From the Guidelines
EstroGel 0.06% should be applied once daily, with the standard dose being 1.25 g (containing 0.75 mg estradiol) delivered via one pump actuation, and used for the shortest possible time with the lowest effective dose 1. The application of EstroGel 0.06% involves applying the gel to clean, dry skin on one arm, from the wrist to the shoulder, and allowing it to dry completely before dressing. Some key points to consider when using EstroGel 0.06% include:
- Applying the gel at the same time every day to maintain consistent estradiol levels
- Avoiding washing the application site for at least one hour after application to ensure optimal absorption
- Using the gel in conjunction with a progestogen medication for women with a uterus to reduce the risk of endometrial hyperplasia
- Regular follow-up appointments (at least annually) to assess the need for continued therapy and minimize potential risks, as the quality of evidence on the benefits and harms of HRT varies for different hormone regimens 1. The goal of using EstroGel 0.06% is to alleviate menopausal symptoms like hot flashes, night sweats, and vaginal dryness by delivering estradiol through the skin, allowing it to enter directly into the bloodstream and bypass first-pass metabolism in the liver. Key considerations for treatment include:
- Starting with the lowest effective dose and adjusting as needed
- Using the medication for the shortest duration consistent with treatment goals and risks
- Monitoring for potential side effects and adjusting the treatment plan accordingly, as evidence is inconclusive to determine whether phytoestrogens are effective for reducing the risk for osteoporosis or cardiovascular disease 1.
From the Research
Administration and Frequency of ESTROGEL METERED-DOSE PUMP 0.06%
- The recommended dosage of Estrogel is 1.25-2.5 g gel (containing 0.75-1.5 mg of estradiol) applied once daily for 12 weeks 2.
- A study found that a transdermal gel with 0.75 mg estradiol was the lowest practical dose that effectively reduced the frequency and severity of moderate to severe hot flushes, improved vaginal maturation index (VMI), and was well tolerated 3.
- Another study compared the efficacy and safety of estradiol transdermal preparations, including Estrogel, and found that Divigel 1.0 mg provided the best efficacy profile, but was also associated with a higher risk of adverse events 4.
- The frequency of administration is typically once daily, with the gel applied to a clean, dry area of skin, such as the thigh or upper arm 2.
Efficacy and Safety
- Estrogel has been shown to be effective in reducing the frequency and severity of moderate to severe hot flushes in postmenopausal women 3, 2.
- The gel has also been found to improve VMI and reduce the severity of all hot flushes 3.
- Common adverse events associated with Estrogel include headache, infection, breast pain, and nausea 3, as well as weight gain, breast tenderness, and bloating 5.
- The overall incidence of adverse events was not significantly different among groups, although a higher incidence of estrogen-related adverse events was reported with the 2.5-g dose of Estrogel 2.