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.

When you say sticky labels are back, they are the only thing I've had until my last batch (which I haven't used because I've switched to Sandrena).

Not sure if this photo has come out very well but the left hand bottle is what I've had since my symptoms started returning. The bottle on the right was the replacement batch the pharmacy gave me after I complained but as I said I haven't used it as my GP changed my prescription.

This shows it a bit better - I've peeled some of the label back. The one on the right has the info printed directly onto the bottle.

So is there a difference between these products? I've pumped a few out of each and they look about the same but I don't have any scales to test it.

As an aside, my mind is boggling at Sandrena - how can such a small amount of gel in a sachet be equivalent to a 1.5ml pump of Oestrogel!? It's much easier to apply and I love not having to wait 10 minutes while it dries but it does feel a bit odd.

The 'sticky labels' issue was one that cropped up a while back (years) when the gel was imported to the UK as a parallel import and called Oestrodose.

The only reason then for the sticky label was that Oestrodse was the French version and the text on the container was in French. So the sticky label was the instructions etc in English.

I have one of these pumps now, when I collected a prescription a few months back. The pharmacy told me it was that or nothing because of demand.

The 'new' sticky label isn't the same issue.

I was discussing this 'new pump' with a friend who's been on patches for years. she's also read about this issue (and on another meno forum where it's been running for years with posters pursuing Besins etc.)

Her advice was that if the new pump design is causing an issue, it's easy enough to squirt out a bit more.

This has always been the guidance with gel- use what you need to, to relieve symptoms.

@MargotMoon Thanks for posting the photos.

I wasn't sure because I'm not in the UK at the moment, but thanks to your information now it's clear that the first batches of cylindrical bottles had the adhesive label and the second batches have the preprinted label.

This probably means that Besins had been diverting bottles intended for other countries to the UK and now they're going to be specific for the UK.

This is probably going to help but it doesn't explain the dose inconsistencies because each "metered' dose should deliver an exact amount of gel, irrespective of the type of labels.

@MargotMoon Regarding Sandrena, the other ingredients are completely different from Oestrogel, so they're not comparable, but your question is interesting because there's another Besins gel that used to come in sachets and now comes in a pump, Testogel. I wonder if someone who had used both could feel any difference 🤔

Are there any ladies that were on oestrogel and swapped to sandrena gel. I have just started sandrena gel I'm on 2 sachets a day and I have already started feeling symptoms creep back.
I was on 4 pumps of oestrogel.

It's probably going to take some time until your body gets adjusted after changing formulations, but it shouldn't take long.

There's a thread on this subject Oestrogel...Sandrena...then? www.mumsnet.com/Talk/menopause/4803311-oestrogelsandrenathen

@Hartieharts What dose is the gel in the Sandrena sachets?
My understanding is they come as 1mg and 0.5 mg.

4 pumps of gel is 3mgs estrogen.

So if you are using 1mg Sandrena x 2 you are not on the equivalent dose.

Did your GP not discuss this with you when you swapped?
(They should have because all products differ slightly anyway.)
Ideally, you could have both the 0.5mg and the 1mg sachets so you can use as much as needed, by increasing by 0.5mg.

*Her advice was that if the new pump design is causing an issue, it's easy enough to squirt out a bit more.

This has always been the guidance with gel- use what you need to, to relieve symptoms.*

The point is that women haven’t been told there is a difference in the dose these bottles pump out, let alone how significant it is. It’s just another case of women having to work things out for themselves and get on with it without adequate information.

In fact, many of us have been told that it’s all in our heads (you yourself refuted it on this thread quite vehemently).

And I’m sorry, the guidance the vast majority of women are getting from GPs is NOT just to pump out ‘what you need to’.

@Namddf Hear hear 👏🏻

@Hartieharts Sandrena Gel contains 0.1% (w/w) and Oestrogel 0.06% (w/w) estradiol, so it's more concentrated.

I forgot to mention you @MargotMoon Sandrena Gel contains 0.1% (w/w) and Oestrogel 0.06% (w/w) estradiol, so it's more concentrate, and the fillers are different, Sandrena needs a small are of skin to be absorbed properly.

@Namddf The guidance on gel is that the starting dose is 2 pumps. But some women need less and some more. The beauty of gel compared to patches and tablets is that women don't need new prescriptions to adjust the dosage. The patient leaflet gives the advice that 3 or 4 pumps can be used.

In Brazil Oestrogel comes with the adhesive label and a turquoise lid (sigh).

I have attached a photo of the bottle and also the batch number. All Oestrogel sold in Brazil are manufactured at Drogenbos, Belgium.

I would like to ask everyone who has the cylindrical bottle (any version of the label) to post a photo of the batch numbers.

This is true but you will effectively need a new prescription because you'll be using the gel more quickly.

My prescription from last week contained 5 cylindrical bottles with this barcode and expiry.

My scales arrived. I will measure tomorrow.

I’m now on 5 pumps of the cylindrical gel as my symptoms returned on my usual 4 (completely fine with 4 on the conical bottle). So I’m now over the licensed dose and I still don’t feel great.

My point is that we’re being left with pure guesswork because no one cares really about menopausal health, least of all big pharma. We’re having to work this all out for ourselves, which wouldn’t happen in any other area of health.

Don’t forget that for some women the right dose of HRT is quite literally a matter of life and death.

Besins are being sued in the States for some kind of dirty tactics. They cannot be trusted as far as I'm concerned. Is there no governing body for these pharmas because they don't give a flying fig about women's health.

Re. Besins used sham patent litigation to monopolize the market for testosterone replacement gels, which led to sky-high prices. No surprise there.

I can't find that in the PIL. My sachets are 0.5mg, not 1mg. Although I've been given enough to increase to 2 sachets a day if I need to.

Agree with a pp who said that there isn't any flexibility with gel - you can't just up the dosage yourself else you run out or you risk going without while you fuck about waiting for a GP appt/the date you can request a repeat prescription.

@MargotMoon Each 0.5 mg Sandrena sachet contains 0.5 mg of estradiol 0.1% w/w (meaning that the actual amount of gel is 0.5 g, which is roughly 0.6 ml) while 1 g of Oestrogel contains 0.06% of estradiol which means 0.6 mg and 1 pump (1.25 g or roughly 1.5 ml) has 0.75 mg.

The difference between the weight in g and the volume in ml is due to the fact that the density of the hydroalcoholic gel is not 1, it's between 0.8-0.9 g/ml, I'm considering the average 0.85 g/ml.

If you have been on 2 pumps of Oestrogel (1.5 g of estradiol) you will need 3 sachets of Sandrena 0.5mg.

3 pumps of Oestrogel = 2.25 mg of estradiol = 2 Sandrena sachets of 1.0 mg or 4 of 0.5 mg.

If you decide to stick to Sandrena (no pun intended) you can ask for the 1.0 mg version to avoid using too many sachets.

@LastHives Can you confirm that the number on the base of your bottle (not the expiry date and batch number) is 3?

I have noticed that the centre of the bottle base has a hollow unlike mine and @vjg13 's!

@MargotMoon Sorry, typo!

If you have been on 2 pumps of Oestrogel (1.5 mg of estradiol) you will need 3 sachets of Sandrena 0.5mg.

@MargotMoon I forgot to say that some doctors advise that 2 doses of Oestrogel would be equivalent to 1.0 mg of Sandrena but it depends on absorption, which varies between women.

It's trial and error, generally you start with the lowest dose and increase if symptoms don't improve within 3 months and within the maximum dose limit.

This is the batch number I have.

Thanks for the explanation. I started on 1 pump of Oestrogel a year ago and it was going fine until I got the crappy stuff and GP increased me to 2 pumps as we didn't know at that point that it was a problem with the cylindrical bottles. So now I've switched to Sandrena I'm going to back square 1 and starting on the lowest dose, and can increase if I need to.