What it is

Estradiol gel contains estradiol, the same estrogen your ovaries made.¹ You rub it on your skin, and the estrogen passes through the skin into your blood without going through the liver first.² Your doctor sets your dose, as a number of pumps.

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How to use it

• Use the number of pumps written on your label, once a day, every day, without breaks.
• Apply it in the early evening, after your shower, at least 1 hour before bed. For 1 hour after applying it, you should not wash the area or let anyone else touch it, especially a male partner. Applying it after your evening shower gives that hour before you share a bed, and puts your morning blood test in the right time window.³
• Where: clean, dry, unbroken skin on the arms and shoulders, or the inner thighs. Spread each pump over one arm and shoulder (or one thigh), covering as large an area as possible.³ Physicians who focus on optimal hormone levels explain that a thin layer over a large area lets the estrogen release slowly through the day.
• Where not: do not apply it on or near the breasts, the vaginal area, or moist skin such as inside the mouth.³
• Apply it yourself. Do not let anyone else apply it for you.³
• Let it dry for 5 minutes, then cover it with clothing, such as long sleeves.³
• Wash your hands with soap and water afterwards.³
• Do not put creams, lotions or oils on the same area, because they may block absorption.

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If you miss a dose

If there are more than 12 hours until your next dose, apply it as soon as you remember, then go back to your usual time the next day. If there are less than 12 hours, skip it and apply the next dose at the usual time. Never apply two doses together.³ For example, if you usually apply it at 7 p.m. and remember before 7 a.m. the next morning, apply it then; if you remember later, wait until 7 p.m. Missing doses can cause spotting.³

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If you stop

• The effect wears off in about 3 days, because the level returns to your own baseline within about 76 hours.³
• Hot flushes come back in up to 87% of women. There is no single best way to stop; some experts suggest lowering the dose slowly over 3–6 months.² Bone loss also speeds up after stopping.² Please talk to us before you stop.
• If you have a womb, keep taking progesterone as your doctor advises.

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Please stop

• The combined contraceptive pill. It already contains estrogen, so with the gel you would get estrogen twice, and its risk of blood clots rises from about age 40. We help you choose another method.⁴
• Other estrogen products or hormone creams from elsewhere, so you do not get the same hormone twice.

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Tell us if you take

None of these means you cannot use the gel. Some medicines affect estrogen, so knowing what you take helps us look after you more closely.

• Seizure medicines (phenobarbital, phenytoin, carbamazepine), tuberculosis medicines (rifampicin, rifabutin), some HIV medicines (nevirapine, efavirenz, ritonavir, nelfinavir), or St John’s wort. These can lower or raise your estrogen level and change your bleeding pattern, so we take this into account when we look at your symptoms and blood test.³ If you use the progestin-only pill for contraception, some of these also make it work less well, so you would need condoms as well.⁵
• Testosterone or DHEA. The gel hardly affects free testosterone, so these can be used together; your doctor reviews them.¹
• Any new medicine you start while using the gel, so we can check that they work well together.

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Contact us if you notice

Our way of using estrogen is very safe, and we have not seen these problems in our patients. We tell you about them because it is our duty to give you complete information, so that you can help us watch out for yourself.

• Sore or swollen breasts, bloating or water retention. These can be signs that the dose is more than you need. We check and adjust your dose.³
• A lump or other change in your breast. Stop the gel and contact us that day. Keep it stopped until you have been checked.
• Yellowing of the skin or eyes, or a big rise in blood pressure. Stop the gel and contact us that day. The label lists these as reasons to stop.³
• A new migraine-type headache. Stop the gel and contact us. If you also take progesterone, keep taking it.³
• Pregnancy. Stop the gel and contact us.³
• Any vaginal bleeding (see the bleeding section on our progesterone page). Keep using your gel while you wait for any check.
• A new diagnosis of a blood clot, breast or other hormone-sensitive cancer, liver disease, stroke or heart attack. Stop the gel and tell us, because the label says to stop if a reason not to use it is found.³

These symptoms usually have other causes, and we will check to be sure. Stop the gel and go to a hospital the same day if you have: painful swelling of one leg, sudden chest pain or sudden breathlessness, which may be a blood clot;³ sudden weakness, numbness or difficulty speaking; or sudden, very heavy vaginal bleeding.

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How to store it

• Store below 30°C.³
• Keep it out of the sight and reach of children.³

Medically reviewed by Dr. Chontirot, MD · Medical licence no. 36583 · Last reviewed: 31 October 2026

References

1. The North American Menopause Society. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767–794.

2. Panay N, Fenton A, Hamoda H, et al. Recommendations and Key Messages on Women’s Midlife Health and Menopause. International Menopause Society; 2026 (summary published in Climacteric, 2025).

3. Package insert (Thailand): estradiol gel 0.06% with metered-dose pump. Besins Manufacturing Belgium; 2021.

4. Faculty of Sexual and Reproductive Healthcare. Contraception for Women Aged Over 40 Years. 2017, amended May 2025.

5. Summary of Product Characteristics: desogestrel 75 microgram film-coated tablets (progestogen-only pill). Organon Pharma (UK) Ltd; emc, UK; updated 2025.

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