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.

These ones

500 sold this month. Probably everyone weighing their gel.

Yes 😂

Thank you @mrsnjw ...500 sold last month 😆. Yes it seems that women have cottoned on to weighing their gel.

Those kind of scales are also popular with drug dealers.

@funnelfan I just added it to my wish list and it suggested I might want to buy 100 tiny zip lock bags too

I’ve found these scales really good as they’ve got a detachable plate that can be easily washed

The problem is that I don’t think it’s just about the amount of gel. I’ve increased from 4 to 5 pumps and I still feel awful.

I think I’ve finally got mine switched to Sandrena though, so I’m hoping that will make a difference. It’s such a shame as Oestrogel worked well for me for quite a while.

@everythingyouneedtoknow I have just read the article (in press) "Oestrogen-based therapies for menopausal symptoms" by Abbie Laing and Tim Hillard, Poole Menopause Centre, University Hospitals Dorset, Poole UK.

It's a very concise non-technical review that I encourage everyone interested to read. All you need to to is request patient access to Elsevier by sending an email.

https://www.sciencedirect.com/science/article/abs/pii/S1521690X23000635

The interesting bit regarding your question is this:

"There are two gel preparations available[1]. One preparation is a pump dispensing pack whereby one metred dose (1.25 g) supplies 0.75 mg 17β-
oestradiol. The daily application of this gel leads to peak 17β-oestradiol levels within 3–5 days and after discontinuation of treatment 17β-oestradiol levels return to pre-treatment levels by 6 days [1]. The other gel preparation is available as single dose sachets that delivers either 0.5 mg or 1 mg 17β-oestradiol respectively. Daily application of this gel leads to peak 17β-oestradiol levels within 6 h and thereafter declines slowly [14]. The two gel formulations are considered bioequivalent [15]."

As this information has been available for some time (references 1, 14 and 15 are from 2005, 2004 and 1998, respectively), there is nothing new, but I think it is interesting to highlight that Sandrena has a much faster absorption (peak in 6h) than Oestrogel (peak in 3-5 days).

Also interesting is that estradiol levels return to pre-treatment levels by 6 days with Oestrogel. If it takes 3-5 days for estradiol levels to peak and 6 days to drop completely, inconsistent delivery through a faulty pump would explain the returning symptoms in women sensitive to hormonal fluctuations.

@Azaleah very interesting... I wonder if the studies done were carried out under the same conditions? My current plan is to remain at 5 pumps for the recommended 4-6wks (that's what my Newson dr said anyway) and then to try 6 pumps for the same amount of time. If even that doesn't work and I want to try more, I'm going to have to try a different type of estrogen.

But I'll get bloods done first at 6 pumps I think, during a time in my cycle when my own estrogen from my body is low (during my period...) so hopefully I can see what I'm getting from 6 pumps.

If it all looks like it could still be low estrogen or I'm not absorbing it then I'll have to try Sandrena. I like the sound of Lenzetto but with the amount of estrogen I need I'm not sure that's practical(!).

@everythingyouneedtoknow The 1998 study was an “in vitro” comparison of Sandrena and Oestrogel using epidermal membranes prepared from excised human female thigh skin (one could argue that Oestrogel also recommends upper arms). The other references are reviews that refer to studies mentioned in the product leaflets and in the summary of product characteristics. I'm trying to find these studies (I think I read them a long time ago in an American FDA document).

Your plan sounds good. If you are applying the gel to your arms, be sure to apply it to your thighs before blood tests. If you are doing this under Newson Health, I'm sure they are aware of this.

"When monitoring plasma E2 during HRT, samples for E2 assay should not be taken from a gel contaminated forearm."

https://www.maturitas.org/article/S0378-5122(03)00043-4/fulltext

@Azaleah thanks, all my gel goes on my thighs. Well, 4 pumps on my thighs (2 on each thigh) and 1 pump divided on my butt cheeks(!!). 6 pumps will mean a pump on each butt cheek.... sheesh..... (I have Testogel too. I'm pretty slick...)

Excised human female thigh skin makes me want to vomit, but there we go.... :)

😂😂😂

@everythingyouneedtoknow These are the relevant FDA documents regarding the approval of Oestrogel (Estrogel) in the US. Information on clinical trials including reviews is available, but changes to the pump and pouch material "have been removed because it contains trade secrets and/or confidential information that is not dsclosable."

A similar set of documents cannot be found at the European Medicines Agency because Oestrogel has not been approved by the EMA, each country has its own procedures and, in the case of the UK, someone has to contact the MHRA to request them. I have already mentioned in this thread and it would be very helpful if someone living in the UK could do it.

https://www.accessdata.fda.gov/drugsatfda_docs/nda/2004/21166_EstrogelTOC.cfm

I’m so glad this thread is still active.

I’m on the white cap oestrogel for my latest prescription and am struggling again with night sweats and rubbish sleep. But am already on 4 pumps per day and dithering whether to increase to 5 pumps. After reading that @everythingyouneedtoknow uses six I think I will increase it. I’m also going to put it all on my thighs as having to get half naked to put it on my arms is grim when it is so cold!

@MagpiePi I use 5 pumps at the mo, but will be increasing to 6 in a few weeks. However, I did have bloods done on 4 pumps which found I only had 283pmol and I'm already on 2x utrogestans nightly continuously (due to endo) so I'm confident that I don't have high estrogen levels and I have good uterine protection, so I'm comfortable increasing.

I've noticed that I get less out of a pump from a cylindrical bottle, too, and I've been using oestrogel for four years plus now, so have a good take on what a pump should look like! I add a little bit extra. If I don't my weird night-time hot feet and hands return quickly, plus sleep disturbances.

Oh, tell me about your hot feet! I get that too but I didn't realise it was a menopause thing. So might that mean I'm not on enough Oestrogel then?

Weird, isn't it! My hands, feet and face feel hot, even on cold nights (and I only wear light shorts pyjamas, heating off, window slightly open). I know that it means I haven't had enough oestrogel that day.

@Abra1t @WhisperingJesse I have hot hands and feet when the weather is hot, which is almost always where I live, but recently I've been taking cold showers and not using anything to cover me while I sleep (even a light sheet is enough to cause a hot flush) which seems to have helped. Cooking and baking also triggers this. It's a wonky brain response to what would be considered normal temperature changes. I'm not on HRT atm, so I think my experience is interesting to be compared to women on HRT who have the same symptoms. When I was still having normal periods, it was the opposite, my hands and feet were very cold to the point where I didn't feel comfortable in any weather!

@Abra1t how much extra are you adding? Half a pump, a quarter...? I've tried adding extra but it all gets a bit random especially with then working out how long a pump pack is going to last me...

This flyer has been sent to pharmacies and laboratories across the UK. I just noticed that the conical bottle doesn't have any green/orange squares. Maybe the conical bottles will come back after all, and hopefully the gel will be made in the same facility.

Roughly a quarter pump, or probably less.

Thing is, I only have hot hands and feet if my HRT dose isn’t right. When I’m taking the correct amount of oestrogel, I don’t feel hot in bed.

@Abra1t Then you can use this symptom to control the amount of gel you need. Better than weighing the gel every day!