Oestrogel arm/thigh application rotation

[Wonderbug81]

I've been peri for 4 years, fairly steady management for a while with HRT (oestrogel, utrogestan). Recently (past 3 months) had v high anxiety and low motivation etc. Blood tests just back and it says testosterone is extremely low.

Also says Estradiol is 97 pmol even with 3 pumps Oestrogel.

Waiting for menopause doctor appt to discuss options but having done some research I've just found out that you're supposed to rotate the location between thigh and arm. I've been using my inner thigh for at least a year.

How much might this have affected things? Anyone had an improvement when they started rotating location or is it likely that I'll need to increase dose too?

Don't want to increase dose unnecessarily because that can often come with its own side effects!

You don't need to rotate the application site.

There's a lot of mixed info on this and it really makes no difference if you rotate or not. (I've used gel for over 15 years.) I use my arms but sometimes the gel does make the skin a bit dry so I them change to my inner thighs.
However, if you want to experiment by swapping, it's easy to do that.

Also, blood tests are really not accurate. There are many scientific papers on this (online) where it's been shown that blood tests are not reliable. My consultant has never used them and says (which is what the research says) that the only reliable test for estrogen would need to be done constantly over 24 hours.

One thing you could try as you're using 3 pumps is to split the dose morning and night. So 1 pump on each thigh in the morning, and 1 pump in the evening.The British Menopause Society suggest this for higher doses. The reason is that you have to spread the gel thinly. If you're putting more than 1 pump on each inner thigh it may not be spread thinly enough. (I spread 1 pump between both legs or arms.)

How are you applying it at the moment?

Thanks. I don't normally pay much attention to these tests either but given I've had anxiety symptoms/high heart rate for 3 months alongside various other symptoms and other specialists discounted other possibilities e.g. cardiologist tested and said most likely to be hormones as no other issues with heart) I think there is some merit in this particular test. Even without the test my symptoms point to needing more oestrogel.

I apply with a plastic spatula so I can get as much on the skin vs hands as possible, leave to dry for 5 mins, don't apply too thinly or thickly. Apply 1.5 pumps across the largest expanse of each inner thigh as possible but will try 1 pump on each thigh and 1 pump on one arm from now on. Doesn't really suit to split the dose across the day.

I genuinely think this may be about getting better absorption. I use 1 pump only and apply that between both arms or both thighs. I'd struggle, personally, to apply 1.5 pumps to inner thighs and get a thin layer that dried quickly.

On 2 pumps I was splitting the dose am and pm, because initially I was getting 'morning sickness' feelings with 2 pumps at once.

Give it a whirl.

Not sure if this is relevant to you, but I recently saw an instagram reel saying that you shouldn’t really rub the gel in… just a quick swipe over and back then wait for it to absorb. I’m not using the gel anymore but I think i was rubbing it in quite a bit when I did use it.

Also, you could consider switching to patches to see if you get better absorption. I prefer Estrodot rather than Evorel

Jeez I hope i am applying it correctly. I apply 3 pumps on my right upper arm with one finger and its not really spread thinly, I just wait till it dries before getting dressed. I have no idea if this is right or not now! Any residue left is wiped on my inner thigh. I've been doing this for a while.

Thank you. I use a flat spatula kind of thing (it's actually a platerer's tool 😁) and leave a thin layer. It's possible the layer is too thin though.

Do you have any symptoms? Usually easiest way to tell if it's OK. There's also an element of, perhaps you actually need 2 pumps but because of the way you apply 3 pumps gets the equivalent of 2 pumps to you as it counters the poor absorption.

I think it's all trial and error. I imagine different types of skin etc also have an effect.

If this helps, in older versions of the pump, the leaflet advised on how much skin was needed to spread the gel.

The template was the leaflet which was/ is a large A4 size.
So that is the amount you ought to be covering in a thin layer.

You don't rub like mad, as if you're cleaning a window (!) but you do need to smooth it up and down with a few strokes so it's not so tacky as when first applied.

@NippyNinjaCrab I can't see how 3 pumps can be spread on one upper arm because you're only supposed to apply it on the outer arm, not the inner side near your breasts. Isn't it taking ages to dry?

Is that for 2 pumps?

I think I'm OK as the plasterer's spreader helps get it quite even as a thin layer. I read about this tip on another forum as a way of getting as much on the area as possible.

I assume it's for 1 pump each upper arm.

I know everyone has their own method.

I pump 1 pump into my palm. I press my palms together lightly just enough so the gel divides between my two hands then rub it over each upper arm.
If anything is left I wipe my palms over my inner thighs.

There are numerous methods online.

One new method is saying apply from shoulder to wrist, yet years ago it was upper arm (or inner thigh) only as it was supposed to be absorbed more by fat and there is little in the forearms.

@JinglingSpringbells I would say approx 15 mins and I brush my teeth and cleanse during that time. I better read my leaflet, I was told upper arm and shoulder nothing was specified only outer arm but it doesn't go anywhere else until dry tbh. 3 pumps is quite a thick layer yes.

You're all doing better than me. I just put a bit on, when I remember, after I've got my pyjamas on.
Still on my first bottle 18 months in.

I've definitely been applying it incorrectly with 3 pumps in one area. It says from wrist to shoulder, outer arms or inner thigh. One pump each area.

After reading oestrogel patient information from across the world, for my three pumps I spread it across my thighs, lower belly and bum. I'm short so outer arms and inner thighs just don't have the acreage i need and it's hard enough to do once a day, nevermind twice. I certainly feel I'm getting a better dose this way.

@NippyNinjaCrab I'm wondering if the leaflets have changed or different packaging has different leaflets?

I've used it for years and the 'whole length of arm' was never part of the guidance. It was outer upper arms (and shoulders) or inner thighs.
I'll read the leaflet again out of interest.

It takes mine about 60 seconds to dry- that's one pump divided between 2 outer upper arms. I was doing 2 pumps for years but have reduced to one.

@Wonderbug81 @NippyNinjaCrab

For info- I've just checked the leaflet partly to see if anything has changed .

Instructions say -

Apply to the shoulder, outer arm or mid-inner thigh.
(Nothing about the arm to wrist.)
For 2 pumps use arms or legs, for 4 pumps use arms and legs.

It says allow to dry for 5 minutes- so that is a guide as to how long it takes if you're spreading it fairly thinly.

I didn't take the leaflet out of my box, I checked it online so I will check the box. That's very misleading online isnt it if it is different info. I have applied it as you recommended ded this morning, I used the cap to apply, did upper outer arms and shoulder a pump each and one inside thigh with the residue on the other thigh. Hopefully that will help with proper absorption now. I do have an appointment booked for 1st April for a review of my HRT, this was because I am having symptoms and I thought I might need an increase. Now I think I have been applying it wrong.

Thank you as always for your expertise and advice on the menopause section xx

@Wonderbug81 hope you’re getting on ok with your oestrogen. @JinglingSpringbells ive posted a bit before in this section and I’m now puzzling over how best to apply 3 pumps of oestrogel. When I went up from 2 to 3 GP said anywhere below the belly button so I do a pump on each inner thigh, then split the third pump on the thighs but as it’s quite thick / not drying v quickly with excess wiped on buttocks and tummy below belly button. All at bedtime, when I also take progesterone. But from reading this I’m wondering if the third pump should be on arms or at a different time of day? Is it too thick if I’m effectively doing 1.5 pumps on each inner thigh?

reluctant to do arms at night as then in bed next to DH

why don't you apply in the morning?
I don't understand why you leave it till bedtime. There is no rule about using gel and Utrogestan at the same time of day. (I've seen that somewhere online but it's not standard guidance.)

Your GP is incorrect anyway - the leaflet in the pack says apply to upper outer arms or inner thighs.

Just split the dose morning and evening or use 2 arms and 1 leg whenever you apply it.

Thank you. I've actually been moved to Evorel patches. I am feeling so much better and without the faff of waiting for the gel to dry every day. Wished I'd started with patches 4 years ago!

Might be worth a try if you're having challenges. One thing that seems to help whether with gel or patches is ensuring the skin isn't dry etc. It's tricky because low estrogen will lead to dry skin but I've been meticulous about applying body cream every day (not around the time of applying the patch) and I think it's helping with absorption.

@JinglingSpringbells i apply in the evening as when I started HRT either the progesterone or oestrogen said to take at the same time (I need to check which) and as I have to take the utrogestan at night it made sense to do the gel at night too.

I agree what the GP said doesn’t match the leaflet but she was very clear any expanse of skin below belly button was ok, so not she’s incorrect, just suggesting something else. I was just musing she didn’t suggest splitting the dose.

presumably I could use 2 legs and 1 arm?

and was there ever any truth in having to rotate / alternate arms and legs?

@Wonderbug81 glad you’re getting on ok with patches. Others I know haven’t liked them for the sticky marks and not being great when it was very hot.

The sticky marks just need to be rubbed a little but they come off easily after a shower. May depend on brand though. Hard to say re hot weather as I was in the first 3 months where you are waiting for symptoms to settle down. Did some people find they weren't working, or that they were coming off from the heat?

Re your application, when the gel was working I was using it all in the morning and utrogestan in evening with no issues but appreciate everyone's different. I suspect that one arm and two legs or vice versa would help and I would try keeping the areas nicely moisturised in the evenings instead as I do think it helps with absorption (makes sense that if the skin is smooth and unbroken it is more likely to absorb). But these are just my hunches of course. I hope you manage to find something that works.

TBH there is a lot of mixed info out there. I have read somewhere on some leaflet or whatever take Utrogestan at the same time as applying gel (or the other way round) but I think it's a bit of nonsense to be honest- there's no logic to it because the drugs are in your system 24 hours.

I'd been using it for years with an excellent consultant (with very regular reviews) and never told that.

There is definitely no guidance about below the waist- this tends to apply more to patches. The only area to avoid is the breasts. If you use your upper outer arm, leave it to dry and wear a bra, it isn't going to get on your breasts.

There is a video on Dr Louise Newson's website of a doctor demonstrating applying gel on her arms.

@JinglingSpringbells thanks. How did you get to see a consultant? I’m still wondering about trying to get a menopause clinic referral as neither GP I see - who are both supposed to be HRT / meno specialists in the practice - seem completely up to date.

I’ll look up the video. I did read the guidance on Dr Louise Newson’s website re applying gel (which was also where I saw it said if more than 2 pumps split morning and evening) but didn’t see a video

Given I have to wait 15 minutes for the gel to dry, I just don't have the time to apply it in the morning. I googled patient info leaflets and found different recommendations, between outer arms, and anywhere below the belly button, so I just slather it where I can. One thing I read about rotating areas was so that the alcohol in the gel doesn't dry out the skin. I don't have that issue luckily.

I need to get a new prescription next month and I might try the patches again. Estradot worked really well for me but they are rarer than hens' teeth and I found the replacement ones very crinkly. But the fannying around waiting for the gel to dry in winter isn't fun either.