Indications
17 beta estradiol (estradiol) is a natural form of the female hormone oestrogen. As a skin gel it is used as hormone replacement therapy (HRT) to relieve menopause symptoms such as hot flushes, night sweats, sleep problems, mood changes and vaginal dryness. In some women it is also used to help prevent osteoporosis (bone thinning) after menopause when other treatments are not suitable.
How It Works
After menopause the ovaries make much less oestrogen, which causes many menopause symptoms and faster bone loss. Estradiol applied to the skin is absorbed into the bloodstream and replaces some of the missing hormone. Because it is absorbed through the skin, it avoids first passing through the liver.
Dosage and Administration
Use exactly as prescribed; the dose is adjusted by the doctor to the lowest that controls symptoms. The gel is usually applied once a day to clean, dry, unbroken skin of the arms, shoulders or inner thighs, spread thinly over a large area and left to dry for a few minutes before dressing. Do not apply it to the breasts or genital area. Wash your hands after use. Women who still have a womb must also take a progestogen as prescribed to protect the womb lining.
Interactions
- Enzyme-inducing medicines such as Carbamazepine, Phenytoin, Rifampicin and St John’s wort can reduce its effect.
- Estradiol can lower blood levels of Lamotrigine, which may affect seizure control.
- It can affect thyroid hormone tests and the dose needs of Levothyroxine.
- Do not apply other skin products, sunscreen or moisturiser to the same area at the same time.
Contraindications
- Known, past or suspected breast cancer or other oestrogen-dependent cancer.
- Unexplained vaginal bleeding.
- Current or past blood clots in the veins or lungs, or known clotting disorders.
- Recent heart attack, angina or stroke.
- Active liver disease or abnormal liver tests.
- Untreated thickening of the womb lining, porphyria, pregnancy and breastfeeding.
Side Effects
Common effects include breast tenderness, headache, nausea, bloating, mood changes, irregular bleeding or spotting, leg cramps and skin irritation where the gel is applied. Long-term HRT slightly increases the risk of breast cancer, blood clots and stroke, and oestrogen alone increases the risk of womb cancer in women with a womb.
Get urgent medical help if you have painful swelling of a leg, sudden chest pain or breathlessness, coughing up blood, sudden weakness or numbness on one side, trouble speaking, a severe migraine-like headache for the first time, yellow skin or eyes, or a sudden rise in blood pressure. See a doctor soon for a breast lump or unexpected vaginal bleeding.
Pregnancy and Lactation
Estradiol gel for HRT must not be used during pregnancy or breastfeeding. If pregnancy occurs, stop using it and see your doctor.
Precautions and Warnings
Have regular reviews with your doctor and attend breast screening. Tell your doctor about endometriosis, fibroids, migraine, epilepsy, high blood pressure, diabetes, gallbladder disease, asthma or lupus. The gel can pass to other people by skin contact, so let it dry and cover the area, and avoid skin contact with children or partners until it has dried. The gel contains alcohol and is flammable until dry. Stop using it about 4 to 6 weeks before planned major surgery if advised by your doctor.
Overdose
Using too much may cause breast tenderness, nausea and vaginal bleeding. Wash the gel off and contact your doctor. Serious harm from overdose is unlikely.
Therapeutic Class
Oestrogen; hormone replacement therapy.
Storage
Store below 30°C, away from heat and flames, and out of the reach of children. Close the tube or pump tightly after use.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.