Sandrena v Oestrogel

[SoyMarina]

Hello, can anyone advise me on this please.
I am 56 so post menopausal.
I have been using oestrogel since September with mixed results.
I was prescribed it (already have the mirena coil)
I started on 3 pumps and increased to 4 in January when symptoms returned.
However, I am struggling again mainly with anxiety and insomnia.
I have kept a diary and it appears that my symptoms return about two thirds way through the canister.
So I was thinking of switching to sandrena for consistency of the product due to it being in sachets.
I hear it is also more potent than sandrena so 2 sachets would be equivalent to 4 pumps.
Also, is it easy to switch from one to the other?

This has been answered already on another similar thread where you have also posted.

It's not that one is more or less potent- they have different doses but you either add more or use less to get the dose you need.

Sandrena is on 0.5mgs or 1mgs estrogen sachets.

1 pump of gel is 0.75mcgs estrogen.

If you used 4 pumps that it 4 x 0.75 = 3mgs.
So you use the number of sandrena sachets to get the same dose.

Thank you JingleHellsBells
I’m not convinced that Estrogel and Sandrena are the same strength.
I shall continue researching and posting on multiple boards/threads.

@SoyMarina

Thank you JingleHellsBells I’m not convinced that Estrogel and Sandrena are the same strength. I shall continue researching and posting on multiple boards/threads.

Medicines are scientifically formulated. The amount of estradiol is controlled by quality control in a pharmaceutical manufacturing process. The type of estrogen is the same in both.

This may help- it's written by Dr Newson and covers both brands of gel.

www.newsonhealth.co.uk/uploads/2021/07/Oestrogel-and-Sandrena-v21-02.pdf

Maybe you're using too much? Older women post menopause sometimes need less than those in peri so you could try 1 pump am and 1 pump pm?

Just an idea, I'm not an expert but I know women who seem to feel wired/jittery and sleep badly if they have too much oestrogel.

Fwiw the product won't become dilute halfway down the cannister, it will be absolutely consistent or else it wouldn't be safe.

Interesting JanileJones
I tend to get other symtoms that suggest low estrogen though, like anxiety, pins and needles feeling in hands and feet.
It is so hard to know whether it's too much or too little estrogen.

'I tend to get other symtoms that suggest low estrogen though, like anxiety, pins and needles feeling in hands and feet'

It can be a tricky balance though, low oestrogen can cause anxiety but as I say too much seems to too, I have a friend who had been on 4 pumps and when she lowered to 2 she felt much less agitated and slept better. At least the gel gives you the option of trying and seeing rather than having to get different doses of pills prescribed.

Just give it a go for a few days, nothing to lose and can soon up it again if needed. Again I'm not an expert but have many friends and family in peri/post and these things are often discussed!

Pins and needles in your feet is not a sign of low estrogen. It can be caused by many things , such as diabetes- have you had your glucose levels checked?

4 pumps is a high dose. Most women are on 2 pumps and some go up to 3 or 4.

I've always found 2 enough but everyone is different.

How does your anxiety show itself? Sometimes when people talk about anxiety it's just normal feelings where most of us feel worried or anxious in certain situations.

How does it affect you?

I was on 2 pumps of Oestrogel until you couldn't get it, was switched to one sachet of Sandrena last week. It seems to be working great for me so far but tbh I'm just grateful to have anything, as no HRT isn't a place I want to go 😬

ChocolateChocolateEverywhere
How are you finding the Sandrena in comparison to Oestrogel?

JinglingHellsBells
I was rarely anxious until the menopause. I tend to know it’s hormonal when I find myself ruminating over small things, like something a bit insensitive somebody said to me in work or the like.
My non balanced hormonal self would just shrug that kind of stuff off.

Tingling can also be a sign of hormonal imbalance or/and anxiety.

Tingling can also be a sign of vitamin deficiency, hyperventilation, thyroid issues, neurological disturbances and many other things.

It’s rather reductive to state it’s due to “hormones”.

Oestrogen gel will predominantly alleviate vasomotor symptoms. It can benefit other menopausal symptoms but I think just increasing oestrogen levels alone isn’t necessarily what you need. Have you spoken to your doctor about the tingling and anxiety?

Thank you Sidge but I not planning to increase my estrogen only to perhaps change to Sandrena.

But if you’re using 4 pumps daily of oestrogel, switching to a Sandrena isn’t going to make much difference at all to your dosing, it’s just a different storage and application process. Sachets rather than pump - more waste, and some women find it more fiddly using sachets. However ultimately it’s personal preference, but is related more to the application process rather than dosing.

You said on another post you were also on anti depressants for anxiety. Are you still on those?

Dr Louise Newson says they don't work and can even be counter productive.

I tend to know it’s hormonal when I find myself ruminating over small things, like something a bit insensitive somebody said to me in work or the like.

Isn't this just normal, though? I have an increasingly thin skin in some ways and do exactly what you do but never ever considered it to be anxiety. I just label myself as over-sensitive.

Dr Louise Newson said that?
I thought she was a menopausal specialist not a mental health one!!
I’m on mirtazapine for anxiety and insomnia and HRT for my menopausal symptoms.

I switched from oestrogel to sandrena last week as some of my symptoms returned, especially insomnia and it coincided with a brand change so I wanted to rule out that being a cause of my symptoms.

I actually went down from 3 pumps to 1 sachet but am happy so far. It sinks in more easily and my sleeping seems slightly better. The dose is more consistent I think. The change has coincided with a big flare up of another health issue so it is hard to isolate caused and effects at the moment.

4 pumps sounds a high dose. I’m on utrogestan tablets and 1 pump of oestrogel and the label on my bottle says 1 to 2 pumps. I’m 61 and have been on this combination for 3 years. It has kept the constant flushes and sweats totally at bay as well as aching joints.

I used to get weird pins and needles and numbness in my hands, feet, nose and lips 😱. It was when I was when I was going through a hugely stressful time. Stress and anxiety can be due to lots of other reasons apart from lack of oestrogen and they can produce a huge range of weird symptoms in my experience.

Do you think it might be worth stopping keeping the diary? Our minds can cause havoc on the body and I wonder if because you’ve seen a pattern as to when your anxiety and other symptoms start to kick in, that they are subconsciously starting up around the same time each month? I hope im making sense? Wouldn’t sandrena just be another brand/formula of the same drug?

Thank you both.
Lots to think about in your posts.
That does make sense re the diary.
I think I tend to overthink things.
I will ask for Sandrena next due the ongoing shortages of oestrogel. It is a pain having to phone around lots of pharmacies every three months.

Chewbecca what do you mean by brand change?

The Oestrogel was switched to Oestrodose, a European version of the same product with a sticker over the label. Should be identical but I wanted to rule out that being the cause of my return of symptoms. The stickered bottle was runnier and I didn’t think the pump was dispensing consistently.

Ah yes, I read about that.

@SoyMarina

Dr Louise Newson said that? I thought she was a menopausal specialist not a mental health one!! I’m on mirtazapine for anxiety and insomnia and HRT for my menopausal symptoms.

@SoyMarina Dr Newson is only following NICE menopause guidelines as should be all drs prescribing for women. The guidance came out in 2015 yet many women are still being prescribed ADs not HRT.

I mentioned her simply because on her website there are some very good fact sheets on this, as well as many case studies of women who were mis-prescribed ADs and suffered as a result.

The NICE guidance (you can read it at the top of this page - pinned post) states that anxiety and insomnia are menopausal symptoms.
Women going through menopause and should not be given ADs for these.

Whoever gave you these for your anxiety and insomnia was not following the NICE guidance.

Many symptoms of the menopause are in fact psychological. This is discussed by NICE.

I started Oestrogel almost 14 years ago and my main symptom was insomnia (and hot flushes.) When I stopped for a few weeks around a year ago, my insomnia came back almost overnight.

I truly do think you ought to reconsider mixing the two, as the ADs/SSRIs may be counter-productive.

@SoyMarina If you are interested, here is the guidance from NICE

www.nice.org.uk/guidance/ng23/chapter/Recommendations#managing-short-term-menopausal-symptoms

Psychological symptoms

1.4.5 Consider HRT to alleviate low mood that arises as a result of the menopause.

1.4.6 Consider CBT to alleviate low mood or anxiety that arise as a result of the menopause.

1.4.7 Ensure that menopausal women and healthcare professionals involved in their care understand that there is no clear evidence for SSRIs or SNRIs to ease low mood in menopausal women who have not been diagnosed with depression (see the NICE guideline on depression in adults).

Thanks JinglingHellsBells
I am aware of the NICE guidelines as is my GP.
I have been on and off ADs long before I hit the menopause, as least 10 years before.
I dont believe HRT and ADs to be counterproductive in my case.

Thank you for making that clear.

Some women reading your thread assume that ADs were available and the right treatment for menopausal anxiety and insomnia.

Important other readers who don't even post, know the guidance.