Oestrogel: new packaging (yet again)?

[Cosmetichamster]

Hi ladies,

Just got this month's prescription for Oestrogel, and I have been issued with a bottle that is new (to me at least). Have a look at the photo: left is what I have known and used since June this year, on the right is the new bottle, also from Besins, same labels, same ingredients, and long use by date (07/25). Obtained from a reputable pharmacy, which has filled all my previous HRT prescriptions.

Has anyone seen this sort of thing? Slightly freaked out here.

@Beachlover777 How many bottles with the orange square do you have? Some women are changing to Lenzetto spray, Sandrena gel or patches, but I suppose if you have been on Oestrogel for just six months it's probably better to insist on it a bit longer. If you don't have many bottles, the next one will probably be the cylindrical one and maybe it'll work for you.

I just noticed that the latest Patient Information Leaflet and bottles no longer show estradiol hemihydrate as the active ingredient, just estradiol.

The only other transdermal HRT that says estradiol are the Evorel mono patches. Evorel sequi and conti have estradiol hemihydrate.

🤔

Probably just a nomenclature thing, because in the PIL description it says '(as hemihydrate)'.

I could’ve written this post this is identical to how I was I yellow carded it and have since had it confirmed by blood tests that my levels had indeed fallen.

I have just had a prescription for lenzetto as cant cope with the ups and downs with the differences in the gels, and my falling hair & dreadful fatigue! Let you all know how it goes🤞🏼

Coming new to this post.

I have just started on the new shape bottles but am sure I have had this shape at some point previously...The last few bottles I have had of the old shape have not felt the same - sweating at night terribly for weeks but maybe other factors involved in that... I had to eke out the remainder of a a bottle the last week or so and definitely feel the worse for it. Grumpy, grumpy, intolerant grumpy...Doesn't the instructions say to avoid using the first and last pumps of a bottle? Will watch with interest as had no idea about all of this.

@Azaleah There is an announcement from BMS which is talking about women being warned about taking high doses of oestrogen (sorry if this has been covered in this post previously but it’s a recent BMS statement). Have you read it? It talks about oestrogen receptors in the body reaching a point where they are no longer receptive to hrt oestrogen because of overloading with high doses. I bring this up because it may be the case however it may not help those who are having an issue with oestrogel in so much as GPs may be referring to this as a rule of thumb. I’m wondering how much empirical evidence there is on this with hrt ? Or it is a hypothesis? Im thinking blood testing would show low levels /high levels. I’ve recently switched to highest strength patches but also top up with one pump of (cylindrical top) gel. Im about to get my bloods tested as GP is worried. My symptoms are under control- I’m gaining weight though which is frustrating but at least I’m not waking up with palpitations and in a pool of water!

@Lotusflower75 How recent is the statement from the BMS you mention? The last one was a few months ago. (Would have to search to find it, but maybe 3-6 months back?) I posted that link but you seem to be saying something new has been written?

Testing estrogen - this is not as straightforward as it seems. Evidently, to get a true result, blood has to be taken regularly over 24 hours which is completely impractical. Women do have their estrogen tested, but (evidently) this is meaningless and many drs do it to appear to help but aren't experienced enough to understand the limitations of a one-off result.

Therefore, many women may be increasing their dose unnecessarily.

Regarding the latest concern over the new packaging, it's concerning if it's happening because quite a lot of women in post menopause have only a few symptoms but are also using it for bone health.

Let’s us know how it goes. Hopefully it will be a lot more balanced for you, the ups and downs are truly awful. Good luck

Interestingly I’ve followed this and recently tried an orange square 🟧 bottle and with in days had lots symptoms so went back to using a 🟩 green bottle and settled back down again. I would not have made the connection previously but it was like night v day the return of symptoms. I’ve only 2 got green bottles left so I hope the pharmacy has them.

@JinglingSpringbells no it’s not the article you posted. This is a 12th Sept 2023.
I agree blood tests aren’t particularly reliable as hormones are very sensitive and up and down throughout the day. However when you are technically post menopausal or had a hysterectomy I think blood tests are going to give you a ball park figure of whether your hormones are through the roof or on the floor. Plus let’s face it it’s all we’ve got 🤣 until someone develops a better system for testing regularly. I’m just a bit concerned that whenever the BMS puts out something that it’s taken as the only truth. I’d just like to see the hard evidence ie. How many women on high amounts of oestrogen have been tested, for how long and how? Has any other country in Europe dove this study/investigation? What were the results? And are they taking into account that some products namely oestrogel is not the same as it used to be?

https://thebms.org.uk/2023/09/tachyphylaxis-with-hrt/

@Lotusflower75 Thanks so much for the new link.
Blood tests- I was posting what I'd been advised by a menopause consultant as I am post menopause. If someone is using hrt it's not possible to test properly as so much depends on when it was taken/ applied, etc etc. I don't want to argue so I am only sharing what an expert told me.

Just quickly regarding the statement above. At the bottom there are links to 5 scientific papers and their authors. I've not read the yet but it appears they are international researchers, not just the UK.

I've always found the BMS substantiates their statements with evidence and some of it is from the IMS (International Menopause Society- their Journal Climacteric has some good articles and the President of it is currently an Australian.)

Definitely not arguing! We are all entitled to our own opinions. That’s why I like this forum because we can all speak freely without fear of being told we are wrong.

thanks so much for you replies @JinglingSpringbells i do appreciate you taking the time to. 🙂
Agree- BMS are in a position where they need to be substantiating all their articles with hard evidence because it’s such a nuanced subject.

@SamR36 Fingers crossed!! I've got an appt with my GP first week of October so would be interested to hear how you get on as I was thinking of asking to switch to a different product. I've increased to 4 pumps of oestrogel (was originally on 2 a year ago) and still getting clumps of hair in the shower drainer every morning 😭

I’m exactly the same, madness isn’t it

@Lotusflower75 I haven't seen it, thanks for the link.

Tachyphylaxis has been associated with estradiol implants, hence the articles from countries where implant use is more widespread than in the UK.

There are no current data on tachyphylaxis with transdermal estradiol, the articles mentioned are observational.

IMHO Dr. Paula Briggs is trying to raise awareness of the issue because she has seen patients with mental symptoms who were taking high doses of HRT based on a supposed 'poor absorber' status.

Some snippets of her article 'Possible tachyphylaxis with transdermal therapy?Nikki Kersey ST1 CSRH, Paula Briggs Consultant CSRH'

'Introduction
This tale from the menopause clinic raises the possibility
of a form of tachyphylaxis with transdermal
estradiol (gel).'

'Case Study
A 47 year old woman was seen in the menopause clinic
with menopausal symptoms including:
• Altered sleep pattern
• Reduction in libido
• Vaginal dryness
• Hot flushes
• Anxiety
Her GP had initiated treatment with a continuous
combined oral HRT preparation, which initially she
responded well to. 12 months later her GP referred
her to the menopause clinic as her symptoms had
recurred, and she had also developed problematic
bleeding. She had a BMI of 26, smoked 15 cigarettes
per day, drank no alcohol and reported being happy at work and had a supportive husband at home.'

She had high levels of estradiol, 1052 pmolL on 4 pumps of Oestrogel, which dropped to 71 pmol/L 8 months after stopping it due to returning symtoms (hot flushes and night sweats).

She was also on citalopram (GP prescription before being referred to the menopause clinic).

She was given Estradot 50 after having her high BP under control.

Bottom line: A 47 year old woman is probably in perimenopause (the article doesn't say anything about her menopausal status), so the blood tests and conclusion could be explained by her own hormonal fluctuations.

That said... I think Dr Paula Briggs has a point.

Have you been following the mainstream media on the subject?

https://www.dailymail.co.uk/health/article-11927783/Is-Britains-foremost-menopause-doctor-risking-womens-lives-alarmingly-high-doses-HRT.html

https://inews.co.uk/inews-lifestyle/menopause-doctor-women-asking-prescribe-unsafe-levels-hrt-social-media-2554733

https://www.independent.co.uk/voices/menopause-hrt-drugs-social-media-b2396609.html

https://www.abc.net.au/listen/programs/lifematters/dr-louise-newson-wants-to-change-the-way-we-treat-menopause/102099014

Newson's clinic has treated some women with very high doses of estrogen and apparently does not always prescribe the 'adequate' amount of progestogen.

I have no idea what the 'adequate' amount of progestogen is if you are taking more than the licensed amount of estradiol.

This is a minefield, as we all know, because many women love estrogen (recently called an 'elixir' in the Daily Mail) but hate the progesterone part of HRT.

This issue is very polarised at the moment (like everything these days) and my humble advice to women taking high doses of estradiol (in fact, I don't like the idea of a 'top up' with gel for patch users, but that's for another post ) is to monitor the endometrium more frequently and perhaps try another regimen rather than just increasing the oestrogen dose.

P.S. I will ask Dr Paula Briggs if her patient was given Oestrogel or Oestrodose! Maybe that could have been the cause of her returning symptoms...

I doubt any doctor will be willing to answer questions (from someone non-medical, who they don't know) about what type of gel their patient was on. Patient- Dr relationships are completely confidential.

The articles/papers will be observational because no women have taken part in clinical trials, either blind , or double blind placebo.

@JinglingSpringbells She doesn't need to disclose the patient's name. I'm a fellow researcher and I'm sure she will reply to my message. That's why we disclose our email address when we publish a scientific article, to exchange views on the subject.

Just because you are a researcher doesn't mean she has to tell you something. There are millions of people working in research (I don't think you research menopause ) and patient confidentiality is paramount.

Note- there is a question mark in the title of the article.

@JinglingXmasbells Yes I have noticed the '?"... She hasn't and she won't disclose the patient's name... Let's wait, shall we? Oh, and I don't need to be an 'official' menopause researcher, I am a menopausal woman and that should be enough.

I'm sorry but I think you are expecting too much.

My consultant would have no idea which gel I was using as it's whatever the hospital pharmacy has in stock that day. And as far as many drs are concerned they think there is no difference.

First, I don't care if you're sorry, second, I'm not expecting anything, third, when we publish a paper on a scientific journal we usually have most of the data stored, fourth, what doctors 'think' is not relevant, the facts are.

@Azaleah Let's not argue. We can each make a point without it being confrontational.

The piece that Dr Briggs wrote was purely observational. The patient wasn't on a trial. It was as far as we can tell, a single case study.

So there is possibly no record of what she used. I know you are in Brazil and maybe the way things work in pharmacies etc is slightly different.

In the UK, Oestrogel and Oestrodose are synonymous. If the script is for the former, the pharmacy can substitute the latter as it's a parallel import. They don't need to inform the prescriber. My consultant has no idea what the pharmacy will give me, whether it's Oestrogel, 'dose , or the newer carton. I could go from one pharmacy to another trying to get Oestrogel with the green top, but even private hospitals are having to accept whatever they can get hold of.

The article we're talking about was based on whether high doses of gel could cause side effects.