We were delighted to hear that that from 1st November 2024, there will be a funded oestrogen gel, (the Estrogel brand) available in Aotearoa, New Zealand.

The type of oestrogen in modern Menopausal Hormone Therapy (MHT, formerly known as HRT) whether the patch, gel or tablet is Oestradiol (you can read an overview of MHT here .

The funding of an oestradiol gel is a significant step forward, particularly given the ongoing oestrogen patch shortages. 

A summary of oestrogen preparations:

Oestradiol comes in preparations designed for  systemic absorption (made to be absorbed into the general bloodstream to help with menopause symptoms like flushes, brain fog for example) and topical vulvovaginal oestrogen cream designed for local absorption when applied to the genitourinary areas to help with vaginal dryness and menopausal urinary symptoms. 

Systemic preparations of oestradiol are in the form of oral tablets (like the Progynova brand), transdermal (skin) patches (like the Estradot brand), or transdermal gels (like the Estrogel brand). In women who have not had a hysterectomy, systemic oestrogens need to be used with a progestogen to protect the endometrium (lining of the uterus) from becoming thickened.

1. Oral oestradiol tablets

1-2mg oral Oestradiol (usually the Progynova brand in New Zealand) is approximately equivalent to 50-100mcg of Oestradiol patches respectively. Oestrogen tablets may be suitable for people in their early to mid 50s or younger, without significant risk factors for blood clots, vascular disease or liver issues. For people with migraines or high blood pressure the transdermal/skin (patch or topical gel) form of oestrogen is preferred.

2. Transdermal oestrogen patches

(usually the Estradot brand in New Zealand) are normally available in 25, 50, 75 and 100mcg patches.  The patches can be cut up to allow gradual dose increases, which can be helpful for those with a tendency to side effects.

3.Transdermal gels are equivalent in safety to oestrogen patches and but until now have not been funded in New Zealand.

The funding of Estrogel is expected to be very helpful in allowing women to access transdermal oestrogen, given the ongoing shortage of oestrogen patches that has affected many women across Aotearoa, New Zealand. Estrogel is equivalent in safety to the transdermal oestrogen patches, and can be a good option for those who have skin sensitivities to the patches.

Read more about transdermal oestrogens here.

Dosing of Estrogel

Estrogel is dispensed via a pump bottle.

Each pump of Estrogel delivers the equivalent of a 25 mcg patch, with dosing as follows:

• 50 mcg patch: 2 pumps daily
• 75 mcg patch: 3 pumps daily
• 100 mcg patch: 4 pumps daily

How to apply oestrogen gels

Do read any accompanying instructions but in general:

1. Wash your hands
2. Apply the gel to clean, dry, and unmoisturized skin.
3. Allow it to dry for about five minutes before putting on clothes
4. Cover the application site (with clothes) to avoid transferring it to others avoid washing the area for at least one hour.
5. 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.

A Step Forward, But More Treatment Options Are Needed

While the funding of Estrogel is a positive development, there is still more to do to improve access to good options for menopause-related treatment in Aotearoa. Women here have access to only a few of the options available internationally, and it would be useful to have a greater variety of treatments in our clinical toolkit. 

Women in other countries have access to additional medications that address symptoms like genitourinary syndrome of menopause (GSM). For example, ospemifene, Intrarosa (prasterone), and intravaginal testosterone but these are not yet accessible in New Zealand. Moreover, women in Australia benefit from options like Angeliq (a combined oestrogen and progestogen patch), Zoely(a contraceptive containing body-identical estradiol), and Bijuva (a combination of estradiol and micronized progesterone).  Funding for androfeme, the only testosterone preparation formulated for some would also help with equity in access. Read our separate article on when to use testosterone in women here

Moving Forward: Advocating for Comprehensive Care

The announcement of Estrogel funding is a positive development, but we recognize that there is still much work to be done to in making menopause treatments equitably accessible and we acknowledge the mahi  (work) of all our colleagues in this space in continuing to address this important issue.

For more updates from us, and to help us raise awareness around issues relating to hormone-related health and  equity of access of safe and effective hormonal therapies, feel free to share this article and the link to our educational website erhassociates.co.nz, subscribe to our newsletter from the website and follow us on social media (@erhassociatesnz on Instagram, Linkedin and Facebook).   

We do not have funded affiliations with manufacturers or distributors of any of the oestrogen tablets patches or gels mentioned here. The products mentioned in this article are simply to provide information on available options.