LENZETTO SPRAY

Lenzetto Spray is a metered-dose transdermal oestradiol spray prescribed for the relief of menopausal symptoms caused by oestrogen deficiency. Each actuation delivers 1.53mg of oestradiol in an alcohol-based solution directly onto the inner forearm skin. Between one and three sprays are applied daily, allowing the dose to be calibrated to the individual woman's symptom response. The spray dries on the skin within minutes and oestradiol is absorbed transdermally, bypassing the liver entirely before entering the bloodstream.

Lenzetto is an oestrogen-only preparation. Women who have not had a hysterectomy must use a separately prescribed progestogen alongside Lenzetto to protect the womb lining from the stimulating effects of unopposed oestrogen. Women who have had a hysterectomy may use Lenzetto as their sole HRT. The spray format sets Lenzetto apart from patches, gels, and tablets in its application method, dose flexibility, and user experience. It is manufactured by Gedeon Richter UK Ltd and is classified as a Prescription Only Medicine.

Lenzetto is a clear, colourless, alcohol-based oestradiol solution supplied in a pressurised metered-dose pump. Each pump actuation delivers exactly 1.53mg of oestradiol in a defined spray volume onto the skin. The metered-dose mechanism ensures that every spray delivers the same quantity of oestradiol regardless of how the bottle is held or how long it has been in use, removing the dose variability that can occur with gel preparations applied by hand.

Each bottle provides 56 actuations, equivalent to 56 daily doses at one spray per day, 28 daily doses at two sprays per day, or approximately 18 daily doses at the maximum three sprays per day. The oestradiol concentration in each spray is 1.53mg, so the daily dose delivered ranges from 1.53mg at one spray to 4.59mg at three sprays. This dose range sits within the transdermal oestradiol therapeutic range and allows the prescriber to match the dose to the woman's symptom severity and response.

Lenzetto contains no progestogen. It is oestrogen-only HRT, suitable as sole therapy for women without a uterus, and requiring concurrent progestogen therapy for women who retain their womb.

Transdermal absorption and liver bypass

When Lenzetto is sprayed onto the inner forearm and allowed to dry, oestradiol in the solution penetrates through the stratum corneum and the underlying skin layers into the dermal capillary network. From there, it enters the venous circulation and travels systemically, reaching oestrogen receptors throughout the body without passing through the liver first.

This liver bypass is the defining pharmacological advantage of all transdermal oestrogen delivery, including the spray format. Oral oestrogen undergoes first-pass hepatic metabolism before reaching the circulation, which stimulates hepatic production of clotting factors, sex hormone binding globulin, and inflammatory proteins. Transdermal oestradiol, including that delivered by Lenzetto, avoids this hepatic stimulation. Current observational evidence, including data from Vinogradova et al. (BMJ 2019), consistently associates transdermal oestrogen with a lower venous thromboembolism risk than oral oestrogen equivalents.

Oestradiol at receptor level

Once in systemic circulation, oestradiol binds to oestrogen receptors in the hypothalamus, urogenital tissues, bone, and other target organs. In the hypothalamus, it stabilises the thermoregulatory signalling that becomes erratic at the menopause, reducing the frequency and severity of hot flushes and night sweats. In the vaginal and urethral tissues, it restores mucosal cell health, improving lubrication and reducing urogenital discomfort. In bone, it suppresses osteoclastic activity, helping to preserve bone mineral density and reduce the long-term fracture risk that accelerates after the menopause.

How the spray format affects absorption

The alcohol-based carrier in Lenzetto promotes rapid evaporation after application, leaving oestradiol deposited on the skin surface in a thin film from which absorption begins immediately. The inner forearm is the designated application site because its skin has consistent thickness, good vascularisation, and relatively low hair density, all of which support reliable transdermal uptake. Absorption continues for several hours after application, producing a serum oestradiol profile that rises after the spray is applied and then declines gradually, with the daily dose topped up each morning.

Preparing the bottle for first use

Before using Lenzetto for the first time, prime the pump by holding the bottle upright and pressing the actuator three times, directing the spray away from the face and other people. This primes the pump mechanism and ensures the first therapeutic actuation delivers a full dose. The bottle does not need to be primed again after this initial preparation.

Applying the spray

Hold the bottle upright with the nozzle pointing toward the skin. Place the nozzle close to the inner forearm surface and press the actuator firmly once for each spray in your prescribed dose. Each spray should cover an area of skin roughly equivalent to two palm-widths. For a two-spray dose, move the nozzle to an adjacent area of the forearm for the second actuation rather than re-spraying the same spot. For a three-spray dose, spread the applications across the full inner forearm length.

Allow the spray to dry completely on the skin before dressing. Drying typically takes about two minutes. Do not rub the application area and do not apply sunscreen, moisturiser, or any other skin product to the sprayed area until at least one hour after application. These products can alter the absorption rate of oestradiol from the spray film.

Timing and consistency

Apply Lenzetto at the same time each day, ideally in the morning as part of a consistent daily routine. Oestradiol from the previous day's spray is gradually depleted from the skin reservoir over 24 hours, so a regular daily application time supports stable serum oestradiol levels and reduces the likelihood of breakthrough symptoms between doses.

Protecting others from contact

Oestradiol can transfer from the treated forearm to other people through skin-to-skin contact while the spray is still wet. Do not allow children, men, or other women to touch the application area until it has dried fully. Unintended oestrogen exposure can affect hormonal development in children and cause hormonal side effects in men. Cover the application area with clothing if physical contact with others is likely before drying is complete.

Missed dose

If you forget to apply Lenzetto and remember on the same day, apply it as soon as you remember. If you only remember the following day, skip the missed dose and resume your usual schedule. Do not apply a double dose to compensate. Occasional missed applications may result in a brief return of vasomotor symptoms, which resolve when regular use resumes.

One actuation: 1.53mg oestradiol per spray

Every spray from Lenzetto delivers exactly 1.53mg of oestradiol. The dose is adjusted by varying the number of actuations applied each day, within the range of one to three sprays. Treatment is initiated at one spray daily and the dose is adjusted upward in response to symptom control, assessed by the prescriber at the first review, typically at three months.

One spray daily: 1.53mg oestradiol

The starting dose for most women initiating Lenzetto. This dose is appropriate where symptoms are moderate and where a cautious introduction is clinically preferred, for example in women who are new to transdermal HRT, those with cardiovascular risk factors, or those who have been without HRT for an extended period.

Two sprays daily: 3.06mg oestradiol

Prescribed where one spray does not provide adequate symptom control after an assessment period. The second spray is applied to an adjacent area of the forearm immediately after the first. This dose is within the standard therapeutic range for transdermal oestradiol and is the most commonly maintained dose in clinical practice.

Three sprays daily: 4.59mg oestradiol

The maximum licensed dose of Lenzetto. This dose is considered where two sprays remain insufficient for symptom control. The prescriber will assess symptom severity, response history, and individual risk factors before prescribing at the maximum dose. Women at this dose should be reviewed regularly to confirm that ongoing use at 4.59mg oestradiol continues to be clinically appropriate.

Adding progestogen

For women with a uterus, the prescriber will co-prescribe a progestogen alongside Lenzetto. This may be an oral progestogen tablet taken cyclically or continuously, a progestogen-releasing intrauterine device, or a separate combined HRT product. The choice depends on menopausal stage, bleed preference, and individual clinical history.

Application site reactions

Because Lenzetto is applied directly to the skin, local reactions at the forearm application site are the most distinctive side effects of this formulation. The alcohol carrier can cause transient skin dryness, mild irritation, or redness immediately after application, which typically settles within minutes. More persistent local effects may include:

• Dry or peeling skin at the regular application area
• Erythema persisting after the spray has dried
• Pruritus or itching at the application site

Rotating the exact position of each daily application across the inner forearm surface reduces cumulative irritation. If persistent skin inflammation develops, contact your prescriber.

Systemic oestrogenic effects

The following effects are commonly reported in the early weeks of treatment and generally resolve as serum oestradiol levels stabilise:

• Breast tenderness or fullness
• Headache or migraine
• Nausea
• Bloating or abdominal discomfort
• Mood change or emotional sensitivity
• Leg cramps
• Fluid retention

Serious effects requiring emergency care

Seek immediate emergency medical attention if you experience:

• Sudden chest pain, breathlessness, or coughing blood — possible pulmonary embolism
• Unilateral leg swelling, pain, or warmth — possible deep vein thrombosis
• Sudden severe headache, visual disturbance, speech difficulty, or one-sided weakness — possible stroke
• Jaundice or severe upper right abdominal pain
• A new or unexplained breast lump
• Unexplained vaginal bleeding in a postmenopausal woman or bleeding outside the expected pattern in a woman using progestogen cyclically

Long-term risk

Oestrogen-only HRT, used without progestogen in women who have had a hysterectomy, is associated with a smaller breast cancer risk elevation than combined HRT, based on current evidence from the Lancet 2019 analysis. Transdermal oestradiol is associated with a lower venous thromboembolism risk than oral oestrogen equivalents. For women using Lenzetto alongside a progestogen, the combined risk profile will depend on the specific progestogen prescribed. Your prescriber will assess the individual benefit-risk balance at each annual review.

Licensed indications

• Relief of symptoms of oestrogen deficiency in menopausal women, including hot flushes, night sweats, vaginal dryness, mood disturbance, and sleep disruption, whether from natural menopause, premature ovarian insufficiency, or surgical menopause
• Prevention of osteoporosis in postmenopausal women at increased fracture risk where other treatments are not suitable or tolerated

Women particularly suited to the spray format

Lenzetto is a clinically relevant option for:

• Women who prefer a transdermal route but find patch adhesion unreliable or skin reactions problematic
• Women who use daily skin care products and prefer a small, defined forearm application site over a gel applied to a larger skin area
• Women who have had a hysterectomy and require oestrogen-only therapy
• Women with cardiovascular or thrombotic risk factors for whom the lower venous thromboembolism risk of transdermal oestrogen is clinically advantageous over oral HRT
• Women who require flexible daily dose adjustment between one and three sprays under prescriber guidance

Contraindications

Lenzetto is contraindicated in women who have, or have had:

• Known, suspected, or previous breast cancer
• Known or suspected oestrogen-sensitive malignancies
• Undiagnosed or unexplained vaginal bleeding
• Active or previous venous thromboembolism or known thrombophilic disorders
• Active or recent arterial thromboembolic disease, including myocardial infarction, angina, or stroke
• Active liver disease or persistently abnormal liver function
• Known hypersensitivity to oestradiol or any component of the spray formulation including the alcohol carrier
• Porphyria

Clinical caution

Prescribers will exercise additional caution in women with hypertension, uterine fibroids, migraine with aura, gallbladder disease, diabetes, systemic lupus erythematosus, a personal or close family history of breast cancer, or previous endometrial hyperplasia. Women who have not had a hysterectomy must not use Lenzetto without a concurrently prescribed progestogen.

Lenzetto is a Prescription Only Medicine. A clinical consultation is the required first step. A prescription is a possible outcome of that consultation, not a guaranteed one. The prescriber must assess whether the transdermal spray route is appropriate for the individual patient, whether the starting dose of one spray is clinically suitable, and whether a concurrent progestogen prescription is required.

At Pharmacy Planet, your consultation will cover your menopausal symptoms and their effect on daily life, your gynaecological and surgical history including whether you have had a hysterectomy, previous HRT use and tolerability, all current medicines and supplements, and personal and family medical history relevant to HRT safety. If you have previously used transdermal HRT in patch or gel form and have specific reasons for preferring the spray format, sharing this during the consultation helps the prescriber match the preparation to your clinical and practical needs.

A key prescribing consideration specific to Lenzetto is the contact transfer risk. The prescriber will confirm that you are aware of the need to prevent skin-to-skin transfer of the spray to children, men, and other women before the application has fully dried. This is a patient safety instruction, not a minor precaution.

A review is typically scheduled at three months to assess dose adequacy and symptom control. Annual reviews follow, at which the prescriber reassesses the ongoing appropriateness of treatment. Because Lenzetto offers dose flexibility within a single product from one to three sprays, dose adjustments are possible without switching preparations.

Store Lenzetto below 25°C. Do not freeze. Keep the bottle upright and in its original packaging when not in use. The pressurised metered-dose pump is sensitive to extreme temperature. Do not expose to heat sources, direct sunlight, or leave the bottle in a car or bathroom where temperature fluctuation is common. High temperatures can affect pump performance and oestradiol stability in the alcohol carrier.

Lenzetto is flammable due to its alcohol content. Do not spray near an open flame, lit cigarette, or other ignition source. Do not puncture or incinerate the bottle even when empty.

Keep out of the sight and reach of children. The metered-dose pump delivers a pharmacologically active oestradiol dose with each actuation. Accidental application to a child's skin represents a genuine hormonal exposure risk. Store the bottle in a location that is inaccessible to children and pets. Return unused or out-of-date bottles to your pharmacy for safe disposal. Do not dispose of in household waste.

Choosing the right HRT is a clinical decision, not a one-size-fits-all choice. Delivery route, oestrogen type, progestogen class, and bleed preference all shape which preparation is most appropriate for any individual woman. The table below compares commonly prescribed oestradiol gels and sprays. All are transdermal preparations that bypass the liver. They require a separately prescribed progestogen for women with a uterus. Note differences in application site and formulation: Oestrogel and Sandrena are alcohol-free gels; Lenzetto uses an alcohol-based carrier.

Pharmacy Planet is a GPhC-registered online pharmacy operating under the oversight of a qualified superintendent pharmacist. All prescriptions are issued by registered healthcare professionals who apply clinical evidence, current NICE guidance, and the individual patient's medical history to each decision.

Lenzetto requires clinical decision-making that goes beyond general HRT prescribing. The starting dose and titration schedule, the requirement to assess whether a progestogen is needed and in what form, the contact transfer safety instruction, and the flammability caution all represent product-specific prescribing considerations that our prescribers address as part of every consultation. If you would like to find out whether Lenzetto Spray may be appropriate for your situation, begin a consultation using the link on this page.

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7. Collaborative Group on Hormonal Factors in Breast Cancer. Type and timing of menopausal hormone therapy and breast cancer risk. Lancet 2019; 394(10204):1159–1168.
8. British Menopause Society. Recommendations on transdermal HRT. Available at: https://thebms.org.uk. Accessed June 2025.