Sandrena

What is Sandrena Gel?

Sandrena gel is a topical Hormone Replacement Therapy (HRT) used to treat menopause symptoms and, in some cases, to help prevent osteoporosis in postmenopausal women who are at increased risk of fractures and cannot use other treatments. Its active ingredient, estradiol, replaces the oestrogen that naturally declines during menopause.

Women who still have their womb will usually also need to take a progestogen alongside Sandrena to protect the womb lining. Your prescriber will advise you on this.

How Does Sandrena Gel Work?

When you apply Sandrena to the skin, estradiol is absorbed directly into the bloodstream. This bypasses the digestive system and liver, which means oestrogen levels rise more steadily than with oral HRT tablets. By restoring oestrogen levels, Sandrena helps to reduce the frequency and severity of menopause symptoms.

How Long Does Sandrena Gel Take to Work?

Some improvement in symptoms can occur within the first few weeks of treatment, though the full benefit typically takes around three months. If your symptoms have not improved by this time, speak to your prescriber, as your dose may need to be adjusted.

How Effective is Sandrena?

Multiple clinical trials have been conducted to investigate how well Sandrena works for women going through menopause. One 12-month trial followed 395 postmenopausal women using Sandrena gel alongside a progestogen. It effectively eased hot flushes, night sweats, and vaginal dryness.

Another 12-month trial compared Sandrena gel with an oestrogen patch in 120 women, again alongside a progestogen. Both treatments worked equally well at easing menopause symptoms and protecting bone density, with a similar safety profile. Women using the patch had a higher chance of heavier bleeding, and the gel also caused less skin irritation than the patch, which is a common drawback of patch-based HRT.

Sandrena can also help prevent osteoporosis. Wider HRT research, including the Women's Health Initiative trial, shows it can lower the risk of hip, spine, and other fractures caused by weakened bones.

How to Apply Sandrena Gel

Sandrena gel should be applied directly to dry, clean skin on the lower body once daily at the dose prescribed by your prescriber. It should not be swallowed, and should never be applied to the breasts, face, or irritated skin.

Please note that Sandrena gel can be transferred to other people or animals via close skin contact. It's important that you don't let others, especially children, touch the area where you applied the gel. Ensure that you cover the application area with clothing once the gel has dried, and shower the site before you expect to make skin contact with others. If another person or animal does make contact with the gel, wash their skin with soap and water immediately and seek medical or veterinary advice if they experience symptoms.

Where to Apply Sandrena Gel

It's important to use Sandrena gel on the lower body, including the thighs, as this is the only area for which the gel has been tested and licensed. Ensure that the treatment is applied to a different side of the body each day.

Examples of where to apply Sandrena gel include:

• Lower abdomen
• Buttocks
• Thighs (inner or outer)

Do not apply the gel to your breasts, face, or on irritated skin.

How to Use Sandrena Gel

Spread the gel over an area 1–2 times the size of your hand, then allow it to dry fully for a few minutes before getting dressed to avoid rubbing it onto clothing. Wash your hands afterwards and avoid contact with your eyes, as the gel may irritate them. Avoid washing, showering, or swimming for at least an hour after application, and don't apply creams, lotions, or sunscreen to the same area, as this may affect how well the gel is absorbed.

Sandrena can be used every day.

How Much Sandrena Gel Should I Use?

Your prescriber will start you on the lowest dose that is likely to work, then adjust it as needed based on how your symptoms respond. The usual starting dose is 1 mg of estradiol (1 g of gel) daily, though the initial dose can vary depending on the severity of your symptoms.

• 0.5 mg a day: one 0.5 g sachet
• 1 mg a day: one 1 g sachet, or two 0.5 g sachets
• 1.5 mg a day: three 0.5 g sachets, or one 0.5 g sachet plus one 1 g sachet

Always use the dose your prescriber has set for you, even if it differs from these examples.

What if You Use Too Much Sandrena

If you accidentally apply more Sandrena gel than recommended, speak to your doctor or pharmacist. You may notice bloating, breast tenderness, anxiety, or nausea, but these effects usually ease once your dose is reduced or treatment is paused. Overdose is unlikely with a gel like Sandrena, and symptoms usually disappear once treatment is stopped or the dose is reduced.

What if You Forget to Use Sandrena Gel

If you forget to use Sandrena gel when you should, apply the missed dose as soon as you remember, unless more than 12 hours have passed. If more than 12 hours have passed, skip the missed dose and continue to use the treatment as usual. Missing a dose may cause some bleeding between periods, known as breakthrough bleeding.

Sandrena Gel Side Effects and Cautions

No medicine is completely risk-free, and Sandrena is no exception. This section covers the side effects you might experience, along with important precautions to take before and during treatment.

Side Effects of Sandrena Gel

As with all medicines, Sandrena gel can cause side effects in some people, though not everyone will experience them. They're grouped below by how often they happen.

Please be aware that the above list does not cover all the potential side effects of Sandrena gel. More information can be found within the Patient Information Leaflet that accompanies the medication.

When to Stop Taking Sandrena

If you notice any of the following side effects while using Sandrena, it's essential to stop treatment and see a doctor immediately:

• Yellowing of the skin or whites of the eyes (jaundice)
• Swollen face, tongue, throat, difficulty swallowing, or hives and breathing difficulties
• A large rise in blood pressure
• Migraine-like headaches that happen for the first time
• If you become pregnant
• Sudden chest pain, difficulty breathing, painful swelling and redness of the legs

Conditions Linked to HRT Use

Some health conditions are reported more often in women using HRT than in those who don't. This doesn't mean these conditions will happen to you, but it's worth understanding the risks before starting treatment.

• Breast cancer: The risk increases the longer HRT is used, and becomes noticeable within 3 years of starting.
• Womb lining thickening or cancer (endometrial hyperplasia or cancer): Oestrogen-only HRT raises this risk, which is why a progestogen is usually prescribed alongside it for women who still have a womb.
• Ovarian cancer: This is rare, but slightly more common in women using HRT.
• Blood clots in the veins (venous thromboembolism): The risk is higher than in non-users, particularly during the first year of use.
• Heart disease: Women over 60 using combined HRT have a slightly higher risk; this doesn't apply to oestrogen-only HRT in women who've had a hysterectomy.
• Stroke: The risk is around 1.5 times higher in HRT users than non-users, and increases with age.
• Memory loss: There's some evidence of a higher risk in women who start HRT after the age of 65.

This isn't a full list of risks. Your prescriber will talk through these with you, and you can find more details in the Patient Information Leaflet.

Allergic Reaction

Stop using Sandrena and see a doctor straight away if you notice any of the following symptoms, as these can be signs of a serious allergic reaction:

• Swelling of the face, tongue, or throat
• Hives
• Difficulty breathing

If You Require Surgery

If you're going to have surgery, tell your surgeon that you're using Sandrena. You may need to stop using it 4 to 6 weeks before the operation to reduce the risk of a blood clot. Ask your doctor when you can start using Sandrena again afterwards.

Sandrena Gel Interactions and Warnings

Although Sandrena gel is usually well-tolerated, it isn't suitable for everyone. This is why it's essential to consult a clinician or doctor to determine if the medication is safe for you to use.

You should not use Sandrena if you:

• Have or have ever had breast cancer
• Have cancer that is sensitive to oestrogens, such as endometrial cancer (cancer of the womb)
• Have any unexplained vaginal bleeding
• Have untreated endometrial hyperplasia
• Have or have ever had a blood clot in a vein (thrombosis)
• Have a blood-clotting disorder
• Have or recently have had a disease relating to blood clots in the arteries (e.g. heart attack, stroke or angina)
• Have or have ever had liver disease or abnormal liver function test results that have not returned to normal
• Have a rare blood disorder called porphyria
• Are allergic to estradiol or any of the other ingredients listed in the Patient Information Leaflet

Precautions for Sandrena Gel

Before starting Sandrena, tell your doctor if you have, or have ever had, any of the following, as these may need extra monitoring or could become worse during treatment:

• Fibroids in the womb, or endometriosis
• An increased risk of blood clots, or a close relative who has had one
• High blood pressure
• A liver disorder, such as a benign liver tumour
• Diabetes
• Migraine or severe headaches
• Epilepsy or asthma

This isn't a full list. Your doctor will go through your medical history with you, and you can find the complete list of precautions in the Patient Information Leaflet.

Sandrena Gel and Other Medications

Some medicines can affect how well Sandrena works, which may lead to irregular bleeding. Tell your doctor if you're taking:

• Medicines for epilepsy, such as phenobarbital, phenytoin, or carbamazepine
• Medicines for tuberculosis, such as rifampicin or rifabutin
• Medicines for HIV, such as nevirapine, efavirenz, ritonavir, or nelfinavir
• St John's Wort, or other herbal remedies containing it

Sandrena can also affect how some other medicines work, including certain epilepsy and hepatitis C treatments. Always tell your doctor or pharmacist about any medicines you're taking, including those bought over the counter or herbal remedies, so they can check for interactions.

Pregnancy and Breastfeeding

Sandrena is only suitable for postmenopausal women and should not be used during pregnancy or while breastfeeding. If you become pregnant while using Sandrena, stop treatment and contact your doctor straight away.

Sandrena is not a contraceptive. If it has been less than 12 months since your last period, or you are under 50, you may still need contraception to prevent pregnancy. Speak to your doctor for advice.

Frequently Asked Questions About Sandrena Gel