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Menopause can feel like an uphill battle, but there's no need to face it alone. If you've been exploring menopause hormone therapy options, you've likely come across estrogen gel. But what is it, and how can it help?
Menopause and Estrogen Gel
Menopause is a significant neuro-hormonal transition in a woman's life, which can be associated with a variety of physical and neuro-cognitive changes. Menopause begins with the perimenopause stage, where there are marked fluctuations in estrogen and lower progesterone and testosterone levels.
After menopause estradiol, progesterone and testosterone levels are minimal. Estradiol is a hormone that plays a crucial role in many functions in the body, is anti-inflammatory and prevents the development of a number of chronic diseases.
Estrogen gel is one type of estrogen hormone therapy that can be effective at alleviating the symptoms of perimenopause and menopause.
Related: 34 Symptoms of Perimenopause
What is Estrogen?
Estrogens are a type of steroid hormone, that are primarily produced by the ovaries, but also is made by fat cells.
There are 3 main estrogens in humans, estrone, estradiol (the main ovarian estrogen) and estriol (the main plaental estrogen).
Estrogens are essential for regulating many functions in the body, including the menstrual cycle and metabolism. It also plays an important role in connective tissue structure including skin, blood vessels, bone, muscle, cartilage, vertebral discs, bladder health and vulvovaginal health.
During menopause, levels of this hormone decrease, leading to common symptoms such as hot flashes, night sweats, and mood swings. Hormone therapy, like estrogen gel, can help mitigate these changes by replenishing estrogen levels.
What is Estrogen Gel?
Estrogen gel contains a type of estrogen that is the most common in the female body known as estradiol. Estrogen gel is a type of topical hormone therapy that delivers estrogen directly to the skin.
It is absorbed into the bloodstream and distributed around the body, so it is given in higher doses than would be used when estrogen is just delivered locally such as vulval/vaginal estrogen creams or face estrogen creams.
It is typically applied once daily in measured doses on specific areas of the body, such as the arms or thighs. Estradiol gel is an easy and safe type of estrogen therapy to use during menopause. It has an alcohol base, similar to hand sanitizer.
Why Should You Consider Estrogen Gel?
Estrogen gel is a good option for HRT.
It is a safe form of estrogen and does not have an increased risk of blood clot.
It is easy to increase or reduce the dose to titrate to symptoms or side effects.
It does not leave a sticky residue.
You use it daily so you can incorporate it into your daily skincare routine.
It is a good option if you have high blood pressure or gallbladder disease, as estrogen pills are not recommended in these conditions.
Estrogen gel is also a good option if you are using an estrogen patch and just need a small top up dose in addition to your patch.
Benefits of Using Estrogen Gel for Menopause Relief
Estrogen gels can be helpful at reducing a number of perimenopause and menopause symptoms. The benefits include:
Reduced/eliminated hot flashes and night sweats
Improved mood and reduced irritability
Increased bone density, reduced fractures and increased muscle mass
Improved vaginal dryness and discomfort during sex
Maintenance of collagen levels in skin, muscles, blood vessels
Reduction in blood pressure and cholesterol levels
Improved overall quality of life during menopause
Estrogen gel may also reduce the risk of certain chronic health conditions, especially when started during perimenopause or within 10 years after your final period. This includes conditions such as diabetes, osteoporosis and heart disease.
Using estrogen via the skin such as in a gel does not cause a risk of blood clots above your baseline risk.
How to Use Estrogen Gel
Use the amount of estrogen gel you have been prescribed.
Estradiol gel typically comes in a gel pump or individual use sachets.
To use estrogen gel:
Apply 1 pump or sachet of estrogen gel to your outer arm or thigh
If you are using multiple sachets or pumps, apply each application to a different arm or leg to avoid oversaturating one area.
Spread the gel in a thin layer of the skin and allow the gel to dry for approximately 5 minutes before getting dressed
Wash hands thoroughly after application
Avoid moisturiser for an hour after use to avoid interferring with estrogen absorption.
Avoid showering for 2 hours after application.
Estrogen gel contains alcohol so should be avoided being used on the face and vulva/vagina. It is also not recommended to be used on the breasts.
It's recommended to stick to a consistent schedule when applying estrogen gel, such as at the same time each day. If you happen to miss a dose, do not double up on the next one. Simply skip that dose and continue with your regular schedule.
Most women dose estrogen gel in the morning. Some women use a split dose and use estrogen gel twice daily.
Potential Side Effects of Estrogen Gel
Like any medication, there are potential side effects to using estrogen gel. These may include:
A rash at site of use - more common among people with sensitive skin, and more often a reaction to the alcohol base rather than estradiol.
Breast tenderness or swelling (often temporary or a lower dose may reduce this symptom).
Fluid retention
Nausea or stomach upset,
Headaches (these often improve with more stable estrogen levels)
Spotting or bleeding between periods (if still menstruating) or postmenopausal bleeding after menopause.
Mild initial symptoms including vaginal bleeding usually settle within the first 3 months of treatment or change in dose.
If you have persistent or unusual vaginal bleeding, you should discuss with your health provider who can advise changes to your treatment or investigations if needed.
If you experience an unusual side effect, severe headache or an allergic reaction, stop using estrogen gel and let your health provider know.
If you have a uterus (womb), estrogen gel must always be used alongside a progestogen (such as progesterone, provera, norethisterone or mirena IUD) to reduce the risk of endometrial thickening and cancer of the uterus (endometrial cancer).
Women who have had a hysterectomy can use estrogen gel without additional progestogen.
Cost of Estrogen Gel
Estrogen gel is on the New Zealand Pharmaceutical Schedule and will be funded from 1 November 2024. It will cost $5-15 per 3 months depending if your prescription comes from your primary care provider or a specialist.
Estrogen Gel Vs Patch: how do they compare?
Estrogen Gel
Daily application: this can be great for people who prefer a consistent routine. It is also slightly more physiological as hormones are typically released in pulsatile fashion.
The alcohol in the gel can dry the skin.
You need to avoid using products on the skin where the gel is used to ensure consistent dose absorption. Moisturisers and sunscreen should be used 1 hour after estrogen gel use.
It is recommended you avoid harsh skincare products that alter the skin structure or function such as:
surface active agents (e.g. sodium lauryl sulphate) found in moisturisers,
benzalkonium or benzethonium chloride products,
skin care products of high alcoholic content and
keratolytics (e.g. salicylic acid, lactic acid).
Peak estrogen absorption occurs at 4-5 hours with lower absorption over the following hours.
Some women use a split dose and apply twice daily.
Estrogen Patch
Twice weekly application: this is great for people who want to stick the patch on and forget about it. It only needs to be changed twice per week.
Sticky residue: the patch can leave a sticky residue on your skin that some people find annoying. It can be removed by rubbing oil onto the residue.
Reaction to the patch: a few people find they develop a skin reaction to the patch.
Some women are low absorbers via the estrogen patch so may find greater symptom control using an estrogen gel.
Peak estrogen absorption occurs on day 2 with lower levels on the preceding and following day.
Changing From Estrogen HRT Patches To Estrogen Gel
This handy chart is based on Australasian Menopause Society and British Menopause Society Guidelines. It can help you change with ease to estrogen gel from a patch or estrogen tablet.
These comparative doses are just guidelines and may not be exact equivalents for you.
When you change preparations, if you have a recurrence of symptoms or increased side effects you may need to adjust your dose.
Estrogen Gel Dose Conversion Chart from Australasian Menopause Society (AMS) and British Menopause Society (BMS) Guidelines
FAQs about Estrogen Gel
Can you use estrogen gel on your face?
No, estrogen gel should not be used on the face as it contains around 40 percent alcohol and can irritate the delicate skin on the face.
Does estrogen gel cause weight gain?
There is no evidence to suggest that estrogen gel directly causes weight gain. Estradiol plays an important role in metabolism of fatty acids and glucose. Hormone fluctuations of perimenopause and low estrogen state of menopause can impact appetite and metabolism, which may result in weight changes.
If you do experience weiht gain discuss with your health provider and they may recommend a lower dose.
How quickly is estrogen gel absorbed?
Estrogen gel is typically absorbed within 5 minutes of application, but peak absorption occurs at around 4-5 hours.
How long does estrogen gel take to work?
It may take several weeks for estrogen gel to fully alleviate symptoms such as hot flashes and vaginal dryness. Results may vary for each individual.
Is estrogen gel safe?
Estrogen gel is considered safe for most women when used as directed. There are no increased health risks associated with it's correct use.
A recent study highlights the safety of estrogen during perimenopause and menopause and it's association with a reduced risk of cancer using data from 10 randomized trials and over 14000 women.
Estrogen is only implicated in breast cancer when it is used in combined with a synthetic progestogen (such as provera or norethisterone). In this case there is a small increased risk of breast cancer - due to synthetic progestogen use.
There is no increased risk of breast cancer when estrogen gel is used alongside natural progesterone such as utrogestan or prometrium.
As with any medication, there are potential side effects and risks. It's important to discuss your individual medical history and any concerns with your healthcare provider before starting estrogen gel.
How should I store estrogen gel?
Estrogen gel should be stored at room temperature and away from heat, light, and moisture. Make sure to keep the cap tightly closed and out of reach of children and pets.
Lifestyle Changes to Support Menopausal Health
Complementing hormone therapy with a healthy lifestyle can enhance your overall well-being.
A balanced whole food diet supports hormone and metabolic health.
Regular exercise helps maintain a healthy weight and mood stability.
Mindfulness practices, such as yoga or meditation, can also alleviate stress and improve emotional well-being.
Ensuring you are prioritising sleep with a relaxing bedtime routine and sleep support such as magnesium or melatonin if HRT alone is insufficient to support adequate sleep.
The Takeaways About Estrogen Gels
Your menopause journey is your own, but estrogen gel is just one option that can make your hormonal transition smoother.
Estrogen gel is a safe transdermal option for HRT during perimenopause and menopause.
It can reduce many of your symptoms, improve your quality of life and help reduce your risk of developing chronic health conditions.
Feel free to explore additional resources or reach out to a healthcare professional for further support. Here's to a healthier, happier you!
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Dr Deb Brunt @ Ōtepoti Integrative Health would love to support you explore the best option to treat your menopausal symptoms.
Dr Deb Brunt is a women's health and menopause specialist in Dunedin, New Zealand and also provides health coaching internationally to support optimal health habits so you can live your best life.
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