The following adverse reactions have also been reported in association with systemic oestrogen/ progestogen treatment: or/35‐44 [SR filter‐Medline; based on CADTHhttps://www.cadth.ca/strings‐attached‐cadths‐database‐search‐filters]

HRT is associated with a 1.3 – 3 fold risk of developing venous thromboembolism (VTE), i.e. deep vein thrombosis or pulmonary embolism. The occurrence of such an event is more likely in the first year of HRT than later (see Section 4.8). Adding a progestogen to oestrogen-only therapy for at least 12 days per cycle can prevent this increased risk. In the Million Women Study (MWS) the use of five years of combined (sequential or continuous) HRT did not increase risk of endometrial cancer (RR of 1.0 (0.8-1.2). If the patient forgets to apply a dose and it is more than 12 hours until the next dose, the missed dose should be applied and normal dosing resumed the next day. If the next dose is less than 12 hours away, it is best just to wait and apply the next dose normally. Patients should be advised not to apply two doses at the same time. glucogel or glucagon or dextrogel or dex4 pr dex‐4 or Glutose or Glutose or Hypostop or hypo‐stop or Insta‐Glucose).ti,ab,kw,kf.

Weston PJ, Harris DL, Harding JE. Dextrose gel treatment does not impair subsequent feeding. Archives of Disease in Childhood - Fetal and Neonatal Edition 2017; 102:F539-41. [DOI: 10.1136/archdischild-2017-312772] [ PubMed] [ CrossRef] [ Google Scholar]

Metabolism of oestradiol takes place mainly in the liver under oestriol, estrone and their conjugated metabolites (glucuronides, sulphates). These metabolites also undergo enterohepatic recirculation. Randomised controlled data found no increased risk of CAD in hysterectomised women using oestrogen-only therapy. HRT, especially oestrogen-progestogen combined treatment, increases the density of mammographic images which may adversely affect the radiological detection of breast cancer. congenital hyperinsulinism/ or nesidioblastosis/ or insulin coma/ [Subtypes of hypoglycemia per MeSH] Generally recognised risk factors for VTE include, use of oestrogens, older age, major surgery, prolonged immobilisation, obesity (BMI > 30kg/m 2), pregnancy/postpartum period, systemic lupus erythematosus (SLE) and cancer. There is no consensus about the possible role of varicose veins in VTE. As in all postoperative patients, prophylactic measures need be considered to prevent VTE following surgery. If prolonged immobilisation is to follow elective surgery temporarily stopping HRT 4 to 6 weeks earlier is recommended. Treatment should not be restarted until the woman is completely mobilised.

More about glucose

We included two studies conducted in high‐income countries, involving 312 late preterm and at‐risk term infants and comparing oral dextrose gel (40% concentration) to placebo gel. One study was at low risk of bias, and the other (an abstract) was at unclear to high risk of bias. Oral dextrose gel compared with placebo gel probably increases correction of hypoglycaemic events (rate ratio 1.08, 95% confidence interval (CI) 0.98 to 1.20; rate difference 66 more per 1000, 95% CI 17 fewer to 166 more; 1 study; 237 infants; moderate‐certainty evidence), and may result in a slight reduction in the risk of major neurological disability at age two years or older, but the evidence is uncertain (risk ratio (RR) 0.46, 95% CI 0.09 to 2.47; risk difference (RD) 24 fewer per 1000, 95% CI 41 fewer to 66 more; 1 study, 185 children; low‐certainty evidence). The evidence is very uncertain about the effect of oral dextrose gel compared with placebo gel or no gel on the need for intravenous treatment for hypoglycaemia (RR 0.78, 95% CI 0.46 to 1.32; RD 37 fewer per 1000, 95% CI 91 fewer to 54 more; 2 studies, 312 infants; very low‐certainty evidence). Investigators in one study of 237 infants reported no adverse events (e.g. choking or vomiting at the time of administration) in the oral dextrose gel or placebo gel group (low‐certainty evidence).

The randomised placebo-controlled trial, the Women's Health Initiative study (WHI), and a meta-analysis of prospective epidemiological studies are consistent in finding an increased risk of breast cancer in women taking combined oestrogen-progestogen for HRT that becomes apparent after about 3 (1-4) years (see Section 4.8). A meta-analysis from 52 epidemiological studies reported an increased risk of ovarian cancer in women currently using HRT compared to women who have never used HRT (RR 1.43, 95% CI 1.31-1.56). For women aged 50 to 54 years taking 5 years of HRT, this results in about 1 extra case per 2000 users. In women aged 50 to 54 who are not taking HRT, about 2 women in 2000 will be diagnosed with ovarian cancer over a 5-year period. Weston P, Harris D, Harding J. Dextrose gel and formula but not breast milk are effective treatments for neonatal hypoglycaemia. Journal of Paediatrics and Child Health 2017; 53( Suppl 2):112. [DOI: 10.1111/jpc.13494_330] [ CrossRef] [ Google Scholar] If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was If you take Dextrose gel in a pre-measured tube, be sure to swallow the entire contents of the tube to get a full dose.

More about Dextrose (D-glucose)

Oestrogel was administered to 17 postmenopausal women once daily on the posterior surface of one arm from wrist to shoulder for 14 consecutive days. Switching from a continuous oestrogen-progestogen combined HRT: treatment with Oestrogel can be started on any day of the cycle. It is usually given until the breast fed baby is transferred onto a formula milk product or weaned onto solid foods

Oestrogens increase thyroid binding globulin (TBG), leading to increased circulating total thyroid hormone, as measured by protein-bound iodine (PBI)), T4 levels (by column or by radio-immunoassay) or T3 levels (by radio-immunoassay). T3 resin uptake is decreased, reflecting the elevated TBG. Free T4 and free T3 concentrations are unaltered. Other binding proteins may be elevated in serum, i.e. corticoid binding globulin (CBG), sex-hormone-binding globulin (SHBG) leading to increased circulating corticosteroids and sex steroids respectively. Free or biological active hormone concentrations are unchanged. Other plasma proteins may be increased (angiotensinogen/renin substrate, alpha-I-antitrypsin, ceruloplasmin). or/39‐48 [SR Filter: EMBASE based on CADTH filter: https://www‐cadth‐ca.ezproxy.uvm.edu/strings‐attached‐cadths‐database‐search‐filters] Oestrogen deficiency at menopause is associated with an increasing bone turnover and decline in bone mass.The World Health Organization (WHO) recommends breastfeeding for all infants up to six months of age ( WHO 2008), and the health benefits of breastfeeding for both mother and infant are well recognised. Human studies have shown that breast milk volume in the first 24 postpartum hours is low and progressively increases by the third day ( Kulski 1981; Le Huerou‐Luron 2010; Saint 1984). The concentration of lactose within breast milk is also low in the first 24 hours ( Kulski 1981; Saint 1984), and steadily increases over the first three days. A slightly greater number of mothers in the group allocated to oral dextrose gel than to placebo gel intended to breastfeed (114 of 115 vs 109 of 115). Ritonavir and nelfinavir, although known as strong inhibitors, by contrast exhibit inducing properties when used concomitantly with steroid hormones. Herbal preparations containing St John's wort (Hypericum perforatum) may induce the metabolism of oestrogens. Blood glucose concentration was measured 30 minutes following gel treatment. Gel was repeated if hypoglycaemia persisted. A maximum of six doses of gel could be given within a 48‐hour period. Your hypoglycemia symptoms should improve in about 10 minutes after taking oral Dextrose. If not, take another dose. Seek medical attention if you still have hypoglycemia symptoms after taking two doses.