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 gels which contain the hormone oestrogen. They are rubbed onto the skin daily. Oestrogen is then absorbed through the skin and into the bloodstream to help relieve the symptoms of perimenopause and menopause. The type of oestrogen contained in these gels is bio-identical (also known as body identical). This means it is the same form of oestrogen that your own ovaries make (17-beta-estradiol). The dose can be adjusted on the advice of your prescriber to give relief of your menopause symptoms. It is not advisable to adjust the dose yourself.

At Rowena Health Specialist Menopause Clinic Dr Sonnenberg sees patients virtually from all over the UK by video link. She is an experienced GP and a British Menopause Society menopause specialist. She will help you understand your symptoms will explain all of the treatment options. If HRT is right for you she will help you to choose the type of HRT that suits you best.

Hormone Replacement Therapy is the use of a variety of hormone treatments to relieve the symptoms of perimenopause and menopause. It is also given to replace hormones in women who have a hormone insufficiency, such as in those with Premature Ovarian Insufficiency (POI).

The perimenopause and menopause can have a significant impact on many women. More than 75% of women experience menopausal symptoms which can have a negative impact on their lives both at home, socially and at work. HRT is the most effective treatment and, compared with placebo, has been consistently shown to improve menopausal symptoms and is associated with a significant improvement in overall quality of life. Oestrogen therapy in approved HRT doses considerably lowers the risk of hip, vertebral and other fractures in women with normal bone density, osteopenia and osteoporosis and improves bone density. Use of HRT has been shown to offer cardiovascular protection when started in healthy younger & midlife women. The benefits of taking HRT in healthy women under the age of 60 usually outweigh any risks. Taking HRT is associated with a small increased risk of having a new breast cancer diagnosis. A conversation about your individual risk is important, and risk varies depending upon your age, family history and lifestyle factors such as your weight, smoking, alcohol and exercise.

HRT can be made of one hormone (oestrogen) or two hormones together (oestrogen and progestogen). Systemic HRT regimes involve the hormones being absorbed into the bloodstream. Oestrogen can be absorbed through the skin (transdermally) as a gel, patch or spray, taken orally as a tablet, or absorbed from a subdermal implant. Oestrogel and Sandrena are the names of the products containing oestrogen prescribed in the UK and are clear, colourless gels.

The hormone oestrogen (usually in the form of oestradiol) forms the main part of HRT. The symptoms of menopause are caused by the ovaries producing less oestrogen as the number of follicles reduces and ovarian function declines. HRT is given to increase the level of oestrogen and relieve the symptoms. In most cases, topping up the oestrogen in your body effectively improves your symptoms like hot flushes, night sweats, mood changes and vaginal dryness.

Taking oestrogen-only HRT can increase the risk of endometrial cancer, so adding a progestogen is necessary to reduce this risk for women who have a uterus (and some other women). Progestogens may be added to an oestrogen for some days of the month (sequential combined HRT) or every day (continuous combined HRT). The oestrogen and progestogen doses are balanced when they are prescribed to ensure safe prescribing, which is why it is really important not to adjust your HRT dose yourself.

The decision whether to take HRT, the dose and the duration of its use should be made on an individualised basis after discussing the benefits and risks to help you make an informed choice.

You can start taking hormone replacement therapy (HRT) in perimenopause, while you are still having periods, or after menopause, when your periods have stopped. It is important to discuss all the treatment options with your doctor so you can both decide what is the best treatment for you. Lifestyle also matters and healthy lifestyle choices can work alongside HRT to improve your symptoms.

Oestrogen given as a gel is available in the form of a pump pack (Oestrogel), or in small sachets (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.

Oestrogen equivalent doses

Low dose

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

Standard dose

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

Moderate dose

Three pumps of oestrogel are equal to 3 measures. This dose is equivalent to a 75mg oestrogen patch, 1.5-2mg Sandrena gel , 4-5 sprays of Lenzetto and 3mg oral oestrogen tablet.

High dose

Four pumps of oestrogel are equal to 4 measures. This dose is equivalent to a 100mcg oestrogen patch, 3mg Sandrena gel sachet, 6 sprays of Lenzetto spray and 4 mg oral oestrogen tablet.

Tip

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. Applying it to the forearms can mean it is absorbed more easily as the skin there is thin, but women often use the upper outer arms or inner thighs.

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 52mg LNG-IUD (Mirena coil) is thought to protect your endometrium if you take low, medium or high doses of oestrogen.

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 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 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. 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 oestradiol concentrations.
11. Wash hands with soap and water after applying gel, as there is a risk of transferring oestrogen to other people or animals.
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. The two gel formulations are considered bioequivalent.
15. Oestrogel and Sandrena are for external use only and should not therefore be swallowed.

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.

Oestrogel patient information leaflet

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.

Side effects from 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.

High dose oestrogen

Some women are prescribed higher doses of oestrogen than those usually recommended. In some cases, this is appropriate, for example, when a woman’s body doesn’t absorb oestrogen well through the skin. This can be confirmed by checking oestrogen levels if symptoms persist despite dose increases.

However, in others, higher doses can lead to oestrogen levels that are higher than necessary to control symptoms. When this happens this can cause symptoms which may make it seem as though even more oestrogen is needed (a syndrome called tachyphylaxis). Actually, too much oestrogen can sometimes make mood and emotional symptoms worse, so careful monitoring and dose adjustment are important to find the right balance.

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 2025 – 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.
• ‌