many Pumps are in Oestrogel?

Each Oestrogel pump pack contains enough gel to last four weeks at the usual starting dose of two pumps per day. If your doctor has increased your dose to four pumps per day, the pack will last two weeks.

What If You’ve Used Too Much Oestrogel

Oestrogel is dispensed in a metered dose. You should use only the prescribed number of pumps of Oestrogel. Using more Oestrogel than you should will not make your symptoms go away faster, but it can cause signs of an overdose, including breast tenderness, nausea and vaginal bleeding.

If you find that the prescribed amount of Oestrogel is not relieving your symptoms, speak to your doctor. Do not adjust your dosage unless your doctor has given you explicit permission to do so.

What Happens if I Miss My Oestrogel Dose?

If you forget to apply your Oestrogel, check how long it is until your next dose. If it is more than 12 hours away, apply the missed dose as soon as you remember and continue as normal the next day. If your next dose is less than 12 hours away, skip the missed dose and carry on with your usual routine.

Do not apply two doses at the same time to make up for a missed one. Occasionally, missing a dose may increase the chance of irregular or breakthrough bleeding.

Oestrogel Side Effects and Cautions

Like all medicines, Oestrogel should be used with caution. The sections below outline the known side effects of Oestrogel and the circumstances in which it may not be suitable for you. Always read the Patient Information Leaflet supplied with your medication and speak to your doctor or pharmacist if you have any concerns.

Oestrogel Pump Side Effects

The side effects below are listed by how commonly they occur. Most side effects are mild and tend to improve within the first few months of treatment, but not everyone will experience them.

The information above does not include all potential Oestrogel side effects. More details can be found within the Patient Information Leaflet that accompanies the medication.

Allergic Reaction

Do not use Oestrogel if you are allergic to estradiol or any of the other ingredients. If you have had an allergic reaction to a similar medicine in the past, let your doctor know before starting treatment.

Stop using Oestrogel and seek immediate medical attention if you notice any of the following signs of an allergic reaction:

• Skin rash or itching
• Swelling of the face, lips, tongue, or throat
• Difficulty swallowing or breathing
• Feeling faint

These symptoms may indicate a serious allergic reaction and require urgent medical attention.

Conditions Reported More Often in Women Using HRT

Studies have shown that certain conditions occur more frequently in women using HRT compared to those who are not. Your doctor will have weighed these risks against the benefits before prescribing Oestrogel. The conditions below are worth being aware of:

• Endometrial cancer: Using oestrogen-only HRT without a progestogen increases the risk of cancer of the womb lining in women who still have their womb.
• Breast cancer: HRT use is associated with a small increased risk of breast cancer. The additional risk depends on how long HRT is used and reduces after stopping, though it may persist for 10 or more years if HRT was used for over 5 years.
• Ovarian cancer: HRT has been associated with a slightly increased risk of ovarian cancer, though ovarian cancer itself is rare.
• Blood clots (thrombosis): The risk of blood clots in the veins is higher in HRT users, particularly in the first year of use. Seek urgent medical attention if you notice painful swelling or redness in a leg, sudden chest pain, or difficulty breathing.
• Stroke: The risk of stroke is around 1.5 times higher in HRT users than non-users, with the level of risk increasing with age.
• Heart disease: Women over 60 using combined oestrogen-progestogen HRT may have a slightly higher risk of heart disease. There is no increased risk for women using oestrogen-only HRT following a hysterectomy.

If You Need Surgery While Using Oestrogel Pump

If you are due to have surgery, tell your doctor or surgeon that you are using Oestrogel. You may need to stop using it around 4 to 6 weeks before the operation to reduce the risk of blood clots. Ask your doctor when you can start using Oestrogel again once you have recovered.

Oestrogel Pump Pack Warnings and Interactions

Although Oestrogel is a popular HRT, it is not suitable for everyone. It’s therefore essential to consult a clinician before starting treatment to ensure it’s safe for you to use.

Do not use Oestrogel Pump if you have:

• A blood-clotting disorder (such as protein C, protein S or antithrombin deficiency)
• A rare inherited blood disorder called porphyria
• Any unexplained vaginal bleeding
• Or are suspected of having cancer which is sensitive to oestrogens, such as endometrial cancer
• Excessive thickening of the womb lining (endometrial hyperplasia), which is untreated
• Or have ever had a blood clot, including in the vein (thrombosis), legs (deep vein thrombosis/DVT) or lungs (pulmonary embolism)
• Or have ever had a liver disease, and your liver function tests have not returned to normal
• Or recently had a disease caused by a blood clot in the arteries, such as a heart attack, stroke or angina
• Had or are suspected to have breast cancer

Oestrogel Precautions

Even if none of the above contraindications applies to you, there are some conditions that may require closer monitoring during treatment. Tell your doctor before starting Oestrogel if you have, or have ever had, any of the following:

• Endometriosis or fibroids: These conditions can worsen with Oestrogel use and may require more frequent check-ups.
• Migraines or severe headaches: These may return or become more frequent during treatment.
• Diabetes: Oestrogel can affect blood sugar control, and your doctor may need to monitor you more closely.
• Epilepsy: HRT may affect seizure frequency in some women.
• High blood pressure: Your blood pressure should be monitored regularly during treatment.
• Gallstones: HRT may increase the risk of gallstone-related problems.
• Systemic Lupus Erythematosus (SLE): An autoimmune disease that affects many organs in the body.
• A history of excessive thickening of the womb lining
• Hereditary or acquired angioedema
• A liver disorder
• An increased risk of blood clots
• An increased risk of oestrogen-sensitive cancer

This list does not cover all precautions. Before starting treatment, read the full Patient Information Leaflet supplied with your medication and discuss your full medical history with your doctor.

Oestrogel and Other Medications

Some medicines can interfere with the effects of Oestrogel. It is essential to inform your doctor of all the medicines you are currently taking, including those purchased over the counter, such as health and herbal supplements.

Inform our clinicians if you will be using any of the following medicines while using Oestrogel:

• Epilepsy medicines (phenytoin, phenobarbital or carbamazepine)
• HIV medicines (nevirapine, efavirenz, ritonavir or nelfinavir)
• Tuberculosis medicines (rifampicin, rifabutin)
• Certain Hepatitis C combination medicines (including ombitasvir, paritaprevir, glecaprevir, sofosbuvir, velpatasvir or voxilaprevir)
• Herbal products containing St John’s Wort (Hypericum perforatum)
• Skin cleansers containing benzalkonium chloride or sodium lauryl sulphate
• Other skin products containing alcohol, including astringents or sunscreens
• Products used to treat warts, acne, dandruff or other skin and scalp conditions
• Other medicines that affect skin composition (e.g. anti-cancer products)

Oestrogel may also affect how some medicines work. In particular, if you take lamotrigine for epilepsy, using Oestrogel alongside it may increase the frequency of seizures. Tell your doctor if you are taking lamotrigine before starting treatment.

Pregnancy and Breastfeeding

Oestrogel is intended for use in postmenopausal women only and should not be used during pregnancy or while breastfeeding. If you become pregnant while using Oestrogel, stop using it immediately and contact your doctor.

Note that Oestrogel is not a contraceptive. If it has been less than 12 months since your last period, or you are under 50, you may still need to use contraception. Speak to your doctor for advice.

Frequently Asked Questions About Oestrogel Pump