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[Luculka]

Hello ladies, I have a dilemma and would be very interested in your insights. It’s about the area where you apply estrogen gel (or spray). I apply my Oestrogel as the package insert recommends—on my upper arms.
     But now I’m listening to a podcast interview with the head of the German Menopause Society—a very experienced and competent gynecologist. And she says that the Menopause Society has recently changed its thinking regarding the arms—they are now more likely to advise women to apply it to the thighs instead. The reason: the arms are too close to the breasts, which could lead to greater estrogen exposure for the breasts, something we want to avoid. This applies to both the gel and the spray. Hmmm.
     But if that’s the case, why do the instructions in the package insert explicitly say upper arms? As always with HRT, I’m confused. But I really trust this expert... it’s making me think. I believe that tomorrow morning, after 9 months, I won’t be applying my estrogen gel to my arms anymore… what are your thoughts ladies? Warm greetings from Switzerland, Lucy

[chopsuey]

Hi Lucy

I use 4 pumps of Oestrogel, so apply it to both arms and thighs. I am careful to apply it to only the outer upper arms and as I apply it in the morning, I don't think there is much chance of it penetrating a bra and clothing. I don't absorb it that well, so the priority for me is to apply it where it seems to work best and I guess there must have been some reasoning behind where to apply it when it was first developed.

I can see why you might want to play safe though and it will be interesting to see if that becomes the guidance in other countries. 

[Wrensong]

Hello Luculka,

I always applied Oestrogel to thighs, never arms, for the very reason you cite & indeed my very experienced gynae, a BMS registered trainer of other medics in menopause care, later advised to avoid the arms, unaware that was what I was already doing.

I no longer use gel but was sure the thigh was mentioned as appropriate in the PIL & if you have a look at page 7 of this link from the online Oestrogel PIL you'll see it is an approved site for application.

https://www.medicines.org.uk/emc/files/pil.353.pdf

"Spread the gel on a large area of skin on each shoulder, outer arm or each mid-inner thigh."

I hope this reassures you it's OK for you to change your application site if you wish & that where you are is a lot cooler than here in Middle England today!
W x

[Gnatty]

I'm not sure any of it makes much logical sense tbh. If it's so bad to apply to arms why was Lenzetto always applied to forearms? Patches in the old days were applied to arms. It all gets taken up into the bloodstream anyway so why the big deal.  If I'm using gel ( patches at the moment) I notice far better absorption using forearms - and of course I do this after putting bra on etc in the morning. As long as we're not being silly with the application I wouldn't worry too much.
Pretty sure LN is relaxed about this ..

[Luculka]

Thank you all so much for your fast responses, Gnatty, Chopsuey, Wrensong, I really appreciate it and every single one is truly helpful! I have now listened to that part of the interview again, and the expert said literally: “It’s not evidence-based, but we observe that when you apply it to the arm, there are these cross-connections of blood vessels to the breast, so probably more of it ends up in the breast.” For women who use several pumps and need a larger area for application, this doctor therefore recommends, in addition to the thighs, also the buttocks and abdomen. By the way, I am 48 years old, in perimenopause, and only use one pump of Oestrogel (until now I have always split it between both upper arms).

[Wrensong]

Gnatty

why was Lenzetto always applied to forearms

According to the SmPC (and the PIL if I remember rightly from when I used it) Lenzetto can also be applied to thighs.  My gynae also listed buttocks as appropriate for either gel or spray, as well as patches.

As you say, probably no big deal, but for those of us whose medical history or family history may increase our risk, I think it's understandable to want to take every possible precaution.
W x

[chopsuey]

“It’s not evidence-based, but we observe that when you apply it to the arm, there are these cross-connections of blood vessels to the breast, so probably more of it ends up in the breast.”

Interesting. I would like to see more research done if that is the case. Certainly, my breasts are bigger and firmer since being on HRT, without any weight gain elsewhere. I shall be continuing with arm application for now anyway.   

[bombsh3ll]

There is no evidence that using the arms increases breast cancer risk.

Additionally if hormone therapy increases breast cancer risk at all, this is due to the progestogen not the estrogen.

The product is absorbed systemically anyway and gets all around your body in minutes regardless.

Personally I prefer oral, but if I were forced to use transdermal I would choose whatever site resulted in the best delivery for me.

Nobody bothers about younger women using the contraceptive patch on their upper arm either, which is many times stronger.

[joziel]

I always apply gel to my thighs even when I was on 12 pumps of it, I got 6 pumps on each thigh and buttock(!!).

I did this mainly because I wanted my arms to stay uncontaminated for venous blood draws....But also because I tend to wear trousers so the risk of contamination (pets, partner) is less when the gel is on my thighs than on my exposed arms.

[Wrensong]

I always apply gel to my thighs even when I was on 12 pumps of it, I got 6 pumps on each thigh and buttock(!!).

I did this mainly because I wanted my arms to stay uncontaminated for venous blood draws

Yes, another good reason Joziel.

W x

[Mary G]

I split my Oestrogel dose by 12 hours and apply it to my inner thighs.  It helps with VA apparently.

[Wrensong]

Mary

It helps with VA apparently

that's interesting.  You mean the proximity of thighs to vulvovaginal area?

[Mary G]

Wrensong, I read it somewhere (can't remember where) and it sort of makes sense because it hits that area first but obviously it's not gospel.

It's my understanding that women who are using a decent dose of systemic oestrogen should not need vaginal oestrogen.  As it happens, I don't get on with vaginal oestrogen and it causes problems for me.

[Wrensong]

Mary, yes that was what I was thinking - it makes sense.  I won't post at length because it would take the thread off piste, but yes it must be great for women who can take enough systemic oestrogen not to need topical HRT as well.  I've needed both to manage GSM, but then I can't handle high doses of systemic E2.
W x

[joziel]

I deliberately put it right at the very top of my inner thighs, for that very reason....