EstroGel
Estradiol gel (EstroGel) is a hormone replacement therapy used to relieve menopausal symptoms like hot flashes and night sweats. Unlike some other estrogen gels, it's also FDA approved to treat vaginal symptoms from menopause, such as vaginal dryness and irritation. It comes as a pump bottle, and the dose is applied to the skin on your entire arm once a day. The gel is available in both brand-name and generic forms. Common side effects include headache, passing gas, and breast pain.
What is Estradiol gel (EstroGel)?
What is Estradiol gel (EstroGel) used for?
Hot flashes and night sweats due to menopause
Vaginal dryness and irritation due to menopause
How Estradiol gel (EstroGel) works
Estradiol gel (EstroGel) contains man-made estradiol, a type of estrogen that the body naturally makes. During menopause, estrogen levels drop, leading to symptoms like hot flashes, night sweats, and vaginal dryness. Estradiol gel (EstroGel) works by replacing estrogen, which helps relieve these menopausal symptoms.
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What are the side effects of Estradiol gel (EstroGel)?
Common Side Effects
- Breast pain (11%)
- Headache (10%)
- Passing gas (5%)
Other Side Effects
- Skin rash and itching
- Nausea
- Stomach bloating
- Diarrhea
- Hair loss
- Dizziness
- Trouble sleeping
- Weight gain
Serious Side Effects
- Heart attack: chest pain, cold sweats, left arm pain, difficulty breathing
- Stroke: sudden weakness on one side of your body, bad headaches, trouble breathing, or changes in your speech or vision
- Blood clot: chest pain, shortness of breath, dizziness, fast heart rate, swelling, pain, or redness in the arms or legs
- Cancer: lumps, pain, swelling, or changes in the breasts; swollen lymph nodes, unusual or heavy vaginal bleeding, bloating, extreme tiredness, stomach-area pain
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Blood clot—pain, swelling, or warmth in the leg, shortness of breath, chest pain
- Breast tissue changes, new lumps, redness, pain, or discharge from the nipple
- Gallbladder problems—severe stomach pain, nausea, vomiting, fever
- Increase in blood pressure
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
- Unusual vaginal discharge, itching, or odor
- Vaginal bleeding after menopause, pelvic pain
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
Pros and cons of Estradiol gel (EstroGel)
Pros
Relieves bothersome menopausal symptoms, such as hot flashes and night sweats
Also FDA approved to treat vaginal symptoms due to menopause
Applied directly to the skin on your entire arm
Only need to use once a day
Cons
Raises your risk of certain cancers, blood clots, and strokes
Risk of exposing others to estrogen through skin contact
Might also need to take a progestin medication if you have a uterus
Need to wait for the gel to dry completely before bathing, showering, or swimming
Pharmacist tips for Estradiol gel (EstroGel)
Estradiol gel (EstroGel) can transfer to others through skin-to-skin contact with the application site. After applying the gel, let it dry completely and wear clothing over the area. And wash your hands with soap and water immediately after applying the medication. Avoid letting others contact the application area for at least 1 hour.
Apply estradiol gel (EstroGel) after your bath or shower, and wait as long as possible before swimming. Washing the area too soon can reduce how much estrogen your body absorbs, which can affect how the medication works.
Talk to your prescriber about the best time to use sunscreen or moisturizer with estradiol gel (EstroGel). A study found applying sunscreen 1 hour after the gel reduced estradiol absorption, while applying moisturizer 1 hour after the gel increased estradiol absorption. Absorbing too much of this medication can lead to more side effects.
If you have a uterus, your prescriber might recommend taking a progestin medication along with estradiol gel (EstroGel) to lower the risk of uterine (endometrial) cancer. Check with your prescriber to confirm your treatment plan.
Using estradiol gel (EstroGel) for a long time can raise the risk of serious health problems, such as breast cancer and heart attacks. That's why it's important to use the lowest dose for the shortest possible duration. Talk with your prescriber regularly to decide if you should continue treatment.
Estradiol gel (EstroGel) is flammable, meaning it can easily catch on fire. Avoid fire, flames, or smoking until the application site has dried to protect yourself and others around you.
Store estradiol gel (EstroGel) at room temperature and keep track of how many doses you've used. The pump delivers a total of 30 doses (30 pumps) after priming. Throw away the used pump even if there's still gel left in the pump, and start a new one.
How to use estradiol gel (EstroGel):
It's important to read the Instructions for Use before using the medication to make sure you apply the dose correctly.
Prime: To use the pump for the first time, you need to prime it. (1) Remove the cap and the small cover on the tip, then hold the pump over a sink. (2) Press down on the pump 5 times and wash the gel down the sink to prevent accidental contact with others. The pump is now ready to use and doesn’t need to be primed again.
Apply: (1) Pump the gel into the palm of your hand and spread it thinly over your entire arm, inside and outside, from wrist to shoulder. Don’t massage or rub in the gel, and wait about 5 minutes for it to dry completely before putting on clothes. (2) Wash your hands with soap and water immediately after applying the medication.
Frequently asked questions about Estradiol gel (EstroGel)
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What are the risks and warnings for Estradiol gel (EstroGel)?
Estradiol gel (EstroGel) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk of blood clot
Risk factors: People ages 50 years and older| High blood pressure | People identified as obese | High cholesterol | Diabetes | History of smoking cigarettes | Recent surgery or bedrest
Estrogens like estradiol gel (EstroGel) can raise the risk of serious blood clots. Higher estrogen levels can raise blood proteins that promote clot formation. These clots can form anywhere in the body and might be life-threatening. Get medical attention right away if you have any signs or symptoms of a blood clot:
Brain (e.g., stroke): weakness or numbness in your arms, legs, or face on one side of the body, trouble speaking, blurry vision, dizziness, loss of balance, trouble walking, or confusion
Eyes (e.g., retinal thrombosis): trouble seeing, bulging eye, double vision
Heart (e.g., heart attack): chest pain, sweating, nausea, or dizziness
Lungs (e.g., pulmonary embolism or PE): trouble breathing, chest pain, or cough
Legs (e.g., deep vein thrombosis or DVT): cramps, swelling, pain, or muscle tightness
Your risk of blood clots is higher if you're older, smoke cigarettes, or have certain medical conditions. It's also higher if you're on bedrest after surgery. Your gynecologist might temporarily stop estradiol gel (EstroGel) for 4-6 weeks before surgery. Talk with your gynecologist if you have any questions regarding your risk of blood clots.
Uterine (endometrial) cancer
Risk factors: Estrogen therapy without additional progestin | Using estrogen therapy for more than 1 year
Estrogens like estradiol gel (EstroGel) can thicken and change the lining of your uterus (endometrium). This can lead to uncontrolled growth, which might cause uterine (endometrial) cancer. To reduce this risk, it's generally recommended to take progestin, another hormone, along with estrogen. Progestin helps slow the growth of the uterine lining. Watch for warning signs of uterine cancer, such as vaginal bleeding that doesn’t stop or keeps coming back. Contact your prescriber right away if you notice any unusual vaginal bleeding.
Breast cancer
Risk factors: Personal or family history of breast cancer | Long-term use of estrogen and progestin together
There's a higher risk of developing breast cancer when taking estrogen, such as estradiol gel (EstroGel), and progestin medications together. The longer you take this combination, the higher your risk is. That's why it's best to use estradiol gel (EstroGel) only for the shortest amount of time needed. Make sure to check your breasts regularly for changes and get breast scans (mammograms). Let your prescriber know if you notice any unusual changes in breast shape, size, or color.
Dementia
Risk factors: Age 65 years or older
People using estrogen therapy like estradiol gel (EstroGel) may have a higher risk of dementia, especially if treatment begins after age 65. Early symptoms of dementia include new forgetfulness, confusion, getting lost, or wandering. If you’re concerned about this risk, talk to your prescriber.
Gallbladder and liver problems
Risk factors: History of or current liver problems
Estradiol gel (EstroGel) can cause problems with your gallbladder, and some people have needed gallbladder surgery after starting this medication. If you experience stomach pain, nausea or vomiting that doesn't go away, fever, or a yellowing of the skin and eyes (jaundice), speak with your prescriber or get medical attention right away.
The estrogen in estradiol gel (EstroGel) is processed by the liver. So if your liver isn't working properly, you might have more side effects from this medication. If you currently have or have had any liver problems, including issues during a past pregnancy, you shouldn't use estradiol gel (EstroGel).
Changes in calcium levels in the blood
Risk factors: Breast cancer | Cancer that has spread to the bones | Low parathyroid hormone levels
Taking estrogens like estradiol gel (EstroGel) can lead to severely high calcium levels in people with breast cancer that has spread to their bones. High calcium can cause symptoms like thirst, stomach pain, nausea, vomiting, constipation, bone pain, muscle weakness, or confusion. Tell your prescriber if you have any of these symptoms because you might have to stop taking estradiol gel (EstroGel).
Use estradiol gel (EstroGel) carefully if you have low parathyroid hormone levels (hypoparathyroidism), which can lead to low calcium in your body. Let your prescriber know if you have signs of low calcium such as burning or tingling of your fingers, toes, or lips, muscle pain and cramps, or confusion.
Vision problems
Although very rare, some people taking estrogens have experienced vision problems caused by a blood clot in the eyes. If you have sudden partial or complete vision loss, bulging eyes, double vision, or migraines, stop taking estradiol gel (EstroGel) and tell your prescriber right away.
High triglycerides
Risk factors: High levels of triglycerides
Estrogens can raise the amount of fats in your blood (triglycerides), which can lead to heart problems or pancreatitis, a serious inflammation of the pancreas. Your prescriber might recommend regular blood tests to watch for this while you're taking estradiol gel (EstroGel). If you experience sudden stomach or back pain, nausea, vomiting, sudden weight loss, or a fast heart rate, contact your prescriber or seek medical care right away.
Low thyroid hormone levels (hypothyroidism)
Risk factors: Low thyroid hormone levels
Estradiol gel (EstroGel) can affect thyroid hormone levels in your blood. If you're taking medications for low thyroid hormone levels, you might need a higher dose of your thyroid replacement therapy. Your prescriber might recommend regular blood tests to check your thyroid hormone levels while you're taking this medication.
Fluid Retention
Risk factors: History of heart or kidney problems
Estrogen products like estradiol gel (EstroGel) can cause some fluid retention or edema, especially in people with heart conditions, like congestive heart failure, or kidney problems. If you notice unusual swelling in any part of your body or if you suddenly gain weight over a short period of time, let your care team know.
Worsening of other medical conditions
Risk factors: History of asthma or diabetes | History of lupus | History of seizures or migraines | History endometriosis
Taking estrogen-containing medications like estradiol gel (EstroGel) can worsen certain medical conditions. These include endometriosis, hereditary angioedema, asthma, diabetes, migraine, and seizures. Before you start estradiol gel (EstroGel) let your healthcare team know about your past medical history so they can talk with you about the risks and benefits of taking this medication.
Potential skin-to-skin transfer
There's a chance that estradiol gel (EstroGel) could transfer to someone else through skin-to-skin contact with the application site. To avoid this, make sure the gel is completely dry before allowing others to touch the area. Once the gel is dry, cover the application site with clothing.
Estradiol gel (EstroGel) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 50g of 0.06% | 1 pump | $218.48 | $218.48 |
Typical dosing for Estradiol gel (EstroGel)
The typical dose is 1.25 grams (one pump) applied to the skin of your entire arm once a day.
More on Estradiol gel (EstroGel) dosage forms
How much does Estradiol gel (EstroGel) cost?
Estradiol gel (EstroGel) contraindications
Undiagnosed abnormal vaginal bleeding
History of breast cancer
History of cancer that depends on estrogen for growth
Blood clots or blood clotting conditions
History of stroke or heart attack
Liver problems
What are alternatives to Estradiol gel (EstroGel)?
Hot flashes and night sweats due to menopause
Vaginal dryness and irritation due to menopause
Hot flashes and night sweats due to menopause
Moderate-to-severe vasomotor symptoms of menopause, like hot flashes and night sweats
What is the latest news about Estradiol gel (EstroGel)?
Estradiol gel (EstroGel) images
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References
Best studies we foundASCEND Therapeutics US, LLC. (2024). Estrogel- estradiol gel, metered [package insert]. DailyMed.
Furness, S., et al. (2012). Hormone therapy in postmenopausal women and risk of endometrial hyperplasia. The Cochrane Database of Systematic Reviews.
Hedrick, R. E., et al. (2009). Transdermal estradiol gel 0.1% for the treatment of vasomotor symptoms in postmenopausal women. Menopause.
Rehak, M., et al. (2010). Retinal vein thrombosis: Pathogenesis and management. Journal of Thrombosis and Haemostasis.
Rosendaal, F. R., et al. (2002). Female hormones and thrombosis. Atherosclerosis, Thrombosis, and Vascular Biology.
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