Position paper of the expert panel of the Polish Society of Menopause and Andropause on the use of Oestrogel in menopausal hormone therapy.

This position paper of the expert panel presents a comprehensive review of the efficacy, safety, and clinical application of bioidentical hormone replacement therapy (HRT), with particular focus on transdermal 17β-oestradiol gel (Oestrogel). Bioidentical hormones - chemically identical to endogenous human hormones - are increasingly recognised as the preferred option in modern HRT, consistent with current international guidelines. Based on a review of randomised clinical trials and observational studies (sourced primarily from PubMed and Medline), transdermal oestradiol demonstrates a superior safety profile compared to oral formulations. Benefits include stable serum oestradiol levels without supraphysiological fluctuations; minimal impact on hepatic synthesis of procoagulant factors, triglycerides, hormone-binding proteins (SHBG, TBG, CBG), and inflammatory mediators (e.g. C-reactive protein); no increased risk of venous thromboembolism or ischaemic stroke; and the ability to use lower doses while maintaining efficacy. Additional advantages are a more physiological E2/E1 ratio, reduced inter-individual variability, and the option to monitor serum oestradiol levels. Oestrogel supports dose flexibility and personalisation, allowing treatment to be tailored according to patient needs and guideline-based therapeutic schemes. When combined with micronised progesterone - the gold-standard progestogen for endometrial protection and the preferred option due to its favourable overall safety profile - this form of HRT offers a modern, well-tolerated, and individualised approach to the management of menopausal symptoms and osteoporosis prevention.