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.

@Abra1t So is that a quarter pump per pump? I'm just trying to work out, if I'm using 5 pumps and I was to add the extra you're adding, is that an extra 1.25 pumps...? Whenever I try to add extra I feel like I'm just being a bit random with gel unless I'm adding a whole pump. I was trying to do half a pump for a while but my Newson dr said it's hard to be precise with half a pump...

It’s barely a quarter extra pump and done by eye as much as anything, based on what I remember as the ‘size’ of the previous pumps. )See previous posts on people weighing doses too!)

I just use my eye tbh. No scales here.

Interesting. Mines only my feet but I've spent most of the year running cold water over my feet before I get into bed otherwise they're too hot for me to sleep. It's not so bad now it's colder but I can put my feet on the cold floors while watching TV so they're not so hot.

If you use more pumps of gel than prescribed, isn't it questioned when getting a repeat prescription that it's too soon?

Ive got these ones too!

@WhisperingJesse just baffle them with tales of deficient pumps and having to weigh it out etc. They will not have a clue.

Okay! I'll give it a try.

I’ve finally got a replacement prescription for Sandrena and have started on it this morning.

But I’m confused - the pharmacist said that 2 sachets is equivalent to 4 pumps of Oestrogel (2mg) but that actually the maximum licensed dose for Sandrena is 1.5mg so I’ll be exceeding the licensed dose.

But actually (as someone up thread pointed out) the equivalent to 4 pumps of oestrogel would be 3 sachets, not 2 (3mg). This is twice the licensed dose!

Why is the licensed dose for Sandrena less than for Oestrogel?

None of it makes sense and now I don’t know what to do. I’ve been feeling so bad for so long I just want to feel better, but reducing my dose to 2mg from 3mg doesn’t seem right.

Also - it says to apply it on alternate sides of the body each day.

Why?

@Namddf ignore the licensed dose thing. It is totally arbitrary and the Newson Clinic are constantly trying to debate it. When different women absorb these products so differently (I have v low absorption on 5 pumps of gel) it makes no sense to licence it according to what we apply to ourselves. If they want to do that, they should be looking at serum estrogen levels - but in peri even that is impossible to do and would involve too much testing.

The only way the licenced dose thing is relevant to anything is that at the moment it can be hard to get a regular NHS GP to prescribe higher than the licensed dose if they haven't been told to by a menopause clinic or a specialist because they are just following the rules they've been told to follow. If you find yourself in that situation, the best thing if you can, is to get a private consult with Newson (or similar meno clinic privately) and get them to write to your GP and tell your GP what to do.

Anyway - you just need to use the amount of Sandrenna which equals the gel dose you were on. Bearing in mind you might absorb it differently though. See this page for equivalents: https://www.balance-menopause.com/menopause-library/what-to-do-if-you-cant-obtain-your-usual-estrogen-gel/

So 3-4 pumps is equal to 1-2mg sachets. It's going to be a bit of a rough equivalence but you can always move up/down if needed.

Thank you @everythingyouneedtoknow that’s really helpful.

I still don’t understand how 4 pumps of gel is equivalent to 2mg of Sandrena though - it adds up to 3mg which would be 3 sachets, surely?

If each pumped dose is actually lower volume than it should be and you use a bit more to make up the deficit it doesn’t alter how quickly you get through the pump.

Because they're not the same product. That's why the chart is helpful.

I like being on Sandrena now, the amount of gel to apply is minuscule compared the pumps of oestrogel.

ignore the licensed dose thing. It is totally arbitrary and the Newson Clinic are constantly trying to debate it.

Unfortunately, the British Menopause Society doesn't agree with that. What I'm posting is not a personal opinion but written in their report.

The BMS issued a strongly worded report a few months ago on the risks of too much estrogen (for the endometrium, without the respective increase in progestogen.)

The Newson clinic wasn't named, but it is clear there is a difference of opinion. The BMS said that it would be very unusual for women to need more than a licensed dose.

A licensed dose is not 'arbitrary'. It's the result of trials and safety trials.

It's possible women absorb very differently but if that's the case, the advice is they should maybe change products to patches or even tablets if they have no additional clotting risk.

It does seem arbitrary though @JinglingXmasbells

4 pumps of oestrogel delivers 3mg of oestradiol and this is the maximum licensed dose. 2 sachets of Sandrena gel delivers 2mg of oestradiol and that is above the licensed dose.

It is simply not logical so seems like (as with a lot of things menopause related) they are just making it up.

For anybody who has contacted Besins, they emailed me but it went in to my junk folder, it was only for more details nothing to report but just so people are aware. It’s been sat there for 2 weeks and they tried again after a week.

It is totally arbitrary. The BMS are so notoriously conservative they would still be promoting the WHI study left to their own devices. They have to be dragged kicking and screaming into modern times. And of course it is arbitrary, even common sense tells you that. On both patches and gel I absorb poorly. Other women using the same dosage that I'm currently using have estrogen levels 4x+ what mine are.

And - read the research Newson have carried out and posted above by @Azaleah to see how there is no relationship between estrogen dose, serum estrogen and endometrial risk... I wouldn't rate anything the BMS state until I'd read it in other sources, I've no idea what their agenda is - there always is one. To sniff it out, you only have to ask 'who in power does this serve?' and you'll have the answer if you know the answer to that question. It works across human society, by the way.

Ladies, keep in mind how the metering pump mechanism works. Once the pump has been fully depressed, the new dose will fill a reservoir that will dispense the next dose. If you don't press the pump all the way down, the next dose won't be correct and you won't have control over the amount dispensed.

I just got one today as well asking for permission to contact your GP and other info.

I've had that email too, twice. Not answered it because my GP is clueless about HRT so there's no point!

Got another one from the UK and they want the bottle which I haven't kept but they don't want it if empty or nearly empty so will have to repeat with my new one.

Hello ladies, how are you doing?

While looking for a photo of both versions of Oestrogel packaging to help a friend in her search for conical bottles in pharmacies, I came across Brook Pharmacy (Dublin)'s FB page. The most recent post (reel) is very interesting because it shows side by side a very old version of the Oestrogel packaging with an orange swirl and the current packaging. Two possible explanations:

1. This is an old video.
2. Besins and/or parallel import companies are procuring old Oestrogel stock in other countries.

https://web.facebook.com/bonnybrookpharmacy

@Namddf I too have been swapped on to sandrena gel two sachets a day and my symptoms are back. I'm just waiting for the doctor to call tomorrow, to see what dose I can try.
I looked at the ingredients and as far as I can see the oestrogel has 1.25mg, so 4 pumps would be 5mg. I know 2mg of sandrena ia just not enough.

I just wish it would be sorted out as I've been struggling on and off now for 5 years. I can't cope with this constant struggle of swapping.

Hopefully the doctor will be able to advise me in the morning.

@Hartieharts I don't know if this info will help you but each pump of gel is 0.75 estrogen. So for most women, 2 pumps, which gives 1.5mgs, is the 'norm' (as it says on the Patient Leaflet.) Obviously some women need more.

The 2 pumps= norm is based on the tablet dose available (which only come as 1mg and 2mgs)

Sandrena is slightly different because it's a different consistency (I understand.)

How much someone absorbs with either gel can vary a lot.

This can depend on where it's applied (to which part of the body), skin permeability, even using soap or shower wash beforehand, (this used to be mentioned on the Patient Leaflet) and how thickly/thinly it's spread each time it's applied.

My understanding (from the older Patient Leaflets some years ago) is that the area over which gel is applied makes a difference. That old leaflet said apply gel over the leaflet area (using it as a template) which was huge! It was about the size of an A4 sheet. So the area and site it's applied can make a big difference (and I know I don't get it the same every day.)

I am still convinced that my (very carefully) pumped Oestrogel doses are not as large as they used to be with the old bottles. I can't be bothered to buy jeweller's scales to prove it.

Anyway as NICE seems to have decided menopausal symptoms can be treated with CBT, who knows what difficulties we may face even getting hold of HRT. So if I have some 'spare' doses left at the end of a pump bottle, I shall hoard them, just in case. Joking, but only just.