Topical estrogen (Divigel®) is a type of hormone replacement therapy (HRT) that contains a female hormone, estrogen. It is applied onto the skin. Learn how to use the medication, its common side effects, special precautions to watch out for, and more.

What is this medication for?

Topical estrogen (Divigel®) is a type of hormone replacement therapy (HRT) that contains a female hormone, estrogen. It is applied onto the skin. It is used to treat menopausal symptoms like hot flushes, excessive sweating, vaginal dryness and bone loss. These symptoms are typically caused by a decrease in the levels of estrogen in the body, which happens naturally after menopause. Topical estrogen works by replacing the estrogen in the body.

Using estrogen alone may cause unusual thickening of the uterus (womb) lining. Hence women who have an intact uterus will require an additional female hormone, progestogen, to prevent this. If your doctor prescribes progestogen to be taken for a specific duration (usually 10 – 14 days) each month, you will experience a withdrawal bleed (menses) after finishing the progestogen capsules/tablets.

How should I take or use this medication?

• Do not stop using your medication without checking with your healthcare professional.
• The medication should be applied once a day, around the same time each day. 
• Before using the medication, clean your skin, wash your hands and allow them to dry thoroughly.
• The medication comes in sachets. Open the sachet and squeeze out the contents onto the skin.
• Apply the medication to the skin of the outer upper arms, lower part of the stomach or the right or left thigh.
• The medication should be applied over a large surface, about 1 – 2 times the size of your hand.
• Do not apply the medication to the face, breasts or vaginal area as well as on cuts, scrapes or irritated skin.
• After the application, allow the gel to dry for a few minutes and do not wash the area for at least one hour. Wash your hands after application.

What should I do if I forget to take or use this medication?

If you miss a dose for less than 12 hours, apply as soon as you remember. Then apply your next dose at the usual time. If it is more than 12 hours since you missed the dose, skip the missed dose and apply the next dose at the usual time. Do not apply two doses to make up for the missed dose.

Sometimes, a missed dose may cause breakthrough bleeding (unexpected bleeding). 

What precautions should I take when taking or using this medication?

Inform your healthcare professional if:

• You are allergic to this medication or any of the other ingredients of this medication.
• You are taking any other medications, including supplements, traditional medications and herbal remedies.
• You have unexplained vaginal bleeding.
• You have a history of or current medical conditions such as liver problems, stroke, heart disease, blood clots, migraine headaches, epilepsy (fits), diabetes mellitus, cancer or have unexplained vaginal bleeding.
• You are going for surgery or will be on bed rest.

What are some common side effects of this medication?

• Breast tenderness
• Headache
  • You may take Paracetamol to manage headaches. Do make sure that you are drinking enough water.
• Nausea, vomiting, bloating and stomach cramps
  • You may consume smaller but more frequent meals, and avoid spicy, fatty food.
• Skin irritation at site of application
  • Alternate application sites e.g. you can apply the gel over both your outer arms one day, and on another day, to both your thighs instead.

Consult your doctor about any symptom that becomes bothersome.

What are some rare but serious side-effects that I need to seek medical advice immediately?

The symptoms of a drug allergy include one or more of the following: 

• Swollen face/eyes/lips/tongue
• Difficulty in breathing
• Itchy skin rashes over your whole body

Taking HRT increases a woman’s risk of developing blood clots and breast cancer. However, these are rare and the doctor would have evaluated and weighed its benefits over risks before making the recommendation. Please discuss with your doctor if you have any concerns.

The symptoms of blood clot include one or more of the following: 

• Any unusual sudden cough, breathlessness or difficulty in breathing
• Severe pain in the chest which may reach the left arm
• Severe pain in the legs or swelling in either of your legs
• Weakness or numbness in any part of your body
• Change in your speech, including slurring of words
• Change in your senses of hearing, smell or taste
• Vision changes such as loss of vision/ blurred vision

It is also advisable to regularly check your breasts while you are on HRT.  If you notice any unusual changes, please see your doctor immediately. 

Other rare but serious side effects that you may or may not experience:

• Have unexpected, heavy or longer than usual menstrual bleeding
• Experience dark urine or light coloured stools, nausea, vomiting, loss of appetite, stomach pain, yellowing of your eyes or skin. These may be signs of liver disease.
• Experience bothersome mood changes

If you experience any of these symptoms, you should stop your medication and see your healthcare professional immediately.

How should I store this medication?

Store in a cool and dry place, away from direct sunlight. Keep this medication away from children. 

How do I throw away this medication safely?

Pack this medication into a black trash bag and seal it tightly before throwing into the rubbish chute or bin. 

Disclaimer

Please take note that the above is not a complete list of all possible side effects. If you have any concerns about your medication or if you have other side effects that you think are caused by this medication, please consult your doctor or pharmacist.

If you take more than the recommended dose, please seek medical advice immediately. The information provided on this page does not replace information from your healthcare professional. Please consult your healthcare professional for more information.

This article is jointly developed by members of the National Medication Information workgroup. The workgroup consists of cluster partners (National Healthcare Group, National University Health System and SingHealth), community pharmacies (Guardian, Unity and Watsons) and Pharmaceutical Society of Singapore. The content does not reflect drug availability and supply information in pharmacies and healthcare institutions. You are advised to check with the respective institutions for such information.

Last updated on June 2024