How to use Oestrogel and Sandrena

This article tells you how to use oestrogel and Sandrena hormone replacement therapy (HRT or MHT). At Rowena Health Specialist Menopause Clinic our Menopause Specialist Dr will help you choose the HRT best suited to you.

We will prescribe oestrogen gel in the form of a pump pack, Oestrogel, or in small sachets of gel called Sandrena. We will advise you of the right dose for you. Menopause care is individual and we all absorb oestrogen differently through the skin. You may need a dose adjustment as you journey through perimenopause to menopause.

Tips: try and apply it at the same time of day, if you are noticing symptoms in the evening and you apply in the morning you can consider dividing your daily dose into two and applying it twice a day. Please talk with us for important advice if you are using gel and need to have a hormonal blood test done.

Oestrogel and Sandrena contain the hormone oestrogen, which is part of your hormone replacement therapy. The oestrogen contained in these gels is body identical, it is derived from the yam plant, a root vegetable. It is the same form of oestrogen that our ovaries make, 17-beta-estradiol. The gel is given to top up your oestrogen hormone, ­ the one that reduces during the perimenopause and menopause. In most cases, topping up the oestrogen in your body effectively improves your symptoms like hot flushes, night sweats, mood changes and vaginal dryness.

Oestrogen equivalent doses

Low dose

One pump of oestrogel is equal to one measure and is equivalent to a 25mcg oestrogen patch and 0.5mg Sandrena gel sachet and 1-2 sprays of Lenzetto and a 1mg oral oestrogen tablet.

Medium dose

Two pumps of oestrogel are equal to two measures and is equivalent to a 50mg oestrogen patch and 1mg Sandrena gel sachet and 2-3 sprays of Lenzetto and a 2mg oral oestrogen tablet.

High dose

Three pumps of oestrogel are equal to 3 measures and are equivalent to a 75mg oestrogen patch and 1.5mg Sandrena gel sachet

Four pumps of oestrogel are equal to 4 measures and are equivalent to a 100mcg oestrogen patch and 2mg Sandrena gel sachet.

Progesterone

If you have a womb your dose of oral or vaginal progesterone will be adjusted if you are taking higher doses of oestrogen in order to protect the lining of the womb (uterus) called the endometrium from the thickening effect that oestrogen can have upon it. The risks of endometrial thickening are endometrial hyperplasia and endometrial cancer so it is important to take your progesterone as it has been prescribed. A Mirena coil is thought to protect your endometrium if you take low, medium or high doses of oestrogen.

Tip: your dose of progesterone will be increased as your dose of oestrogen increases depending upon your medical history, we can help you with this. It is so important to protect the lining of your womb by taking your progesterone or progestogen. Do talk with us if you are having problems with this, we can help. Book an appointment at Rowena Health Specialist Menopause Clinic.

How to use the oestrogel pump

Each pump has 64 doses in it. It is not greasy and does not have an odour. It does not usually stain clothes and most women find it dries easily. It is usually advisable to wait around 30 minutes after applying it, before using other creams on the area, including sun cream.

1. Make sure that your hands and the area where you are going to apply the gel are clean, dry and unbroken.
2. Remove the canister cap to reveal the plunger.
3. Hold the estrogel pump pack in one hand and place your other hand under the spout to collect the gel.
4. Push the plunger down firmly all the way, this will dispense one measure of the gel.
5. Apply the gel to either the upper outer arm and shoulder of one or both arms or the mid-inner thigh of one or both legs.
6. Do not apply near the breasts, or near the genital area.
7. Spread the gel over a large area of skin on each area and try to keep this constant each day.
8. Usually we advise that one pump of the gel is used on one area of skin, for example one pump on the right arm, one left arm, one left leg and one right leg if you use 4 pumps of gel.
9. Replace the cap and leave to dry for 5 minutes before wearing clothes.
10. Do not wash the site of application for 2 hours – site washing 1 hour after gel application resulted in a 22% mean average decrease in 24-hour serum 17 B – oestradiol concentrations.
11. Wash hands with soap and water after applying gel, as there is a risk of transferring 17B-oestradiol to other persons or animals.
12. Contact of the skin with another person or animal risks transferring 17 B oestradiol to that person or animal.
13. Daily application of Oestrogel leads to a peak 17-B oestradiol level within 3-5 days and after stopping treatment 17-B oestradiol levels will return to pre-treatment levels by 6 days.
14. Daily application of Sandrena gel results in a peak estradiol level within 6 hours and thereafter it declines slowly.
15. The two gel formulations are considered bioequivalent.

How to use Sandrena oestrogen gel sachets

These are available in 0.5mg and 1mg sachets. The sachets can be particularly useful when travelling or just to keep in your handbag in case you are away from home when you need to apply a dose.

Tear open the sachet and squeeze the amount onto your hand and follow the instructions above. 0.5mg of Sandrena can be applied to each body part.

Your oestrogen gel can be applied at any time of day most convenient to you. The whole dose can be applied at the same time of day or you can split the dose and apply it twice a day, this is often best if you have more than two pumps of gel.

What are the advantages to using oestrogen gel rather than tablets?

The absorption of oestrogen through the skin, transdermally, is usually more reliable, as it goes straight into your bloodstream through your skin and does not have to be absorbed through the gut. There is no risk of blood clot using oestrogen as a gel, at normal doses, whereas there is a small increased risk when taking oestrogen as an oral tablet. Women who have a history of migraines can use oestrogen as a gel, they should not take it in tablet form.

Taking your oestrogen as a gel gives you flexibility of changing the dose depending on your symptoms. Often women find that their need for oestrogen can increase or decrease with time ­ the dose of gel can alter accordingly. Changing the amount of gel you use should only be in consultation with your menopause doctor or GP.

Oestrogen can also be taken transdermally in the form of a spray, known as Lenzetto. It is sprayed on the skin of the inner forearm; it works in the same way as an oestrogen gel and has the same advantages over oestrogen tablets. It dries completely in 67 seconds and washing is allowed 30 minutes after dosing. Upon application to the forearm in a spray, it forms a reservoir underneath the skin, the oestradiol is released slowly from this reservoir at a steady rate over 24 hours. The applicator device is touchless minimising the risk of transfer to other people. We will talk to you about how to use this in clinic as it needs to be primed and used correctly to create the reservoir for absorption.

Side effects from oestrogen? This can happen to some women, and in clinic we will talk with you about these, how long they can occur, how to help them with lifestyle and diet, and what to do if you are on higher doses of oestrogen and still feel symptoms. You need the right advice in this case, each woman is individual. Some women need to try a different type of oestrogen, a patch, spray or even an oral tablet. Please read my article on Hormone Replacement Therapy for more information about HRT and side effects from hormones and do read all of the other articles on the website and subscribe to the newsletter for extra information.

Tip: Please take care with animals licking the area of application of gel or spray and take care with patches and other hormonal products, so that they do not become attached to, or eaten by your animal or another person.

Do come and see us at Rowena Health Menopause Clinic, we offer menopause consultations online from the comfort of you home, via video link, if you are in the UK and we’d be delighted to support you. Click here to book an appointment.

Last updated: October 2023 Dr Carys Sonnenberg Rowena Health Menopause Specialist Dr.

References:

Kopper N, Gudeman J, Thompson D. Transdermal hormone therapy in postmenopausal women: a review of metabolic effects and drug delivery technologies. Drug Des, Dev Ther 2008;vol. 2:193–202.