Estradiol 0.06% gel during perimenopause

[TheFarSide]

I'm 52 and went to my doctor 6 months ago with various perimenopause symptoms - the worst of which from my point of view are genito-urinary issues (low libido, dryness, frequent urination), mild depression and anxiety.

I didn't want HRT because, apparently, you have to incorporate a regular bleed if your periods haven't stopped yet - and the only good thing about perimenopause so far has been longer gaps between periods.

Anyway, I was prescribed Oestrogel (estradiol 0.06%) which I've been pondering about for six months and have only just "cashed in" my prescription (triggered by a new bout of symptoms including hot flushes and night sweats).

Having done some research, it seems that estradiol is usually prescribed after menopause, and I'm not yet menopausal. Is this a problem? I've been a bit freaked out by all the warnings on the Patient Information Leaflet. Also, there aren't any instructions on dosage from the GP.

I realise I'll probably have to go back to my GP to get answers to these questions, but if any of you have any advice/comments that would be great.

Oestrogel is the oestrogen part of HRT. You can't use it on its own unless you also take progestogens ( only exception is if you have no uterus.)
Oestrogel is used in peri and post menopause. I've used it for 6 years but have to take progestogens too. Was prescribed by a consultant during peri.
You can't use it on its own and I'm shocked a dr doesn't know this!!!

It wouldn't be too drastic to say 'change your GP' because what yours has done is put you at risk for uterine cancer- without a progestogen your lining will build up - even if you still have the odd period- and cancerous changes may occur eventually.

Don't use it until you have seen another dr- preferably one who knows the bare minimum about menopause and HRT!
Meanwhile have a look at www.menopausematters and the part of the site devoted to HRT, its risks and benefits.

www.menopausematters.co.uk

The dose for Oestrogel is normally 2 squirts but most women start on 1 for a couple of weeks or so to see how they get on, then you can increase to 2, 3 or a max. of 4.

I wouldn't take much notice of all the 'warnings' on the leaflets- the manufacturers have to include all of this to cover themselves - you will be better off looking at more recent research into the pros and cons, (which show the risks are less than they were previously thought) not the 'old' stats from 12 years ago that are used for these leaflets, by and large.

Many thanks pinkfrocks - you have confirmed what was bugging me. I wasn't thrilled with the GP - she was a young woman, and I did expect her to be up-to-date and sympathetic but in fact she was pretty patronising. I asked her if there was a menopause clinic in my area (because I felt I wanted to have a conversation about HRT with an expert rather than a quick consultation with a busy GP) - she just said "you can talk to me" which wasn't a very inviting prospect. Anyway, I'll hold off squirting this gel all over my body and give the surgery a ring on Monday. Thanks again :-)

Sounds like she was maybe absent or hung over when they 'did the menopause' at med school!

Just for your info- you can take HRT as a 3-monthly cycle but not many GPs will suggest this; I used to follow that regime but dropped down to a 2-monthly cycle as the bleeding was a bit heavy.

I've been thinking about this situation and I think I know what's gone wrong. She was meant to prescribe a topical vaginal oestrogen cream, which is what we had discussed, but has prescribed HRT gel instead ... or possibly the chemist gave me the wrong product.

Doh! Hard to know how she confuses two products with entirely different names: one is Ovestin (cream) and the other is Oestrogel.

Hope you get sorted anyway.

Pinkfrocks is correct I am on Oestrogel and Utragestan (progesterone) too and love it. It is fab HRT. I also have Gynest Cream for vaginal dryness. Yes Pinkfrocks I am a Menopuase Matters member/poster too!

Update: I have been back to the surgery and seen another GP. It took a few minutes (plus me showing him the menopausematters website on my phone, and him making a couple of phone calls to other GP surgeries) to convince him that I should have been given estriol rather than estradiol. He was very embarrassed and apologetic, and said he would be raising the general issue of HRT with his colleagues. He admitted the practice isn't very good on this subject, partly because the main GP is a strict Catholic and they don't deal with contraception at all. He was so crestfallen and keen to research the different HRT preparations that I forgave him. Thanks for your input pinkfrocks :-) - all's well that ends well.

Is your practice the only one in your area? Are you the only menopausal woman they have ever dealt with???

It sounds as if they are in the dark ages. I don't know how you feel about all of this but to me, an outsider, it's appalling that a) the surgery allows the religious beliefs of one GP to dictate policy- I didn't think that was permitted. (Drs can act on conscience re. abortion but not contraception) and b) that no dr is au fait with mainstream, well established treatment for vaginal atrophy.

You really shouldn't have to go in explaining the differences between eostriol and eostrodiol- most women wouldn't know anyway. These products are more often known by their brand names- eg Ovestin and Oestrogel. Even an idiot should know that Oestrogel which is mainly alcohol ( shown as the ingredients) is not what is used vaginally!

I despair really. Can you not change to a different surgery?

pinkfrocks - the problem is, I'm very happy with the practice in all other respects. The GP did say he was going to raise the issue with his partners, and I might put some feedback on their website just to chivvy things along.

But I share your frustration. And I wouldn't have been able to challenge them so confidently without your comments.

I can understand that you are happy with the practice in some respects but it's really not on that a modern practice (in London?) needs to be patient-led re. menopause treatment.
The British Menopause Society runs training courses all year round across the UK to train health professionals and has top consultants talking to drs. There is no valid reason why your drs cannot attend these workshops. Given that you are going to spend perhaps 30 years post meno I'd say have a good think about whether your drs can offer you support.