Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Erika28 on September 02, 2019, 02:18:04 PM
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Hi,
I recently tried something, just to find out what would happen. From years of being on Estrogel, I had many bottles left so I thought that instead of having them be wasted, I should use them and experiment. Since about 1 month and a half, I've been applying 1 pump to my vulva. On top of my existing regimen which consists of estradiol and testosterone injected intramuscularly which, honestly, have not alleviated some of my issues.
To my amazement, I've observed a significant improvement in mood, energy and memory. My skin is softer, more even and smooth. My features have softened and I look younger than ever. I also noticed an increase in my attraction to men, my desire to engage and my libido.
The gel burns a little, as expected but it's tolerable and this lasts, at most, a few minutes.
As some of you may already know, the vulva, being thin, mucosal and very vascularized, absorption in this area is increased, several fold (I believe up to 5 times, maybe more). This may account for why I'm having such good results.
Food for thought...I just couldn't keep this to myself and had to absolutely share with the rest of you. :)
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Thanks for sharing and glad to know you are getting good results Erika28 but probably not a good idea to apply gel to such a delicate area for which it has not been formulated. I know ( at least I think it is still available) that in US there are oestrogen creams developed for systemic absorption that are applied through the vagina but not here in UK. Applied in this way is giving an increased oestrogen dose as it will surely be absorbed to some extent.
A better way if you need a higher dose is to get this authorised through GP or meno specialist and use local oestrogen for this delicate area, and try to get testosterone prescribed for continuing problems with libido.
Anything which causes additional burning to this very delicate area is surely not to be recommended when so many women suffer this symptom as part of the horrible condition of vaginal atrophy?
Here's to a good libido though!
Hurdity x
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Hi Erika28, Thank you for your post. I agree with Hurdity that it isn't meant for such a delicate area but I'm m desperate for relief as both Estrogel and patches made my symptoms worse
So I'm very interested. Did you find any relief of symptoms when you used Estrogel on your skin in the past? Why did you change to injections?
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Erika28- glad this seems to be doing the trick for you but I really think you'd be much safer referring use in this way to your medics to see what they say?
Years ago I read that rubbing crushed aspirins as a paste to your skin made it glow. I hotfooted it to the supermarket to buy some, made the paste and slapped it on. Wow, I looked great, my skin was so fabulous that I repeated it a few days later. Again, great results, made a significant difference. And then the problems, peeling skin, horrible. Went to see someone who couldn't believe I had done that ( tip was from a beauty article in the Sunday Times ) . I had effectively given myself a chemical peel and she then had to spend a year trying to sort it! She runs training programmes and I'm still mentioned all these years later when she's training new beauticians.
Just be careful and get the ok from your doctors if you want to continue this regime x
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Hi Erika, have you applied Estrogel to your face?
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I discussed this with my doctor and had her ok. I am continuing using it this way and am quite satisfied with results.
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Interesting 🤔
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Hi Erika, have you applied Estrogel to your face?
Tracey E - I use Sandrena gel and after I've applied it, I put my moisturiser on the leftover gelbon my hand and rub it into my face. Tiny amount but I've seen a difference in my skin.
Erika28 - I've read reports before that the vulval region is a very efficient area to absorb hormones.
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I wouldn't use it that way myself: the instructions say in bold “Do not apply to the breasts or genital areaâ€.
I think it's a higher concentration than the creams formulated for VA.
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Absolutely Wilks. And as for the face.....
I discussed this with my doctor and had her ok. I am continuing using it this way and am quite satisfied with results.
....whatever your doctor says - this is not advisable for women to try. I am sure most doctors and gynaes would not sanction this for oestrogel. I presume you are not in UK Erika and seeing a private doctor?
Hurdity x
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As an experimenter myself!!! If it works and no troubles go for it. I ‘invented ‘ my own regime after the ‘wise' regime had little effect on my symptoms- bingo mostly gone.
The alcohol base in the gel may make your bits a bit dry possibly sore ,but hey ho you would know what has done it and us ladies are pretty good at thinking outside and around the box.
I now enjoy being mostly symptom free to quit my invention...
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Sgtvhilts - agree entirely, particularly if your doc has ok'd it. We're forever telling ladies that one size does not fit all and holding onto that sentiment we must allow ladies to find their balance in conjunction with their docs approval and support them when they do.
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As an experimenter myself!!! If it works and no troubles go for it. I ‘invented ‘ my own regime after the ‘wise' regime had little effect on my symptoms- bingo mostly gone.
The alcohol base in the gel may make your bits a bit dry possibly sore ,but hey ho you would know what has done it and us ladies are pretty good at thinking outside and around the box.
I now enjoy being mostly symptom free to quit my invention...
Hey Sgtvhilts - I'm all for thinking outside of the box - in fact science and medicine would not progress without it and associated creative thinking, but when it comes to medical stuff and from a patients' point of view, "the box" is there for a reason - for safety ( as well as efficacy). It means that drugs and products have been trialled and the resultant product instructions can be followed with some confidence about safety and efficacy, and taking into account the warnings (which are sometimes overcautious I acknowledge!).
I really do not think it is advisable for anyone to experiment in this way with a product developed to applied in a particular place on the body.
Sgtvhilts - agree entirely, particularly if your doc has ok'd it. We're forever telling ladies that one size does not fit all and holding onto that sentiment we must allow ladies to find their balance in conjunction with their docs approval and support them when they do.
Erika - sorry but we have no idea who your doc is, and what sort of doc. Which particular aspect of your regime has the doc given approval to? Most docs who prescribe or allow off-licence or off-label regimes do so on the basis of published research which supports this - even if not licensed in UK eg the use of utrogestan vaginally, or longer cycles etc - NOT the use of a product in a completely different way from that which it has been designed.
Kilted cupid - of course one size does not fit all we all accept that - but we certainly should not allow or rather encourage WOMEN (I don't regard myself as a "lady" ;D - not sophisticated enough!) to experiment in this way to find a balance. And I don't support anyone who posts in a way that might encourage other women to use products like this because one member says her doc has OK'ed it giving the impression that it is medically OK generally.
Also re the application of gel to the vulva area - yes of course products are absorbed well here in these very thin and delicate tissues - but gel is designed and formulated to be absorbed through the skin (not the face though....) and the dosage is worked out on the basis that a certain proportion gets through into the bloodstream when applied to the particular areas of the body studied. Although the amount absorbed is very variable between different women it is within a certain range of values tested through trials, and if absorption is higher through the vulval area then there is no knowing at all what systemic levels will be achieved and these could potentially ve very high - too high for many women possibly.
In addition all these products and their excipients (ie what the active ingredient is mixed with - the fillers) have been extensively tested as to how they work/absorbed on/through different areas of the body/skin so using a product in a different area could cause irritation or worse (like MicheleMabelle found to her cost).
Hurdity x
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Every woman needs an individualised dose of oestrogen, yes. However, if you play about with applying gel to your vulva when it's specifically for your skin, you could end up with an unnecessarily high dose, which over a long period of time could increase your risk of breast cancer. Although HRT carries a low risk of developing breast cancer, I would still be cautious about only taking the max dose needed to treat my symptoms.
OP- What about trying transdermal rather than intramuscular testosterone?
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Erika28- glad this seems to be doing the trick for you but I really think you'd be much safer referring use in this way to your medics to see what they say?
Years ago I read that rubbing crushed aspirins as a paste to your skin made it glow. I hotfooted it to the supermarket to buy some, made the paste and slapped it on. Wow, I looked great, my skin was so fabulous that I repeated it a few days later. Again, great results, made a significant difference. And then the problems, peeling skin, horrible. Went to see someone who couldn't believe I had done that ( tip was from a beauty article in the Sunday Times ) . I had effectively given myself a chemical peel and she then had to spend a year trying to sort it! She runs training programmes and I'm still mentioned all these years later when she's training new beauticians.
Just be careful and get the ok from your doctors if you want to continue this regime x
Hi MicheleMaBelle,
I wonder if someone has confused acetylsalicylic acid (aspirin) with salicylic acid, a well known skin exfoliating agent?
BeaR.
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Asprin can work very nicely as a skin exfoliant - I use it on my chin to help the hairs. But once a month is fine, not every few days :o. And some people are allergic to asprin
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Asprin can work very nicely as a skin exfoliant - I use it on my chin to help the hairs. But once a month is fine, not every few days :o. And some people are allergic to asprin
Hi dahliagirl,
Absolutely, but why use aspirin off-label when there are many skin products containing salicylic acid for this purpose? Same with vaginal estradiol gel?
BeaR.
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It's cheap ;D
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Hi dahliagirl,
Absolutely, but why use aspirin off-label when there are many skin products containing salicylic acid for this purpose? Same with vaginal estradiol gel?
BeaR.
bear I don't know what you mean by "same with vaginal estradiol gel" ???
Hurdity
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dahliagirl how does it help the hairs though??
Don't leave me hangin like this, I'm stroking my chin(hairs)in integument. ;D
TD
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It's cheap ;D
I knew you would say that ;D
BeaR.
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What happened to KiltedCupid's post? :-\
BeaR.
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Hi dahliagirl,
Absolutely, but why use aspirin off-label when there are many skin products containing salicylic acid for this purpose? Same with vaginal estradiol gel?
BeaR.
bear I don't know what you mean by "same with vaginal estradiol gel" ???
Hurdity
Meant to say transdermal estradiol gel being applied to the vulvovaginal area by the OP.
BeaR.
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Meant to say transdermal estradiol gel being applied to the vulvovaginal area by the OP.
BeaR.
But there is no vaginal estradiol gel for systemic HRT though, which is what Erika was using it for? That is the whole point of the posts expressing caution :-\ Sorry I still don't understand!
What happened to KiltedCupid's post? :-\
BeaR.
There is no post here as far as I can see, or if there was I missed it :-\
Hurdity x
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Don't leave me hangin like this, I'm stroking my chin(hairs)in integument
Sorry, I wasn't making much sense there ::)
My chin hairs get stuck on the way out and my chin gets sore when I poke them, so sometime I use the asprin as a exfoliator to help them through. Then I pull the *%%s out >:D
I need to save my pennies for electrolysis.
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FWIW my well-informed gyno (in US) suggested I use the testosterone gel she prescribed this way, and the compounding pharmacy said yes that is one of the ways it can be applied. I rotate with other areas, seems fine.
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I am followed by a private doctor in Canada who is a specialist in female hormones, she even wrote a book on the subject. She thinks outside the box, like me. I am very lucky to have her! I will share studies I come across, with her and she will share her own findings with me, based on the 1,000 patients she treats. I very much enjoy our discussions. :)
So far, the gel has worked out fine for me, applied in that area. No complaints, only positives. I understand it's not licensed for use in that area but I also don't worry about the repercussions of my actions as I've studied extensively hormones for several years and read countless studies published in scientific journals worldwide. The evidence in favour of higher estrogen levels increasing the risk of breast cancer (i.e. CAUSING breast cancer) is at best, weak and at worst, lacking. Epidemiological studies only report associations from which no cause and effect may be established. Findings from animal studies cannot be extrapolated to humans. Remember that! There is even evidence suggesting the contrary as the greater the number of pregnancies (when very high levels of estradiol are present) the lower the risk of cancer, over time. Estrogen should, however, be balanced with just enough progesterone to prevent uterine/endometrial cancer as well as bleeding.
I feel and look good. This is what matters most to me. I finally have the energy and will to get out and do things. The desire to engage sexually with a man and the ability to respond sexually. Life is enjoyable again. I can't tell you how much I'm grateful for this.
I will continue, with my doctor, to monitor things closely but like I said, so far, so good! A cream can be compounded by a pharmacy too and be applied to this region. I'm experimenting with this approach as we speak, with the doctor's approval as she sent a prescription to the pharmacy. I will keep you all posted.
Lastly, it's important to realize that pharmaceutical companies put warnings which sometimes aren't supported by any evidence. Their recommendation to not apply the gel to the breasts is actually not even evidence-based and originates from the unverified hypothesis that maybe, estrogen increases the risk of breast cancer. They always err on the side of overcautiousness for financial reasons and I don't blame them.
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It is no correct to say that pharmaceutical companies do not include warnings that are unsupported by any evidence and they are bound by ethical regulations to promote the safe use of meds.
The available evidence does show that HRT slightly increases the risk of breast cancer, but is a significantly smaller risk factor than obesity and alcohol consumption. I take HRT myself, and it has helped me massively.
HRT may not cause breast cancer per se, but some types of breast cancer are driven by oestrogen and can be treated by blocking the effects of oestrogen.
If a doctor agrees “off label†use of a medication with a patient that's a specific agreement between those 2 individuals. I just disagree with encouraging others to do that without the agreement of their doctor.
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The relation between estradiol, progesterone and breast cancer is very complex and we just don't know enough yet to conclude anything. Associations do not permit us to make any assertions one way or another. Two large randomized controlled trials, where one variable is manipulated and all the others are controlled, found estrogen reduced the risk. Cancer cells may contain estrogen receptors but that doesn't mean estrogen caused those cancer cells to grow in the first place. Interestingly enough, since the 1960's, high dose estrogen has proven to be just as effective for advanced breast cancer as antiestrogens but few people know about this. Food for thought...
As far as using it off license, I'm just sharing my experience and not recommending anyone follow the same route. One needs to absolutely discuss this with their doctor before. I agree.
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Erica, you sound exactly like me.
My view is essentially, if it works, then do it.
I am on a self invented high Oestrogen regime and I feel great.
We are only on this earth once, and I am sure going to enjoy the time that is given to me.
I might be a bit ‘far out', but what do you expect when one of my ‘heros' is Keith Richards LOL
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Erika28- There is a huge amount of evidence supporting that some types of breast cancer are driven by oestrogen/ progesterone and several effective, approved anti cancer treatments are based on blocking oestrogen. Supported by randomised, controlled Phase 3 trials.
I agree that the understanding of the causes of breast cancer are complex; not all types are hormone-driven, and that the best available evidence sUpports that HRT likely poses only a very small risk. I know the amount of oestradiol absorbed from gels and patches differs among women so we require different doses.
I use HRT myself, and it's literally been a lifesaver for me. I totally get it that the benefits for many of us outweigh the risks. I just disagree with some of the assertions you're presenting to this forum.
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Erica,. don't have much time to go in to details at the moment but I agree with your views. Please continue to share your thoughts and experiences.
Alicess 🌷
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What? Even when she's making false and irresponsible statements?
How are we going to be able to collect reliable safety data on the long term real-world use data of HRT when people are encouraging others to apply high doses of the most potent form of oestrogen to their vaginas? Against recommendations, and justifying it with incorrect assertions?
I left this forum for a year or so because someone with an “agenda†was spreading incorrect information to put people off HRT, denying that low oestrogen levels can adversely affect your bone and heart health. I returned a few months ago, but I see that most of you prefer fake information, so it's not a place I want to be associated with.
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Erika28- There is a huge amount of evidence supporting that some types of breast cancer are driven by oestrogen/ progesterone and several effective, approved anti cancer treatments are based on blocking oestrogen. Supported by randomised, controlled Phase 3 trials.
I agree that the understanding of the causes of breast cancer are complex; not all types are hormone-driven, and that the best available evidence sUpports that HRT likely poses only a very small risk. I know the amount of oestradiol absorbed from gels and patches differs among women so we require different doses.
I use HRT myself, and it's literally been a lifesaver for me. I totally get it that the benefits for many of us outweigh the risks. I just disagree with some of the assertions you're presenting to this forum.
My assertions are based off research I've read in the last 10-15 years. To be able to assert with certainty that estradiol CAUSES breast cancer, you need large randomized trials, repeated over and over again, showing estradiol alone increases significantly the risk of breast cancer. We actually have the opposite of that: 2 large randomized trials which showed estradiol alone REDUCED the risk, one only significantly after cessation of the study. The media rarely mentions these, if ever! As mentioned earlier, high dose estrogen has been used for decades in the treatment of advanced breast cancer and found to be AS EFFECTIVE as anti-estrogens. Lastly, pregnancy, a period when hormone levels are VERY HIGH, has shown to be associated with a LOWER risk of cancer, over time. And we have much more...I have a whole document with a multitude of studies.
I would be happy to go over the research with you and you would likely agree with me, at the end of it. When you dig deeper, you see the truth of the matter. Then, you realize how MONEY drives treatments. ;)
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What? Even when she's making false and irresponsible statements?
How are we going to be able to collect reliable safety data on the long term real-world use data of HRT when people are encouraging others to apply high doses of the most potent form of oestrogen to their vaginas? Against recommendations, and justifying it with incorrect assertions?
I left this forum for a year or so because someone with an “agenda†was spreading incorrect information to put people off HRT, denying that low oestrogen levels can adversely affect your bone and heart health. I returned a few months ago, but I see that most of you prefer fake information, so it's not a place I want to be associated with.
If needed, I can provide the research supporting my assertions. I have absolutely no problem with this. I have no agenda except the truth, which when we start to dig deeper, we realize we really don't know much anyways and there is so much more to learn. I truly care about others and only want them to be as informed as possible so they can make the best possible decision. I present data and let others draw their own intelligent conclusions.
I'm not encouraging anyone to do anything. I'm only sharing my personal experience with hormones. People should ALWAYS consult their doctors before doing anything. A forum is a place of exchange and this is what I do: I exchange information. :)
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Oh heavens not this thread again....
FWIW my well-informed gyno (in US) suggested I use the testosterone gel she prescribed this way, and the compounding pharmacy said yes that is one of the ways it can be applied. I rotate with other areas, seems fine.
No! Absolutely not! I am sure no reputable gynae (endorsed by British Menopause Society) will advocate putting testosterone gel - a preparation produced for men - onto female genitalia - if that's what you mean by " that is one of the ways it can be applied." Also since compounding pharmacies ie BHRT are also not recommended by the BMS (nor N American one for that matter as far as I recall) - then whatever they say cannot be taken as any sort of endorsement. You can do what you like - but it is not recommended for anyone else to even think about it!
Here is the BMS info about T replacement in women:
"10 How should testosterone gel/cream be used?
The testosterone gel/cream should be to applied to clean dry skin (lower abdomen/upper thighs) and allowed to dry before dressing. Skin contact with partners or children should be avoided until dry and hands should be washed immediately after application. The area of application should not be washed for 2-3 hours after application."
https://thebms.org.uk/publications/tools-for-clinicians/testosterone-replacement-in-menopause/
Hurdity
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What? Even when she's making false and irresponsible statements?
How are we going to be able to collect reliable safety data on the long term real-world use data of HRT when people are encouraging others to apply high doses of the most potent form of oestrogen to their vaginas? Against recommendations, and justifying it with incorrect assertions?
I left this forum for a year or so because someone with an “agenda†was spreading incorrect information to put people off HRT, denying that low oestrogen levels can adversely affect your bone and heart health. I returned a few months ago, but I see that most of you prefer fake information, so it's not a place I want to be associated with.
Hi Wilks - it's good to see you back on the forum and I can assure you that "most of" us DO NOT "prefer fake information". The big C word has been happening so many of us are otherwise occupied but please continue to post as this forum is endorsed by a renowned gynaecologist and is underpinned by science. False information or stuff not back up be evidence is usally challenged - but as always we only come on here when we have time in between busy lives ::)
I am followed by a private doctor in Canada who is a specialist in female hormones, she even wrote a book on the subject. She thinks outside the box, like me. I am very lucky to have her! I will share studies I come across, with her and she will share her own findings with me, based on the 1,000 patients she treats. I very much enjoy our discussions. :)
I have already responded to the use of the oft quoted cliche "thinking outside the box" which tends to be used to advocate any unconventional treatment that anyone wants to justify! It's not done to requote your own posts except probably in a very long thread but what I said about this is on the first page.... this (thinking outside the box) does not justify applying oestrogel to your vagina for the reasons given earlier - however much you appear to be trying to sell the idea to us!
Compounding pharmacies - like I said - are used by a minority, unregulated and not recommended, as we have perfectly good cheap tested, efficacious products available on NHS.
The issue about breast cancer is another matter entirely.
Yes sharing of information can be helpful and interesting but not if it appears to encourage a minority regime that is untested, totally off-piste, potentially unsafe, and the regime together with the monitoring needed only available privately at great expense.
The licensed HRT products should only be used in or on parts of the body that they have either been licensed for and/or research has shown are effective and safe at the doses used or can be easly extrapolated from the doses used for that preparation.
Hurdity
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I never used it (anywhere) but I was told by the endocrinologist prescribing testosterone that it worked better for libido if applied to the vaginal area. I assumed that's where everyone who used it applied it!
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See my other post on pepperminty's thread. I am sure no reputable gynae would advocate applying any form of T to genitals and if they have please post here who they are and the info! I've quoted an extract from the Androfeme (T cream for women licensed in Oz) product info on the other thread. T gel would be variably absorbed and give erratic serum T levels so totally inappropriate on labia or vagina. Any sort of compounded creams will not have been tested re T levels in body and won't be standardised so defo not recommended (to apply to genitals or anywhere). Just because your endocrinologist suggested this dangermouse does not mean it's OK! If you can link me to trials showing what product was used and applied to labia, and the outcomes re T levels etc together with recommended dosage, or the name of the doc so that we can look at their website maybe, then I'll take notice! With respect, we have to go on what advice is published rather than hearsay.
Hurdity x
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Erica- you are a grown adult. You can do what you like, with what you like- regardless of what is proven and what is not.
It is about informed consent and knowing full well that you accept the consequences of your actions.
I do what I like- safe in the knowledge if it goes ti*s up then I knew what I chose to do and accept the consequences of my actions. Sure, I won't be very happy if I get some hideous ‘disease', but I chose to take the risk.
Do what works for you.
I smoke like a trooper- I love it. Will it kill me- probably/maybe/maybe not;but as my old nan used to say “smoking prevents dementia “ how nan?= they are all dead before they get that old! LOL
People will then day ... oh , you shouldn't ‘burden' the NHS....... er , no.. I have paid my national insurance as well as medical insurance for the last 30 + years so have every right to use it. Dementia is also a ‘burden' on the NHS is it not.
Life really is for living- for the time that is given to us
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Sgtvhilts, I agree, sometimes conventional forms of HRT don't work and you have no option other than to find your own solutions. I used Angeliq topped up with a patch for a long time.
I can't take any of the standard forms of progesterone so I now use bespoke 50mg progesterone alongside Oestrogel and testosterone and it's working extremely well.
The only other option was a hysterectomy so in as last ditch effort, I decided to take responsibility for it myself and find something that worked. What was I supposed to do?
I wish I could use a standard HRT regime but it's just not possible.
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See my other post on pepperminty's thread. I am sure no reputable gynae would advocate applying any form of T to genitals and if they have please post here who they are and the info! I've quoted an extract from the Androfeme (T cream for women licensed in Oz) product info on the other thread. T gel would be variably absorbed and give erratic serum T levels so totally inappropriate on labia or vagina. Any sort of compounded creams will not have been tested re T levels in body and won't be standardised so defo not recommended (to apply to genitals or anywhere). Just because your endocrinologist suggested this dangermouse does not mean it's OK! If you can link me to trials showing what product was used and applied to labia, and the outcomes re T levels etc together with recommended dosage, or the name of the doc so that we can look at their website maybe, then I'll take notice! With respect, we have to go on what advice is published rather than hearsay.
Hurdity x
I suspect all hormones are more effective if applied to mucous membranes, the dose needed is probably less than if taken orally if that's how testosterone is normally taken.
This could be what you're looking for: https://www.ncbi.nlm.nih.gov/m/pubmed/16681480/
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When i was given Estrogel by mistake from a Dr other than my own, instead of Ovestin, my own Dr was horrified ,and i suspect the other Dr,a new young one had a good telling off
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Here is a study detailing estrogen application intravaginally.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4354766/
Rigg and colleagues measured the levels of estradiol, estrone, LH, and FSH after application of 2 g of vaginal cream containing either 0.2 mg estradiol (E2), 2.0 mg estradiol (E2), or 1.25 mg conjugated equine estrogen (CEE) in six postmenopausal women.23 Each participant rotated treatment with each type of cream. With the low dose estradiol (0.2 mg), an increase in serum estradiol was seen in 30 minutes with a peak of 80 ± 19 pg/ml reached at 4 hours. In comparison, the high dose estradiol cream (2.0 mg) led to an increase in serum estradiol that occurred in 15 minutes with its peak occurring in 4 hours at 527 ± 45 pg/ml. CEE cream showed a much slower rise of estradiol level, with a significant increase occurring after 3 hours and a peak reached at 6 hours of 33 ± 6.6 pg/ml.
What's interesting is when you look at the graph, you notice how levels remain quite stable over 24 hours. I have the entire study of this (N Engl J Med 1978; 298:195-197, DOI: 10.1056/NEJM197801262980406)
Also,
Intravaginal estradiol is also utilized in women undergoing embryo transfer. Tourgeman et al. studied oral versus vaginal estrogen administered to women preparing for embryo transfer.27 The women were given leuprolide, inducing a temporary menopausal state, and then administered either oral micronized estradiol (2mg bid orally or vaginally) during days 15-21 of their cycle. Two hours after the final dose of oral estradiol, mean serum levels were 279 pg/ml compared to mean serum levels following vaginal estradiol (2344 pg/ml).
And,
In a study by Martin et al.28 postmenopausal women were given 0.5 mg vaginal micronized estradiol as a one time dose. Another group was given 0.5 mg vaginally with alternate day dosing for 14 days. The levels of estradiol, estrone, and gonadotropins were analyzed at 2, 4, 6, 8,10 and 24-hours post application. With the one time dose, estradiol reached a mean peak level of 1105 ± 160 pg/ml at 4 hours. At 10 hours, the estradiol level was 24 times baseline levels. In contrast, estrone reached 11 times baseline after 8 hours (exact values not given, approximately 400 pg/ml vs 0). There was a significant decrease in both FSH and LH during the first 10 hours (FSH approximately 90 to 70 mIU/ml, and LH 40 to 25 mIU/ml).28 These data were compared to an earlier study in which 2 mg oral estradiol was used. Use of vaginal estradiol 0.5 mg resulted in a peak serum estradiol 10 times higher than 2 mg oral estradiol (0.5mg of vaginal estradiol resulted in mean peak levels of 1105 pg/ml at 4 hours as noted above vs 2.0 mg oral estradiol esulted in peak level of 110 pg/ml at 2 hours ). Estrone levels were 25% higher with the vaginal application. Oral delivery of estradiol yielded serum levels of estrone which significantly exceeded levels of serum estradiol secondary to hepatic “first pass†metabolism. However, vaginal administration of estradiol results in higher serum levels of estradiol compared to estrone because the vaginally administered estradiol is not subject to “first pass†metabolism. 28, 29
With estradiol tablets taken vaginally, levels fluctuate more. There is quite a rapid peak and then drop so that by 24 hours, levels are back to where they were before taking the tablet. Cream results in much steadier levels.
I have all 3 studies as pdfs. I work at a university, this is why. :)
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I suspect all hormones are more effective if applied to mucous membranes, the dose needed is probably less than if taken orally if that's how testosterone is normally taken.
This could be what you're looking for: https://www.ncbi.nlm.nih.gov/m/pubmed/16681480/
Hi dangermouse - thanks for the link - I'd seen that paper but it was just a study looking at one application of a synthetic testosterone product (not used for T replacement in women) to see at how it was absorbed in the body - so not relevant to our situation. Testosterone is never taken orally anyway for HRT - always transdermally (and occasionally subcutaneously via pellet) - for the reason you give - that it is better absorbed as well as not leading to metabolic by-products from going through liver etc.
There is no product available which can be applied vaginally or onto labia (I posted the Androfeme info on the other thread about T).
Hurdity x
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Here is a study detailing estrogen application intravaginally.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4354766/
Rigg and colleagues measured the levels of estradiol, estrone, LH, and FSH after application of 2 g of vaginal cream containing either 0.2 mg estradiol (E2), 2.0 mg estradiol (E2), or 1.25 mg conjugated equine estrogen (CEE) in six postmenopausal women.23 Each participant rotated treatment with each type of cream. With the low dose estradiol (0.2 mg), an increase in serum estradiol was seen in 30 minutes with a peak of 80 ± 19 pg/ml reached at 4 hours. In comparison, the high dose estradiol cream (2.0 mg) led to an increase in serum estradiol that occurred in 15 minutes with its peak occurring in 4 hours at 527 ± 45 pg/ml. CEE cream showed a much slower rise of estradiol level, with a significant increase occurring after 3 hours and a peak reached at 6 hours of 33 ± 6.6 pg/ml.
What's interesting is when you look at the graph, you notice how levels remain quite stable over 24 hours. I have the entire study of this (N Engl J Med 1978; 298:195-197, DOI: 10.1056/NEJM197801262980406)
Also,
Intravaginal estradiol is also utilized in women undergoing embryo transfer. Tourgeman et al. studied oral versus vaginal estrogen administered to women preparing for embryo transfer.27 The women were given leuprolide, inducing a temporary menopausal state, and then administered either oral micronized estradiol (2mg bid orally or vaginally) during days 15-21 of their cycle. Two hours after the final dose of oral estradiol, mean serum levels were 279 pg/ml compared to mean serum levels following vaginal estradiol (2344 pg/ml).
And,
In a study by Martin et al.28 postmenopausal women were given 0.5 mg vaginal micronized estradiol as a one time dose. Another group was given 0.5 mg vaginally with alternate day dosing for 14 days. The levels of estradiol, estrone, and gonadotropins were analyzed at 2, 4, 6, 8,10 and 24-hours post application. With the one time dose, estradiol reached a mean peak level of 1105 ± 160 pg/ml at 4 hours. At 10 hours, the estradiol level was 24 times baseline levels. In contrast, estrone reached 11 times baseline after 8 hours (exact values not given, approximately 400 pg/ml vs 0). There was a significant decrease in both FSH and LH during the first 10 hours (FSH approximately 90 to 70 mIU/ml, and LH 40 to 25 mIU/ml).28 These data were compared to an earlier study in which 2 mg oral estradiol was used. Use of vaginal estradiol 0.5 mg resulted in a peak serum estradiol 10 times higher than 2 mg oral estradiol (0.5mg of vaginal estradiol resulted in mean peak levels of 1105 pg/ml at 4 hours as noted above vs 2.0 mg oral estradiol esulted in peak level of 110 pg/ml at 2 hours ). Estrone levels were 25% higher with the vaginal application. Oral delivery of estradiol yielded serum levels of estrone which significantly exceeded levels of serum estradiol secondary to hepatic “first pass†metabolism. However, vaginal administration of estradiol results in higher serum levels of estradiol compared to estrone because the vaginally administered estradiol is not subject to “first pass†metabolism. 28, 29
With estradiol tablets taken vaginally, levels fluctuate more. There is quite a rapid peak and then drop so that by 24 hours, levels are back to where they were before taking the tablet. Cream results in much steadier levels.
I have all 3 studies as pdfs. I work at a university, this is why. :)
Thanks for the links Erika28 but I don't see their relevance to what was being discussed? Yes it is well known that transdermal and especially vaginal absorption (though mucous membranes) is an effective way of getting a drug into the system but these studies do not alter the point that estradiol gel developed for transdermal application and absorption through the skin of the abdomen or trunk, should not be applied to/into the vagina - not least because of the unknown range of systemic levels attained which can have drastic consequances for the womb lining. The estradiol levels attained in one of these studies are absurdly high anyway! I would have thought that if you are a university researcher (as you have access to the full studies) you would know that these studies were not designed to test or provide support to vaginal use of estradiol gel as an ongoing part of HRT? Only trials using the available products and carried out for the same length of time as (or similar to) the existing trials ( prior to launching the HRT products ie the gel) - should be used. Any oestrogen product designed to provide a systemic dose of HRT would have been developed and tested extensively for this purpose.
I think maybe there used to be an oestrogen cream designed for systemic HRT in US - Estrace - but might be wrong about this? The current formulation of Estrace is as a vaginal cream.
Of course you can do what you like "regardless of what is proven and what is not" - but like I said - the information on this website about HRT and products is all bona fide based on medical and scientific research and endorsed by BMS - so it is important on this forum (which is an adjunct of the main website) to challenge "advice" given that advocates considerable departure from current medical recommendations (in the broadest sense).
Hurdity x
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I'm not a university researcher. I just work at the university as an administrator and was a former student there.
I supplied those studies just for information, nothing more. It's an interesting read.
Why don't more women in the UK use pellets containing estradiol? These seem to be quite effective, last a long time (4-6 months) and have been advocated by some like John Studd.