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[Niamh]

Oooh thank you interesting yes! I'm really still feeling the impact of my 7 day dose of progesterone even though I'm 6 days post stopping, I also feel quite stressed so maybe it's all had an impact?!! Who knows I wasn't worried until I saw the result so it's mad I'm now a bit obsessed with a number on a piece of paper! Thank you for your reply X

[Hurdity]

This makes for interesting reading.

Murphy, you mention absoprtion is 'better on arms than lower body which again is apparently less safe'

Is this the case? I put it on shoulders, upper arms. I think the consultant i saw visually showed me this when talking about the gel.

Is it less safe long term?

Hi there - I have mentioned this in the past when women have asked about application - I posted about it here:

All the other transdermal oestrogens - ie all the patches and Sandrena gel - say to apply it to the lower half of the abdomen whereas estrogel is alone in saying the upper half of the body can also be used.

As Maryjane says I would not use any oestrogen product on my arms or shoulders due to proximity to the breast and concentration gradient from the arms - especially from shoulder and inner arm. - and surely this is borne out by the caveats re blood tests? If application of gel to the arm is likely to give a falsely high serum reading from blood samples in proximity - surely this also might apply to other tissues close by eg the breast - ie levels could also be higher than in other parts of the body?

Hurdity x

Basically that's it - the question was posed and I expressed how I saw it - puzzled really - that the one type most commonly used and prescribed by gynaes (Estrogel) is alone amongst the transdermal HRT types in saying upper body is OK (but not on or near breasts). I am just perhaps over-cautious - but in my book shoulders are quite near the breasts - and as there is no long term information as far as I know personally I would go for lower trunk - as I do with my patches and testosterone gel. Not wishing to worry anyone and yes go with what your consultant says - but I still do not understand why this one (estrogel) should be different from the others. Maybe one of you private gals could ask your consultant next time you see him/her!!! You will see Maryjane was also advised this too (lower body).

Hurdity x

[Noheroicsplease]

Thanks for such an informative reply.

I'll put the estrogel on inner thighs now...Is that better?

[Hurdity]

Noheroicsplease - it is not up to me to say where you should put it - the instructions say it is OK on upper body - as this is a discussion forum I raised the question as to why - which has not been answered. All I am saying is what I would do - but some of the leading consultants say upper body therefore it should be fine! Others apparently say not - and this is what is says for Sandrena gel - as an example:

The Sandrena dose is applied once daily on the skin of the lower trunk of the right or left thigh, on alternate days. The application surface should be 1-2 times the size of a hand. Sandrena should not be applied on the breasts, on the face or irritated skin. After application the gel should be allowed to dry for a few minutes and the application site should not be washed within 1 hour. Contact of the gel with eyes should be avoided. Hands should be washed after application.

This is what is says re Estrogel:

The correct dose of gel should be dispensed and applied to clean, dry, intact areas of skin e.g. on the arms and shoulders, or inner thighs. The area of application should be at least 750 cm2. One measure from the dispenser, or half the prescribed dose, should be applied to each arm/shoulder (or thigh). Oestrogel should NOT be applied on or near the breasts or on the vulval region.

Sandrena does not say you can't apply to shoulders and arms but it doesn't suggest it either. I don't want to alarm anybody at all but this is a genuine question!!

Sorry Meeka I think this is going a bit off your original topic!!!

Hurdity x

[Noheroicsplease]

Sorry, Hurdity. I didn't mean to imply that I relied on your information only. Nor did I mean to take this off topic. Sorry. 

[Hurdity]

Hey it's OK Noheroicsplease!! It was me that was taking it off topic by taking the question further! No problem! I often say that when I've gone off topic.....I just didn't want to sound as though I was saying you should or shouldn't apply it wherever - but just pointing out that the instructions are inconsistent and expressing my view! No offence meant nor taken

Hurdity xx

[Tempest]

I really don't want to take away from the OP or thread jack either, but I just wanted to add as a point of interest that this: https://evamist.com is a new development that I've heard rumours may be making its way to the UK at some point (only rumours)!

Interestingly, this is dosed inner forearm, starting near elbows so I assume a good chance of transfer to the breast maybe? Especially in bed at night when laying on one's side. I wonder if there is any in depth published risk data for this? Just a point of interest - sorry again for thread jacking!

[Hurdity]

Interesting Tempest and very convenient but I'm not sure I like the idea of an estradiol spray though as some will get into the air maybe and into the environment more than other methods I would have thought? 

Re the studies. I can't say I have meticulously trawled the net - too busy for that! Would need to do this full time! However now and again I have a Google when the subject comes up but haven't been able to find anything. The only studies I've found relate to application area (ie size of area covered). There was a detailed paper which investigated that - the results of which form the basis for the standard advice on how to apply the gel and the area of skin to cover. I can't remember which part of the body was used but I don't think that was the subject of the investigation. I did find a paper about Intrinsa testosterone patches which compared serum levels from application of patch to front or rear lower abdomen. I think the same thing has been done for some oestrogen patches (with conflicting results I recall!). Not though for serum concentrations at different distances from the application site nor if the oestrogen is transported laterally through the skin as well as directly through it - it definitely is for testosterone as I read this somewhere. Sorry I don't have any refs - sometimes I click on papers, have a quick read and some info goes in (to my head) but then forget where I got it from!! Even if I bookmark it's difficult as I have so many..... if you find anything or if your consultant (or anyone else's for that matter) has any info ( papers!) - that would be fab

Hurdity x

[Meeka]

Many thanks for all the replies......I don't mind at all if it goes off topic a little. .....I think its all relevant really and very helpful to know other peoples thoughts and experiences.

I have always applied the gel to my thigh area......I'm quite tall but relatively slim and weigh under 9 stone.

I had the blood test taken in the afternoon and apply the gel in the evening......Maybe the time of the blood test was relevant in the low reading....

I feel fine and didn't expect my reading to be low.  I don't have any sweats in the day but recently I have had a light sweat during some nights........felt more like I had got too hot with too many bed clothes than a hormone sweat.    I have been quite anxious but I have things to be anxious about at the moment....work issues etc.  My breasts are also quite full at the moment which usually indicates my oestrogen levels are adequate........my breasts tend to deflate when my oestrogen is low.   Also my hair is not shedding from my head which was one of the reasons I started on HRT......my hair was getting very thin prior to HRT. 

I also have a decent bleed when I use progesterone,   only lasts around 3 days but everything looks OK.   I guess I will have to see Prof Studd........I have the feeling he may advice an implant due to my bones.....didn't really want to do that.    I also have concerns that keeping my oestrogen very high may not be too good in other areas.    I havnt been able to book an appointment to see Prof Studd yet as I have such a lot going on at work etc.    I have discussed it with my GP ......they are very vague about hrt .

I guess I could increase to 4 pumps and see if I feel any less anxious and these slight night sweats improve, I think I will split the dose, morning and night.

Thank you again for all the replies......much appreciated.

[KatyB]

All, I found a useful site which discusses route implications / pros and cons of different application routes in some detail here :
http://surmeno.blogspot.co.uk/2006/03/route-considerations.html

Its a blog by someone who's had surgical menopause but it covers oral, dermal, vaginal / rectal, gel, cream etc application. I did find another paper (now lost ref unfortunately) which suggested that further away from the uterus the application was the less dose would be delivered to uterus, but that would be primarily relevant for progesterone - for oestrogen depends where the receptors are....and on the other hand that soft / fatty tissue would hold the dose better.....don't be offended!

Hope that's useful - academic knowledge only on my part but I've found others links useful....


KatyB

[murphydurf]

What a brilliant site KatyB - I'd come across snippets from there when searching previously but that link is wonderful. Just discovered that I can take my tablets under the tongue which is avoiding first pass effect - yay! Thank you so much for posting the link.

Mx

[KatyB]

Very glad it was useful, maybe I should post it as a topic so people can find it easier?

[Kkay]

A quick note re measuring estrogen levels; variation in levels can probably also be due to the timing of the blood sample taken as relative to the estrogel or patch application (as mentioned by someone on this thread I think and by Surmeno on her blog). I have a book by a US-based reproductive endocrinologist called Elizabeth Vliet (Screaming to Be Heard: Hormone Connections Women Suspect and Doctors Ignore) where she says measuring estrogen levels are important - not all menopause specialists think so - but that its important to standardise the timing of tge sample: 12 hours from estrogel application or the third day of the patch.

The Surmeno entry on this is really interesting (and really confusing, as I've mentioned earlier on this thread) 🙄

[Hurdity]

  Kkay - I have that book too! I've only read bits of it and the trouble is when I want to refer to it I can never remember which part of the book I found her golden nuggets of information!

Hurdity x

[Tempest]

Hi, Murph!

Yes, sublingual dosing is a great idea isn't it? Just note that its 'off licence' here in the UK (boy, do we have a LOT of catching up to do)!

Imagine if you went to the GP and said 'so is it ok if I take my hrt sublingually'? They'd have an apoplectic.....Half of them don't even know what bioidenticals are and think Estrogel is for VA......

Just wish we had compounding pharmacies and troches too......I'd pay big bucks to have that option!!