Understanding Oestrogel, Sandrena and Lenzetto for improving perimenopause and menopause symptoms
• Replacement oestrogen can be given during perimenopause and menopause to improve both symptoms and future health
• Oestrogen-only gels and spray contain oestradiol, a body identical hormone
• Understand the benefits and risk of oestrogen-only gel and spray
During perimenopause and menopause, oestradiol (oestrogen) levels fluctuate and then decline, which usually leads to symptoms occurring. Oestradiol-only HRT is prescribed to relieve these symptoms - it works by replacing the oestradiol that is lost.
Oestradiol can be given either through your skin, known as transdermal oestradiol, or orally in the form of a tablet. Oestradiol-only gel and spray is a type of systemic HRT, which means when the gel or spray is applied to your skin, it releases oestradiol directly into your bloodstream where it travels through your entire body and improves symptoms related to low oestradiol.
RELATED: Oestrogen in patches, gels or sprays
What types of oestradiol-only gel and spray are available?
Brands such as Oestrogel, Sandrena and Lenzetto all contain the hormone oestradiol. This is identical to the oestradiol that’s produced by your body.
Oestrogel is packaged in a pump-action bottle and each bottle has 64 pumps of oestrogen gel in it. The most common dose is between two and four pumps a day but this is individualised and some women need more.
Sandrena is a gel that’s packaged in sachets, which come in 0.5mg or 1mg sachets. The dose will vary depending on your symptoms.
Lenzetto is a spray formulation, and each spray contains 1.53mg oestradiol. The dose is usually between one and three sprays per day, but your doctor may adjust this according to your symptoms and some wome need more.
RELATED: How to find the right dose and type
What are the benefits of oestrogen-only gel and spray?
There is no increased risk of clot or stroke using transdermal oestradiol, and women who have a history of migraines can still take oestradiol through the skin.
Gels and sprays offer flexibility – if your need for oestradiol increases or decreases, you can alter your dose, in consultation with your healthcare professional.
As well as reducing menopausal symptoms, taking HRT can reduce your future risk of diseases, including osteoporosis, diabetes, cancers, diabetes, dementia and cardiovascular disease.
What are the disadvantages of oestradiol-only gel or spray?
For most people, the benefits of HRT outweigh any risks.
Some women find the gels messy to use, particularly if they use more than one dose. Other women find they can slide off or float on their skin and not absorb effectively but this can depend on many factors, including your skin texture and thickness. Other women find the spray inconsistent or that it doesn’t get absorbed properly.
Oestrogel, Sandrena and Lenzetto contain alcohol (ethanol), which can cause a burning sensation on damaged skin, for instance if you have eczema.
If you find the gel or spray awkward to use or if you don’t absorb the oestradiol effectively, you may want to try oestradiol patches instead.
Many women find that the absorption of oestradiol from Lenzetto spray is unreliable so dosing can be hard to be optimised.
The Sandrena gel is thicker in consistency than Oestrogel, which means that usually a smaller amount is needed which can be preferable.
RELATED: Oestrogen-only patches
Can I expect any side effects?
It often takes a few months for your body to adjust to taking any HRT, so you may notice some mild side effects. The most common are breast discomfort, leg cramps, and breakthrough bleeding or spotting. These usually settle over time, but talk to your doctor if side effects persist for longer than the first six months.
How do I use oestrogen-only gel and spray?
Oestrogel and Sandrena should be rubbed into your skin on either the outside of your arms, from your shoulder to your elbow, or the inside of your thighs. It is not greasy and most women find it dries easily.
Once your skin is dry, it is usually advisable to wait around 30 minutes before using other creams on the area, including sun cream. You should wash your hands with soap and water after applying the gel.
If you use Oestrogel and need more than two pumps, it is often preferable to divide the doses between the morning and the evening.
Lenzetto should be applied every day, at around the same time, directly onto the skin on the inside of your forearm. To apply your daily dose, take off the plastic cap, hold the container upright and rest the plastic cone against your skin. Press the button once to release a single spray. If you’ve been prescribed more than one spray, you should move the cone along your arm, making sure that you don’t overlap the area that you have already sprayed. Alternatively, you can apply to your inner thigh. Let the spray dry for at least two minutes before getting dressed, and don’t rub it in.
RELATED: HRT easy prescribing guide
What else do I need to know?
If you still have your womb, you’ll also need to take a form of progesterone or progestogen, which is usually given as a tablet or via the Mirena coil. This is because taking oestrogen can thicken the cells in the lining of your womb but taking progesterone or progestogen protects the lining of the womb. Some women take progesterone if they have had a hysterectomy or have a Mirena coil in as there are many benefits from taking progeterone – watch my video All About Progesterone.
Two to three sprays of Lenzetto is roughly the equivalent of two pumps of Oestrogel, 1mg sachet of Sandrena gel, a 50mcg patch or 1mg oestrogen-only tablet. You can read more about doses of commonly prescribed HRT in my HRT Easy Prescribing Guide.
Vaginal hormones, including oestrogen and prasterone, can be taken – instead of or as well as – oestrogen-only gel or spray and can help alleviate symptoms associated with Genitourinary Syndrome of the Menopause (GSM), including vaginal dryness, discomfort or pain during sex, irritation or burning of the vulva or vagina, needing to go to the toilet more often and feeling very desperate to go, and urinary tract infections such as cystitis.
RELATED: Vaginal hormones: what you need to know
Resources
NHS: Oestrogen tablets, patches, gel and spay
