Transdermal spray and gel prices

Transdermal spray and gels estradiol amount per standard dose.

Name	Type	Estriol per dose
Lenzetto	spray	1.53 mg
Sandrena 0.5mg	gel	0.5 mg
Sandrena 1.0 mg	gel	1.0 mg
Oestrogel Pump-Pack	gel	0.75 mg

HRT and the menopause

Replacing oestrogen in the form of HRT, will relieve many of the symptoms of the menopause, in particular hot flushes and night sweats.

Who can use transdermal oestrogen gel or spray?

Transdermal oestrogen is absorbed through the skin straight into the bloodstream. It does not pass through the liver first. Because of this, transdermal oestrogen does not increase the risk of developing blood clots. It is therefore often recommended for women who have previously suffered from blood clots (thrombosis) or are at increased risk of developing blood clots.

Other situations where transdermal preparations are often recommended include:

• Starting HRT over age 60.
• Overweight with a BMI > 30.
• Side effects with HRT tablets.
• Raised blood pressure.
• High blood triglyceride levels.
• Taking other medications which stimulate the liver enzymes.
• Gut problems which affect absorption of tablets.
• Migraine.
• Gallbladder disease.
• Lactose intolerance (most HRT tablets contain lactose).

Who should not use transdermal oestrogen gel or spray?

HRT should not be used by women with any of the following:

• Breast cancer or any other hormone dependent cancer (or strong family history of) present or past.
• Vaginal bleeding that hasn't been investigated by a doctor.
• Over thickening of the womb lining (endometrial hyperplasia).
• A strong family history of blood clots, or disorder causing increased risk of blood clots eg inherited thrombophilia.
• Active liver disease.
• Porphyria.
• Systemic Lupus Erythematosus.
• Pregnancy.

Specialists may sometimes prescribe outside this guidance after individual assessment.

There is a short online medical questionnaire to ensure treatment from Dr Fox is suitable.

How to use transdermal oestrogen gel or spray

The spray or gel is used once daily, preferably at the same time each day. It should be applied away from the breast, face, or genital areas. Each manufacturer suggests a slightly different area of skin to use.

Apply the product yourself and wait for it to dry before getting dressed. Leave at least an hour between using other creams, sunscreen, washing, or having skin contact with a partner or child.

It should not be used on broken or inflamed skin, or on areas treated with other skin medications. Wash hands after use.

Oestrogel Pump-Pack

On first use only, remove the cap and prepare the Oestrogel Pump-Pack by pressing the plunger several times until some gel comes out. This dose should not be used. To apply a dose, collect the gel from the Pump-Pack in one hand whilst pushing the plunger down firmly with the other hand. Smooth the gel over a large area of skin on your shoulders and outer arms or on the mid-inner thighs. 1 - 3 pump doses can be used. The starting low dose is 1 pump per day and the standard dosage is 2 pumps. The Pump-Pack will last 4 weeks at 2 doses per day.

Sandrena gel sachet

The Sandrena gel sachet should be applied to the lower body or thighs, on a different side each day. Rub the gel in, gently, over an area of skin 1-2 times your hand size. Allow the gel to dry and do not wash that area for at least an hour. Start using a 0.5mg sachet once a day. This can be increased up to a standard dose of 1mg-1.5mg per day if symptoms are not controlled on the lower dosage. Use the number of sachets needed to make up your dose.

Lenzetto spray

On first use only, prime the pump by pressing the button down firmly three times, with the cover still on.

It is recommended to use Lenzetto on the inner arm or inner thigh.

Allow the skin at least 2 minutes to dry.

The starting dose is 1 spray per day which can be increased after at least 4 weeks to 2 sprays if symptoms are not controlled. The maximum licensed dosage is 3 sprays a day.

Taking progestogen capsules with transdermal oestrogen gel or spray

For those women who have not had a hysterectomy or do not have a Mirena coil (or other 52mg levonorgestrel coil eg Benilexa or Levosart) that has been fitted in the last 5 years, progestogen capsules need to be taken alongside transdermal oestrogen to protect the womb lining (endometrium) from over-thickening. Dr Fox offers body-identical Utrogestan 100mg, micronised progesterone capsules in combination with transdermal oestrogen gel or spray.

Sequential/ Cyclical HRT:

For women who have had a natural period in the last 12 months ^*: spray or gel combined with two 100mg capsules of Utrogestan to be taken at bedtime for 12 consecutive days each month. A bleed usually occurs for a few days after stopping the Utrogestan.

Continuous HRT:

For those women whose periods have stopped naturally (not on contraception) for over 12 months, or aged over 54 or have been using sequential HRT for 5 years or more: gel or spray combined with one 100mg Utrogestan capsule daily at bedtime.

^*If on contraception that stops your periods it is usually recommended to use cyclical HRT for 5 years or until age 54. You can try continuous combined HRT but should be aware that this may cause irregular bleeding and if this continues for more than 3 months you should change to sequential /cyclical combined HRT.

Other medicines and transdermal oestrogen gel and spray

The following medications may trigger irregular bleeding with HRT use:

• Epilepsy medication (phenobarbital, phenytoin, carbamazepine).
• Antibiotics for tuberculosis (rifampicin, rifabutin).
• HIV treatments.
• Hepatitis C treatments.
• Bosentan for raised blood pressure in the lungs.
• St John's Wort.

All types of HRT may interfere with the action of some other medications making them less or more effective. Discuss with your regular doctor if taking:

• Levothyroxine (underactive thyroid).
• Lamotrigine (epilepsy).
• Tacrolimus, cyclosporin (immune suppressants).
• Fentanyl (pain killer).
• Theophylline (asthma).

Possible risks from using transdermal oestrogen gel or spray

All forms of HRT slightly increase the risk of developing breast, ovarian cancer and sometimes womb cancer. See also "Is there a cancer risk with HRT?"

Transdermal oestrogen has not been shown to increase risk of developing blood clots (which is different to what is written in the patient information leaflets).

Possible side effects from transdermal oestrogen gel or spray

Skin rashes and itching, where the spray or gel is applied, may develop. If this is severe, the products should be discontinued.

Other side effects due to the oestrogen can occur such as headache, abdominal pain, vaginal discharge or discomfort.

The manufacturers suggest that transdermal oestrogen gel or spray is stopped immediately and a doctor consulted if any of the following occur:

• Jaundice - yellow eyes or skin.
• Sudden raised blood pressure.
• First ever migraine type headache.
• Pregnancy.
• Suspected blood clot which may cause swelling in one leg, sudden chest pain, or sudden breathing difficulty.

Further information is in the manufacturers' patient information leaflets.

Non-HRT options for symptoms of menopause

General healthy lifestyle measures can help with symptoms of the menopause. Eat a balanced diet, low in saturated fats and salt, with high calcium and vitamin D content. If you cannot obtain the recommended amount of calcium and vitamin D from your diet, you might wish to consider taking supplements.

Regular exercise helps to maintain bone and muscle mass. Alcohol is a known trigger for flushes and sweats, so a reduction can help, as will caffeine reduction. Losing excess weight can also reduce symptoms.

Smoking contributes to osteoporosis and heart disease risk. Smoking also increases the risk of breast cancer and many other cancers, so stopping smoking at the menopause will improve long term health.

Anxiety and mood symptoms, and also hot flushes and night sweats, may respond to Cognitive Behavioural therapy (CBT) either in person or online. St John's Wort, a herbal remedy for low mood, helps some women, but this cannot be used if also taking some other medications (including tamoxifen).

Herbal remedies which have been shown to help with menopausal symptoms are red clover, other soya based isoflavones and also black cohosh. Black cohosh is effective but some black cohosh products have been linked to mild liver damage, which may or may not recover on stopping.

Pregnancy and breastfeeding

HRT including transdermal oestrogen gel and spray should not be used during pregnancy or when breastfeeding. If you become pregnant whilst using HRT, you should stop immediately.

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