Oestrogel: new packaging (yet again)? - Thread 2

[ConfusedEasily]

Carrying on from a previous thread by Cosmetichamster which can be found here:

https://www.mumsnet.com/talk/menopause/4696464-oestrogel-new-packaging-yet-again

Plus boobs the size of watermelons that aren’t fitting in my bra!

Hi, I've been following this thread from the start as I'm also having problems with the cylindrical bottle. I did a yellow card and reported to Besins and they responded by collecting a couple of my used bottles from my local chemist.

It has taken over a month to get a further response but now they have asked for my consent to contact my Dr and want to know any other medications and my age/height/weight.

I'm not quite sure to make of this or if I want to go ahead with consenting to them contacting my Dr. What would others having problems do in this situation?

1 pump of Oestrogel = 0.75mg estradiol (the active ingredient)
1 sachet of Sandrena = 1mg estradiol

Therefore 4 pumps of Oestrogel = 3 sachets of Sandrena

2 pumps of Oestrogel = 1.5 sachets of Sandrena

etc

The tables tell you that 4 pumps of Oestrogel = 2 sachets of Sandrena, which is wrong. That’s not the same amount of the active ingredient.

I’ve been on the cylindrical oestrogen for a few months and everything seemed ok until I went through about a fortnight of night sweats recently.
Went to the gp to talk about upping the dose from 4 to 5 pumps and was told it wasn’t licensed above 4. Also that any alternative could only be given to the same maximum dose. I was offered anti depressants which have a side effect of reducing night sweats. I don’t think my symptoms are that bad so haven’t taken these up.
Things seem to have settled down but I’m still waking at 3.30am.
I think that the pump on the white top bottles isn’t very accurate and you can get varying amounts.

Bellaciao explained it really well here on the previous thread, @Namddf The two products are different and Sandrena is much stronger.

Bellaciao · 18/11/2023 10:22

Just to add - if it hasn't already been said - that Sandrena gel is nearly twice as concentrated as Estrogel - Sandrena is 0.1% and Estrogel is 0.06%, as well as being a different consistency as Jingling said, with different "fillers" (excipients).

It is therefore a completely different product in this sense, despite the active ingredient being the same, and will be absorbed differently. It is not possible to make a direct comparison in terms of total oestrogen. The higher concentration means also I think, that it may not need to be spread on such a wide area as Estrogel but haven't checked this?

A better comparison to look for equivalents would be to compare the steady state estradiol level in a trial group of women after a given dose and from there extrapolate to the equivalent dose between them. This may well have been compared by the powers that be eg BMS in order to arrive at their equivalence information ( but I haven't checked).

The concentration is simply about how much estradiol is in the product per g of product.

1 pump Oestrogel has 0.75mg of estradiol. A 1g sachet of Sandrena has 1mg of estradiol. So yes, they are different concentrations, which is why 4 pumps of Oestrogel doesn’t = 4 sachets of Sandrena. They’re not directly equivalent.

What matters is the amount of estradiol in a dose. And to get the equivalent amount of estradiol in 4 pumps of Oestrogel you need 3 sachets of Sandrena. It’s maths.

Also, from personal experience I know that I need 4 pumps of Oestrogel to feel ok. When I swapped that for 2 sachets of Sandrena (which I was told was equivalent to 4 pumps Oestrogel) I had a return of symptoms. When I increased it to 3 sachets my symptoms went away again.

So basically you would need 1.5 sachets if you were on two pumps ? ( sorry, always been rubbish at maths!) . I really wish they would just sort out whatever is going on with the oestrogel as so many of us have been settled and now it’s like starting over again on this hideous journey !!

The info on the tables you found is correct.

Your most recent post says the same thing.

No, it doesn’t unfortunately.

The tables say that 2 sachets would be the equivalent of 4 pumps, which isn’t right. My GP said the same thing (reading off the tables)

And to make things more confusing, anything over 1.5 sachets is officially off licence for Sandrena.

It’s a total mess.

I’ve spoken to my menopause consultant today who was not surprised when I told her my issues and agreed there is definitely an issue with the new bottles . I’ve been prescribed Sandrena to see how I get on with it

@Rockschooldropout At least someone professional is acknowledging it.

My GP was none the wiser and still isn’t convinced. If I were a GP I’d be doing a hell of a lot of research into this.

@Namddf The info on the equivalent tables is produced by the British Menopause Society. I doubt they are wrong because they're the experts in all of this and the information was produced when there was a really bad shortage of estrogen, both as gel and patches. If you are having issues with swapping it's worth perhaps contacting them via their website to see if they have further advice.

As a PP said, Sandrena is almost twice as strong as Oestrogel. So, approximately, 1 sachet of Sandrena is the same (or slightly more) than 2 pumps of gel. You won't get an exact equivalent but at least with gels it's possible to use half a pump/ hafl a sachet to get the best personal level.

My 60 pumped doses (30 days times two pumps) of oestrogel per cylinder should have been up on the night of the 7th. And here I am, still pumping away. Nine extra pumps so far...

(And that's with very careful pumping, discarding first pump, etc. And I've been using the stuff for more than four years now.)

@Abra1t I think that the volume of gel you get is different each time you pump.

I’m going to ask to swap to Sandrena or patches as this oestrogel doesn’t work as well anymore. I’m on 4 pumps/day and don’t feel happy to just up the dose.

Anyone have experience of changing? Is it better to go to Sandrena or are patches as effective?

@Namddf this is a private clinic but as soon as I started telling her she was nodding her head .. it seemed she knew what I was going to say .. She’s not impressed and said there is clearly an issue that Besins aren’t acknowledging.
she’s put me on 1.5 sachets of sandrena so once I get that I’ll see what happens

@Abra1t I've always got more from the pumps of gel than expected. They contain 64 pumps and for whatever reason, I usually get another 2-3 days.

Afternoon all,
Sorry to see more people are being affected by this but,hopefully the message is slowly getting through to the professionals which may help in (eventually) getting an acknowledgment from Besins.
I spoke with my GP and have moved back to Evorel 50 patches.
I was on 75 for a week but asked to change back to 50 as I felt bloated and nauseous.
So far I feel ok on the 50 patches. It’s ridiculous as I seem to spend so much of my day analysing if I feel ok instead of just getting on with my life.
I should probably ask husband as he certainly noticed the negative change over the past few months.
I’m so fed up of waking up wondering what the day is going to be like but pleased I made the change as I was feeling dreadful on the ‘new’ Oestrogel.
I am less tearful and calmer (given the time of year) and night sweats have gone away again.
Such a lottery the whole thing and not one we should have to navigate.

Me too. This is five days extra and counting, though.

@JinglingSpringbells We’ll have to agree to disagree!

What I’m confused about is that on another thread you told someone that 2 pumps Oestrogel = 1 and a half sachets of Sandrena and their GP was wrong. So you agreed with me then?

https://www.mumsnet.com/talk/menopause/4508697-Confused-about-Oestrogel-vs-Sandrena-switched-due-to-shortages

@Namddf Sandrena comes in 0.5 mgs sachets a s well as 1mgs. I'd suggest anyone who's not sure follows the advice on the BMS chart. They are the experts and that chart is replicated on many other sites including one by Dr Newson and the Women's Health Concern. They all say that any equivalent is 'approximate' as there is no direct equivalent between two different gels.

The volume of gel you get is different each time you pump.

I agree with this. I was on one pump from the old bottle. Switched in September to the new bottle. I take two pumps of gel now.

You’re not consistent with what you’re saying, so I will disregard it.

I think we all know that it’s very hard to trust the ‘experts’ when it comes to menopause as there is so little research and knowledge among some health professionals.

Most of the women on this board will have had to take things into their own hands at some point and do their own research, as advice is so inconsistent and unclear.

My menopause ‘expert’ GP told me that if I was still having regular periods I couldn’t be perimenopausal, for example.

So no, I definitely wouldn’t blindly trust the ‘experts’.

I’m aware, obviously, that Sandrena comes in different size sachets - I’m talking about dosages and the amount of estrogen per mg.

I changed to oestrogel from Evorel patches 2 months ago as I felt my symptoms were starting to return and I thought the gel would be more flexible. I have upped it to 3 pumps but I find my sleep is getting worse and I am getting a lot of aches which I never had before. So I feel that it isn’t working at all for me even though I’m on a supposedly higher dose