Transdermal estrogen, which is absorbed directly through the skin, offers one option for relief of menopausal symptoms. These FDA (Food and Drug Administration)-approved products include gels, an emulsion, and a spray. The gels (Divigel, Elestrin, Estrogel) and emulsion lotion (Estrasorb) are applied to the arms or legs as directed. The spray (Evamist) is applied to the inside of the forearm between the elbow and the wrist. There are also estrogen creams prepared and dispensed from compounding pharmacies but these are not approved by the FDA.
NB: All of these skin applications have the potential for transfer to children and pets.
A number of reports have been filed with the FDA describing the unintended transfer of estrogen to children and pets from the skin of women using Evamist. Reports in the medical and veterinary literature also describe unintended transfer of compounded estrogen creams to children and pets.
Signs that Children & Pets Unintentionally Exposed to Estrogen
Children show signs of premature puberty:
- Nipple swelling and breast development in girls
- Breast enlargement in boys
Pets show signs of excess estrogen:
- Breast or nipple enlargement in male and females
- Vulvar enlargement in females
Safety Recommendations from the FDA for Women Using Evamist*
- Read the Package Insert when picking up a prescription for Evamist.
- Thoroughly wash hands after applying topical estrogens and before handling food products, animals, or small children.
- Do not allow children to make contact with the area where Evamist was sprayed. If contact with children cannot be avoided, wear a garment to cover the application site.
- If a child comes into direct contact with the arm where Evamist was sprayed, wash the child’s skin with soap and water as soon as possible.
- Contact the child’s healthcare professional if any of the signs above are noted. Tell the healthcare professional the child may have been exposed to Evamist.
- Do not allow pets to lick or touch the arm where Evamist was applied. Contact your pet’s veterinarian if your pet shows signs of nipple or vulvar enlargement. Tell them that your pet may have been exposed to Evamist.
- Dispose of estrogen products out of the reach of children and pets.
- Report any side effects from topical estrogens to the FDA’s MedWatch.
*It probably makes sense for women using other topical estrogens, especially compounded estrogen creams, to consider similar precautions. More information is available at the FDA website.
This information from The North American Menopause Society (NAMS) is not to be used as a medical diagnosis. This page may be photocopied. For all questions about medical issues, NAMS recommends that patients consult their healthcare providers.