Oestrogen tablets, patches, gel and spray

Oestrogen is used as a type of hormone replacement therapy (HRT). The type of oestrogen most commonly used in HRT is known as estradiol.

It's used to treat symptoms of the menopause. It also helps prevent weakening bones (osteoporosis) which is common after the menopause.

Menopause is when your periods stop due to lower hormone levels. It usually affects women between the ages of 45 and 55, but it can happen earlier. It affects anyone who has periods.

The fall in the amount of oestrogen your body produces can cause symptoms including hot flushes, low mood and vaginal dryness or irritation. Taking oestrogen as a form of HRT restores your levels of oestrogen and helps to relieve these symptoms.

Taking oestrogen can thicken your womb lining, which slightly increases the risk of womb cancer. If you still have your womb, you'll need to also take a progestogen medicine to protect your womb, such as Utrogestan (micronised progesterone). Alternatively, you can take a combined medicine that contains both oestrogen and progestogen.

If you've had a hysterectomy to remove your womb you can usually take oestrogen without progestogen.

Oestrogen is only available on prescription. It comes as tablets that you swallow and patches, gels or sprays that you put on your skin.

Brand names include Elleste Solo, Bedol, Progynova and Zumenon tablets, Evorel, Estradot, Estraderm, Femseven and Progynovna patches, Oestrogel and Sandrena gel, and Lenzetto spray.

If you're approaching the menopause and have symptoms (perimenopause) or have already gone through the menopause (post-menopause) you can usually take oestrogen tablets, patches, gel and spray.

If you still have your womb, you'll need to take your oestrogen with progestogen as well. This protects your womb while you're taking oestrogen.

If you've had a hysterectomy to remove your womb, you can usually take oestrogen without progestogen.

Oestrogen tablets, patches, gel and spray are not suitable for everyone. To make sure they're safe for you, tell a doctor or specialist nurse if you:

• have ever had an allergic reaction to oestrogen or any of the ingredients in the tablet, patch, gel or spray, or to any other medicine
• have ever had breast cancer, are having tests for breast cancer, or are considered high risk due to family history
• have ever had any other type of cancer
• have vaginal bleeding with no known cause
• have ever had a blood clot in a vein (thrombosis), such as in the legs (deep vein thrombosis) or the lungs (pulmonary embolism)
• have thrombophilia, a condition that increases the risk of blood clots
• have ever had angina or a heart attack
• have liver problems
• are pregnant or breastfeeding
• have a rare inherited condition called porphyria
• have diabetes
• have high blood pressure
• have migraines or severe headaches

Oestrogen (estradiol) tablets come in strengths of 1mg or 2mg. You take them once a day.

The patches release different amounts of estradiol into your body every 24 hours, depending on the brand.

Your dose of oestrogen depends on your symptoms, your age and any other health conditions you have. You'll usually start on a low dose, and it may be increased later, depending on how well it works and whether you get any side effects.

It may take a few weeks before you notice your symptoms improving, and you may get some side effects at first. It's best to keep taking it for at least 3 months, if possible, to see if it helps.

If your symptoms do not improve, your doctor may suggest changing your dose, or changing the type of HRT you're taking.

Swallow the tablets with a drink of water. Try to take them at the same time each day.

When you first start taking oestrogen tablets, if you're still having regular periods, start taking the tablets between day 1 and day 5 of your period. Then continue to take them every day.

If your periods have stopped or are infrequent, or if you've had a hysterectomy, you can start taking the tablets at any time.

Always follow the instructions on the leaflet that comes with your medicine.

When you first start using oestrogen patches, if you're still having regular periods, start using the patches between day 1 and day 5 of your period.

If your periods have stopped or are infrequent, or if you've had a hysterectomy, you can start using the patches at any time.

Always follow the instructions on the leaflet that comes with your medicine.

Stick the patch onto an area of skin below your waist, such as on your thigh or buttock. Do not put the patch:

• near your breasts
• on top of cuts, spots or irritated skin
• under elasticated or tight areas of clothing
• on creases or folds in your skin
• on your skin if you have recently used cream, talc or moisturiser
• on skin exposed to direct sunlight

Wait at least 1 hour after putting the patch on before you do any activity or exercise that will make you sweat as this can affect how the patch sticks to your skin.

You'll need to change your patch either once or twice a week, depending on the brand. Check the leaflet that comes with your patches.

Make sure you remove the old patch when you put on a new one. Put the new patch on a different area of skin.

If your patch falls off, put a new patch on a different area of skin, and then change it again at the usual time.

Your patch should stay on while bathing or showering but if it does fall off, dry your skin and cool down before putting on a new one.

Oestrogen gel comes in sachets (for example Sandrena) or in a pump dispenser (for example Oestrogel).

Put the gel on once a day. Try to use it at the same time each day.

Your doctor will tell you how many pumps or sachets to use. Follow the instructions that come with the gel.

1. Wash your hands.
2. Squeeze the right amount of gel onto your hand.
3. Gently rub the gel over a large area of clean, dry skin, on your lower body or arms – check the instructions for where you can use it.
4. Wait up to 5 minutes for the gel to dry before getting dressed.
5. Do not wash the area for at least 1 hour.
6. Wash your hands after putting on the gel.

Do not use the same area of skin 2 days in a row. Do not use the gel on skin near your breasts or genitals.

Oestrogen spray is called by the brand name Lenzetto.

The usual dose is 1 to 3 sprays, once a day, at the same time each day. Your doctor will tell you how many sprays to use.

1. Take off the cover and put the cone flat against your skin, on your inner forearm.
2. Press the button fully down once.
3. If you need to use more than 1 spray, move the cone to a different place on your arm for each spray.
4. Allow up to 2 minutes for the spray to dry before getting dressed.
5. Do not wash the area for at least 1 hour.

It's common to take HRT for 2 to 5 years to treat menopause symptoms, but sometimes you may need to take it for longer.

If you have premature menopause (premature ovarian insufficiency, or POI), where your periods stop before the age of 40, or early menopause, where your periods stop before the age of 45, you'll usually be advised to take HRT at least until you're 51 years old, which is the average age of menopause.

How long you take HRT for depends on the benefits and risks to you. Ask your doctor for advice.

If you forget your daily dose of oestrogen tablets, gel or spray, just skip the missed dose and take or use your next dose at the usual time.

If you forget to put on a patch, change your patch as soon as you remember and then change it again on the usual day.

Never take or use 2 doses at the same time. Never take or use an extra dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask a pharmacist for advice on other ways to help you remember to take your medicine.

Taking or using an extra dose of oestrogen is unlikely to harm you.

If you're worried, talk to a doctor or pharmacist for advice.

Talk to your doctor if you're thinking of stopping your oestrogen. They may suggest that you reduce your dose gradually, to help prevent your menopause symptoms coming back.

If you're having problems with side effects, your doctor might suggest changing your dose, or switching to another type of HRT.

These common side effects of oestrogen tablets, patches, gel and spray happen in more than 1 in 100 people. There are things you can do to help cope with them:

Headaches usually only last for a few days after you start taking oestrogen as your body gets used to the medicine. Try taking a painkiller such as ibuprofen or paracetamol.

If headaches last longer than a week or are severe, speak to your doctor. You may need to change your dose or switch to a different type of HRT.

This usually improves after a few weeks as your body gets used to the medicine. Speak to a doctor if it bothers you or does not go away.

If you notice a lump or changes in your breasts after a few months of taking oestrogen, contact your doctor for advice.

Unless you've had a hysterectomy to remove your womb, vaginal bleeding or spotting is common for the first 3 to 6 months after starting HRT, but usually settles down.

If you get heavy bleeding or unexpected bleeding after you've been taking HRT for 6 months, talk to your doctor.

Talk to your doctor if you've had a hysterectomy and you get any vaginal bleeding.

If you're taking oestrogen tablets, try taking them with food. Stick to simple meals and do not eat rich or spicy foods.

This side effect should wear off after a few days as your body gets used to the medicine. If it lasts more than a week, speak to your doctor. You may need to change your dose or switch to a different type of HRT.

This may last for the first few months as your body gets used to the medicine.

If it lasts longer than this or becomes too difficult to cope with, speak to your doctor. You may need to change your dose or switch to a different type of HRT.

Leg cramps usually only last for the first few weeks after you start taking oestrogen. Stretching your calf muscles regularly and gentle exercise may help prevent it.

If you keep getting leg cramps after the first few months of taking oestrogen, talk to your doctor as you may need a different treatment.

If this covers a large area of skin it will usually only last for about a week as your body gets used to the medicine.

It may help to take an antihistamine which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you.

If it does not go away after about a week, talk to your doctor, as you may need a different treatment.

If you're using patches, gel or spray and the rash or itchiness is only affecting the area where you're putting the oestrogen, talk to your doctor as you may need a different treatment.

Drink lots of fluids, such as water or squash, to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee.

If the diarrhoea lasts more than a week, speak to your doctor. You may need to try reducing your dose or changing to a different type of HRT.

Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.

If you have hair loss this may not always be caused by taking oestrogen, as it's sometimes a symptom of the menopause. If it worries you, speak to your doctor.

Speak to a pharmacist or doctor if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Serious side effects from oestrogen are rare.

Call a doctor or call 111 for advice now if you have pain, redness or swelling in one of your legs, usually in your calf – this could be a sign of deep vein thrombosis (DVT).

Speak to a GP if you have:

• a lump or changes in your breasts, especially dimpling of the skin, changes in the nipple or any lumps you can see or feel – this could be a sign of breast cancer
• any changes in vaginal bleeding after you have been taking oestrogen for more than a few months – this could be a sign of womb cancer

It's important to attend your breast screening (mammogram) appointments while you're taking HRT.

• you have pain in your chest and breathlessness – this could be a sign of a blood clot in your lungs (pulmonary embolism) or heart problems
• you have difficulty speaking or moving your arm or leg, or your face has dropped on one side – this could be a sign of a stroke

Do not drive to A&E. Ask someone to drive you or call 999 and ask for an ambulance.

Bring all the medicines you take with you.

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to oestrogen.

Call 999 now if:

• your lips, mouth, throat or tongue suddenly become swollen
• you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
• your throat feels tight or you're struggling to swallow
• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
• you suddenly become very confused, drowsy or dizzy
• someone faints and cannot be woken up
• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of oestrogen tablets, patches, gel and spray. For a full list see the leaflet inside your medicines packet.

Oestrogen tablets, patches gel and spray are not known to be harmful in pregnancy, but if you get pregnant while taking HRT then stop taking it and speak to your doctor.

Levels of oestrogen and progesterone are naturally high during pregnancy, so you will not need HRT.

There is not much information on taking oestrogen for HRT while breastfeeding. Most of the information comes from the use of other types of oestrogen as a contraceptive.

If you're breastfeeding and need to use HRT, oestrogen tablets, patches, gel or spray are not usually prescribed, unless a specialist recommends it.

Taking oestrogen as HRT is unlikely to affect your fertility.

Oestrogen tablets, patches, gel and spray do not act as a contraceptive.

Even if you think that you've gone through the menopause, unless you've had a hysterectomy there's a small chance that you could become pregnant.

You're advised to use contraception for at least 1 year from your last period if you're over 50 years old and for 2 years if you're under 50 years old. Discuss this with your doctor or family planning practitioner.

Tell your doctor if you're:

• trying to get pregnant
• pregnant
• breastfeeding

There are some medicines that may affect how oestrogen works.

Tell your doctor or pharmacist if you're taking:

• medicines for epilepsy, such as phenytoin, carbamazepine or phenobarbital
• certain medicines for infections, such as rifampicin, rifabutin, nevirapine, efavirenz, ritonavir or nelfinavir

There are several different herbal products sold to help relieve menopause symptoms. These include evening primrose oil, soya, red clover, black cohosh, ginseng and St John's wort.

All of these products might affect other medicines you're taking, so it's important to check with your doctor or pharmacist before starting to take them.

It's not possible to say that other herbal remedies and supplements are safe to take with oestrogen. They're not tested in the same way as pharmacy or prescription medicines. They're generally not tested for the effect they can have on other medicines.

Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.