How to use Oestrogel and Sandrena

This article tells you how to use Oestrogel and Sandrena as part of Hormone Replacement Therapy (HRT), also known as Menopause Hormone Therapy (MHT). Oestrogel and Sandrena are both products that can be prescribed as part of HRT. They are transdermal gels, containing the hormone oestrogen. Oestrogen is absorbed through the skin rather than taken as a an oral tablet.

What is HRT?

To read more about hormone replacement therapy read our article Hormone replacement therapy explained: click here

What are perimenopause and menopause?

To read more about perimenopause and menopause, symptoms, diagnosis and treatment read our article: click here

What are Oestrogel and Sandrena?

Oestrogel is a pump-action gel containing estradiol (a form of oestrogen) that is applied daily to the skin, usually the arm or thigh. The dose is easy to adjust under advice from your prescriber by changing the number of pumps used.

Sandrena is also an estradiol gel but comes in single-dose sachets or 0.5mg or 1mg, rather than a pump, delivering a pre-measured amount each time.

Both work in the same way, oestrogen is absorbed through the skin directly into the bloodstream, bypassing the liver. This transdermal route is generally considered safer than oral oestrogen tablets, particularly in relation to blood clot (VTE) risk, which is why gels are often the preferred choice in modern menopause prescribing.

The main practical difference is the format (pump versus sachet ) which comes down to personal preference and the dose required.

How to use the Oestrogel pump

Each pump contains 64 doses. Discard the first pump of each carton.

The gel is not greasy and is odourless. It does not usually stain clothes and most women find it dries easily.

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. Gel is usually applied to the outer arms/shoulders or inner thighs.
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 oestradiol concentrations.
11. Oestrogen gels should not be applied immediately before skin-to-skin contact with children or pets because accidental hormone transfer can occur. Hands should always be washed after application and the application site allowed to dry completely.
12. Daily application of Oestrogel leads to a peak oestradiol level within 3-5 days and after stopping treatment oestradiol levels will return to pre-treatment levels by about 6 days.
13. Daily application of Sandrena gel results in a peak estradiol level within 6 hours and thereafter it declines slowly.
14. Oestrogel and Sandrena are for external use only and should not therefore be swallowed.
15. Try and apply your oestrogen gel 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.

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.

What if you miss a dose?

• If it is more than 12 hours until your next dose, apply the gel as soon as you remember and apply the next dose at the normal time.
• If it is less than 12 hours until your next dose, skip the missed dose and apply the next dose at the normal time.
• Do not use a double dose (two doses at the same time) to make up for a forgotten dose. If you forget a dose, you may have breakthrough bleeding or spotting.

Are there side effects from using oestrogen?

These include fluid retention, bloating, weight gain, nausea and dyspepsia, headaches, breast discomfort and anxiety. We can help by reducing the dose or changing the way we prescribe oestrogen (like a patch, spray or oral tablet).

We also need to consider other causes for symptoms.

What doses of oestrogen are available?

Oestrogel: Low dose: 1 pump. Medium dose: 2-3 pumps High dose: 4 pumps

Sandrena: Low dose: 0.5mg. Medium dose: 1mg 1.5mg (2mg but this is outside the product licensed dose). High dose: 2.5mg and 3mg (but this is outside the product licensed dose).

Your prescriber will advise you of the best dose for you.

Equivalent oestrogen doses to other products for women aged 45-55 years

Be aware that absorption from different products in individual people varies:

Low dose: 1 pump Oestrogel = 0.5mg Sandrena = 25/30/37.5mcg oestrogen patch = 1-2 sprays of Lenzetto = 0.5mg oral estradiol tablet

Medium dose: 2/3 pumps Oestrogel = 1-2mg Sandrena = 40/50/75mcg oestrogen patch = 3-4 sprays of Lenzetto = 1-2mg oral estradiol tablet

High dose: 4 pumps Oestrogel = 2.5-3mg Sandrena = 100mcg oestrogen patch = 5-6 sprays Lenzetto = 3mg oral oestradiol tablet

Women with premature ovarian insufficiency (POI) which is menopause under the age of 40, usually require higher doses of oestrogen than women who are older. The guidelines recommend doses of 75mcg-100mcg patch or equivalent.

These doses are taken from the BMS recommended doses and some of these doses states are outside the product licensed doses, so they are added for information only and not a recommendation for your individual treatment dose.

Is a higher dose of oestrogen better?

Occasionally symptoms may worsen despite increasing oestrogen doses. In some women this may reflect excessive oestrogen exposure rather than deficiency, therefore dose escalation is not always the answer.

Progesterone

If you have a womb your dose of progestogen 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 52 mg LNG-IUD (Mirena) provides licensed endometrial protection for HRT for up to 5 years and is widely used in women receiving low, medium and higher doses of transdermal oestrogen, although evidence is more limited at very high oestrogen doses.

Tip

Your dose of progesterone should be balanced with your dose of oestrogen. It is so important to protect the lining of your womb by taking your progesterone or progestogen.

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: June 2026- Dr Carys Sonnenberg – Rowena Health -British Menopause Society Menopause Specialist

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. 2:193–2022.
• Oestrogel patient information leaflet
• Sandrena patient information leaflet
• Mukherjee, A. and Davis, S.R. (2025). Update on Menopause Hormone Therapy; Current Indications and Unanswered Questions. Clinical Endocrinology. doi:https://doi.org/10.1111/cen.15211.