You may have heard about a new form of HRT – oestrogen spray. Here, Stella’s clinical advisor Dr Lucy Wilkinson covers what it is and how to use it.
What is HRT spray?
Hormone replacement therapy (HRT) is an effective treatment for menopause symptoms including hot flushes, poor sleep and mood changes. Several different types are available, including oral HRT (tablets) and transdermal HRT (patches and gels).
HRT spray is a new type of transdermal HRT, containing oestrogen. The spray is applied to your skin and from there absorbed directly into your bloodstream.
The spray contains oestrogen, which is needed to treat your menopause symptoms.
Right now the only brand of HRT spray available in the UK is Lenzetto. In the USA, the HRT spray’s brand name is Evamist.
Learn more about the different types of HRT.
How does it work?
During perimenopause and postmenopause, your oestrogen levels become unpredictable and eventually fall. This causes the symptoms of menopause which can be so troublesome, including hot flushes, poor sleep and mood changes (among others!)
HRT works by replacing the oestrogen that your body no longer produces. HRT spray works in this way too. The oestrogen is sprayed onto your skin and from there absorbed into your bloodstream and distributed around the body.
How do you use the HRT spray?
The leaflet in your HRT spray package contains full instructions. As a general guide:
- Apply the spray to clean, dry skin
- The best place is the inner part of your forearm. If this isn’t possible, apply to your inner thigh. Choose an area of skin which is free from rashes or skin problems as these can affect the absorption
- Do not apply the spray to the breasts or genital area
- Hold the applicator to your skin. One press delivers one dose of oestrogen. If you need a second or third spray, apply this to a different patch of skin
- Let the spray dry for two minutes before getting dressed. Avoid bathing or washing for at least an hour. Avoid physical contact with others at least until the spray has dried
Each spray of Lenzetto contains 1.53mg of oestrogen in the form of estradiol. Most people begin by taking one spray per day, but your doctor may advise increasing this if needed. It can take a while for HRT to work fully, so ask your doctor before taking more than prescribed.
If you still have your womb, you will also need to take some form of progesterone. This is because taking oestrogen alone can lead to abnormal thickening of the womb lining, and in some cases even cancer. Thankfully, using progesterone removes this risk. Progesterone is available in a number of different forms including tablets and intrauterine coils. Your doctor will be able to advise which options are available for you.
Worried that your HRT might not be working for you? Read more here.
What are the benefits of HRT spray?
HRT spray is an effective way to control your menopause symptoms. It also provides other benefits of HRT, including helping to prevent osteoporosis. Although this is a new product, it’s popular for a number of reasons.
- Like other forms of transdermal HRT (patches and gels), HRT spray is not thought to come with any increased risk of serious blood clots (including DVT and PE).
- Your dose can be easily adjusted if needed
- You do not need to wear a patch or worry about it falling off
- It is easy to apply and dries quickly
Start your free online menopause assessment to see if HRT is right for you
What are the side effects of HRT spray?
Like all medications, HRT spray can cause side effects. These include:
- Sore breasts
- Bloating
- Nausea
- Cramps
- Indigestion
- Irregular vaginal bleeding
These usually settle within 12 weeks of starting treatment. If they persist or are severe, see your doctor. They might be able to advise a different dosage or type of oestrogen.
See your doctor urgently if you have any:
- Vaginal bleeding if it has been over a year since your last period
- Bleeding after sex
- Breast lumps or other changes (see here for more information on how to check your breasts)
- Any severe pain
- Any leg swelling, tenderness or redness
- Any other persistent, severe or worrying symptoms
What are the risks of HRT spray?
Like all medications, HRT comes with a few risks as well as benefits. Your risk profile will depend not only on the HRT spray itself, but also your own personal medical history and any other medications you use alongside the spray (for example, progesterone if you need to take combined HRT).
HRT spray is considered a lower risk form of HRT. It has been found to cause little or no change in your risk of breast cancer if used alone.
HRT spray is not thought to increase your risk of serious blood clots like pulmonary embolism or deep vein thrombosis (collectively known as venous thromboembolism or VTE). Despite this, if you have risk factors that put you at higher risk of these conditions (including strong family history or a BMI over 30), you may need to see a specialist for HRT to be prescribed.
You can read more about the risks and benefits of HRT here.
Should I use oestrogen gel or spray?
This is a personal choice, as well as being dependent on availability in your area. Both the gel and the spray are thought to come with the same benefits, risks and side effects.
Consider:
- How satisfied you are with the applicator and absorption of each product
- Any cost differences if you pay for your prescriptions privately
- Any ongoing supply issues
Your doctor will be able to advise you further if needed.
Final word
HRT spray is a popular and convenient way to take oestrogen for relief of menopause symptoms. Speak to your doctor if you would like to find out more.
Find out more about menopause on our blog or in our symptoms library.
Hillard, T. et al (2017). Management of the Menopause. ed. London: British Menopause Society, pp. 82-99
National Institute for Health and Care Excellence (2019) Menopause: diagnosis and management (NICE Guideline 23). Available at: https://www.nice.org.uk/guidance/ng23 [Accessed 28th December 2022]
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