Oestrogen Gel advice please!

[Ceetee23]

Hi I’ve just been prescribed oestrogen gel (I already have the Mirena coil in) for early perimenopause symptoms. There’s prob a few minor physical ones but majority psychological and after doing hormone diaries for the gynae they are totally cyclical. Anyway posted a thread on here a while back re peri and people were so helpful.

I now have oestrogen gel and have to do one pump a day for 2/3 weeks then increase to two.

I did first pump this morning and have been so nauseous since with a massive headache. Will these symptoms subside with continued use?

Also when do people generally apply it, morning or night? And where? Thanks all x

Hi OP, I’ve been using the gel for about 2 years now after having a total hysterectomy 7 years ago (used patches to start with). Never had any side effects and I am quite prone to headaches and sickness normally. I use it in the morning after a shower. Top of the legs - let it dry (can take a while so no good if you’re in a hurry!). I’m no doctor but it seems a lot to be using it if you already have the Mirena coil and you haven’t gone through menopause. My body can’t make oestrogen at all and I am only on 2 pumps a day.

Sorry ignore that unsolicited medical advice!! Not appropriate and i’m sure that your doctor has worked out the best combination/dosage for you

Op, I use it at night after a shower, and just before bed.

PP is right - you need to let it dry, which can take a couple of minutes.

I haven't had any nausea at all, and I've used two pumps of gel every night for over a year.

Hmm maybe the nausea and headache are unrelated? Ill see how it goes. Applied to my arm this morning so guess I’ll carry on doing it in the morning for now.

Do you have to apply it in the same place each day or does it not matter?

I think you can try different parts of the body to see what works best. My GP said rub it in my belly but I saw all the advice seemed to be arm or leg so I do it on my arms now. My GP didn't really tell me how much to use, just says 1-4 pumps on the prescription, so I started with one. I was getting excess mucus below so went to every other day for a while. I think I need to increase the dose though because other than the mucus (dryness was an issue before), I've had no positive response (sleep, skin, hair, mood, etc.)

I apply it to slightly different places daily.

Using two pumps creates quite a large volume of gel. I don't think there's enough room on my arm for it. Definitely need the space on a thigh.

My gp told me 4 pumps a day!!
I’ve been using it for two weeks - I do feel a little nauseous. I may take it down a pump.

@chandellina

You should have blood tests to determine the amount you use!!

I am surprised your GP didn't make that clear - or possibly didn't know?

I started with one pump and after blood tests showed my oestrogen levels were not sufficient, I was changed to two pumps.

Thanks. I did have blood tests before being prescribed. Maybe I was in a brain fog and not listening!

Actually I forgot to mention the biggest effect for me was I immediately gained 2-3 kilos. It was crazy because I was low carbing at the time and hardly eating. I suddenly got hips back that I'd spent an awful lot of time diminishing with exercise!!

This was when I started HRT in late January (have a mirena coil for the progesterone) and now I'm running every single day and doing an hour of yoga and weight came down maybe 1 kilo.

I would just stop the gel but there's osteoporosis in my family and I want to protect my bones. Plus I want to give it a little more time.

themustress

I did not have a blood test

@chandellina @Beerincomechampagnetastes @TheMustressMhor

Just got to pop along and put a few things right on this.

(I've used gel for 12 years, prescribed by one of the UK's very top meno consultants.)

You do not have blood tests for gel or any other type of HRT.
There are two reasons for this

1 In peri, your estrogen levels can change by the hour, so there is no point.

2 The way to determine if the dose is right is by the impact on symptoms. If they go away, the dose is right, if not, after a few weeks, you increase it.

The starting dose for gel is 2 pumps (this is on the patient leaflet and online.)

Some women start with less- 1 pump- to see how that goes. I did that and found it got rid of daytime flushes but not night sweats so I upped to 2 pumps.

It's trial and error.

3 @chandellina Feel a bit worried about your GP. The leaflet in the pack (long as a War and Peace!) says where to apply and some leaflets even have a diagram.

It's

1 Your upper arms

OR

2 Your inner thighs

You can split the dose am and pm if it makes you feel better.

You avoid skin to skin contact with anyone for an hour only the areas with the gel on or it can transfer.)

You do not apply it on top of body lotion etc.

There is definitely no need to change the area you apply it to. In fact that isn't good. The estrogen is absorbed best through fat cells- they have receptors. If you keep swapping areas, you may get a fall off or a spike in the amount in your bloodstream.

I started on one pump just before bed OP and for a few days I did get some nausea but slept it off. So I would suggest you start with that

It cured my night sweats but gp said need 2 pumps for osteoporosis protection so now I pump once before bed and then on a morning after a shower

Second pump was fine did not make me nauseous. I usually pump my upper arm before bed so it can dry off untouched as I go to sleep, sometimes thigh for day pump.

Make sure your skin is clean.

Comforting to know people have also felt nauseous I’ll see how things go but seems I’m doing the right thing starting with one pump and see how I get on for now. I will continue to apply to my clean dry arm!

Final question: if I’m doing one pump do I just rub on the one arm? The leaflet says something about using both arms and I wondered if this was maybe if you had more gel than one pump and needed more surface area? X

Thanks for the info @JinglingHellsBells that’s super helpful. And @pleasebeafleabite good to know the nausea didn’t reoccur on increase for you.

I've been using it for about 8 months. 2 pumps a day, after I've showered, one for each upper arm .... then I wipe off the remainder on my palms on my thighs. While it's drying I do other routine stuff like moisturising my face, brushing my hair, sorting out what I'm wearing and by the time I've done that it's dry. Have never had any side effects (am very prone to headaches but these haven't got worse) and haven't had a night sweat since I started, and perhaps just two or three flushes in that time compared to two or three a week before. General aches and pains, and anxiety, have diminished though not gone completely .... I was going to ask my GP if I could up the dosage slightly to see if it helped but that'd obviously need a new prescription for extra gel and right now, it seems too trivial to bother her with. I had hoped it'd miraculously make my ghastly meno witch bristles disappear but sadly not

can I ask @JinglingHellsBells is it rubbed in or just spread about like butter on toast!

I apply one pump to both inner thighs, spread out about the size of a hand print and then rub excess from hands on inner forearm and waft about for aaaagggges waiting for it to stop being sticky to get dressed. It dries pretty much straightaway on my arms as it's thinner, but on my legs I wonder if I should spread it further?

Haha @catsmother I’m with you on the bristles!!

is it rubbed in or just spread about like butter on toast!

Somewhere in between! Def not rubbed. I use a kind of long sweeping movement until it's spread thinly.

I apply half a pump to each upper arm. (Squirt it into my palm then divide roughly between that and my other hand.)

thanks @Jingling :o

as far as headaches go, I swear my migraines were mostly hormonal, terrible through puberty, when pg with dd (not the boys) and from 40 on...i began to think i'd rather cut off my head with a blender, but since my new mirena and esp since this gel I really haven't had a doozy at all. ...a couple of auras, a couple of blind spots, a few headaches, but all fended off with sunspecs and OTC painkillers.

levelling out the oestrogen seems to suit me!

Co-incidence - I was just coming on to ask about swopping to gel after the patch

I have to take progesterone tablets too

Thanks for the advise @JinglingHellsBells

Hi I’m just coming back on here to ask some further advice on Estrogel. The nausea and headaches and generally feeling like I had a hangover lasted for about 3/4 days for those in similar positions.

I continued on one blob of gel for about 4 weeks and my libido improved (I should say just appeared!) and no migraines and it felt like all the mood symptoms and rage just had the edge taken off. Not gone and still difficult at time’s but improved, at times I felt happy!

My consultant suggested I go up in dose (I’m 41 so they anticipated a dose of maybe 4 blobs ultimately) I’ve been on two blobs for a week and had nausea that’s gone but just feel back to how I was pre gel. Quite low and irritable and anxious and just exhausted and achy.

How long should I be patient for? I was hopeful in the first few weeks now losing hope. Wasn’t sure how long you need to give the gel to build and settle?

It could be that the Mirena isn't suiting you. I have read that the hormone-release of it is roughly the same as a low-dose combination patch and that some does get into the blood stream. Although some women love the Mirena, it's worth considering that you may be getting the downside of it now. Your other option would be to swap it for Utrogestan (tablets 12 per cycle) which would be used on a cycle basis so you would get a bled once a month which you may not want.

Also, I think it's important not to expect HRT to 'do it all'. Self-care like daily exercise, good diet, mindfulness etc , yoga, whatever.... can all help with peri meno moods.

Thanks I know in my consultation letter that they mentioned the use of utrogestan if this combo wasn’t working. And very good point about managing expectations.

How long do you think I should give the gel considering I’ve only been on two blobs a week?

I'd say at least 2-4 weeks.
Had your periods stopped or do you not know?

My cycles had shortened from 29 to 24 days but not stopped and I still get a shorter light bleed on the Mirena which I’ve had since 2018.
I’ll give it some more time. Had quite a difference in the first few weeks on one blob it felt so lovely then just seemed to tail off and now feel foggy and a bit nauseous and exhausted and low. Might be my body adjusting. Thanks for your reply.

I just wanted to update this as I always find it useful when people post on how they’re doing.

I am on two squirts of oestrogel and doing well. Going onto oestrogel and upping the dose gave me nausea for 3ish days each time. But it did go away. I was cautious and left it 4 weeks before going up to 2 squirts. And I felt pretty ‘hormonal’ for roughly three weeks (depressed, weepy, jittery anxiety) and was seriously thinking this gel was making me worse. But after 4 weeks things settled and I just feel pretty steady. Which just feels incredible really after a long time of feeling wretched. I’m pretty sensitive to hormone shifts So I think the gel took a while to settle with me.

Glad I persevered. That’s what worked for me anyway if of anything help to others. Good luck x