Genitourinary Syndrome of Menopause
Vaginal dryness during menopause may also cause soreness, painful sex and urinary symptoms....
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Low-dose local vaginal oestrogen gel
A low-dose estriol gel used inside the vagina to help relieve dryness and irritation caused by lower oestrogen after menopause.
Blissel is measured using an applicator and acts locally on vaginal tissue. Your LIVVE clinician will check your symptoms, medical history and current HRT before prescribing. Blissel must not be combined with systemic oestrogen, such as HRT patches, skin gels, sprays or tablets.
Contains estriol, a form of oestrogen
50 micrograms of estriol per measured dose
Dose-marked applicator
Daily starting course, then twice-weekly maintenance
Prescription-only treatment through LIVVE
Quick product facts
The key details, with more guidance below on symptoms, application, safety and ongoing use.
Medicine type
Local vaginal oestrogen
Active ingredient
Estriol
A form of oestrogen.
Strength
50 micrograms per gram
Equivalent to 0.005%.
Form
Vaginal gel
Measured dose
1 g of gel
An applicator filled to the mark delivers 50 micrograms of estriol.
Typical routine
Daily for 3 weeks, then twice weekly
Preferably at bedtime. Follow your prescribed schedule.
Prescription needed?
Yes, through LIVVE
Subject to clinical assessment.
Can it accompany systemic oestrogen?
No, under the Blissel product information
Your clinician will review your full HRT plan.
Application video guide
Watch our clinician explain how to fill the applicator, insert the gel and follow the cleaning or disposal instructions for your pack.
Video coming soon
How to measure and apply Blissel
Wash and dry your hands before use.
Remove the tube cap. Before first use, check the seal is intact, then use the point in the cap to pierce it. Do not use a tube with a broken seal before first opening.
Insert the plunger fully into the applicator barrel, then screw the barrel onto the tube.
Squeeze the tube to fill the applicator to the marked dose line. This measures 1 g of gel.
Unscrew the applicator and replace the tube cap.
Lie down with your knees bent and apart. Gently insert the applicator into the vagina and slowly press the plunger fully down to release the gel. Do not force insertion if it is painful.
Remove the applicator and separate the plunger from the barrel.
Follow your pack leaflet: rinse a reusable barrel and plunger thoroughly with warm, clean water. If your pack has disposable barrels, discard the used barrel and rinse the reusable plunger. Do not reuse a disposable barrel.
Use Blissel exactly as prescribed and follow the leaflet supplied with your pack. Contact LIVVE if you are unsure which applicator you have or find insertion difficult.
What is Blissel?
Blissel contains estriol, a form of oestrogen, in a water-based vaginal gel. It is used to treat symptoms of vaginal dryness, soreness and irritation caused by lower oestrogen after menopause.
One applicator filled to the mark contains 1 g of gel, providing 50 micrograms of estriol. Use the applicator supplied with your medicine and follow its instructions.
Blissel acts mainly in the vagina, with low absorption into the bloodstream. Local treatment still needs an individual assessment and regular review.
Understanding your symptoms
A fall in oestrogen can make the vaginal lining thinner, drier and more fragile. This is called vaginal atrophy. It can cause dryness, irritation and discomfort, including during sex.
Comparing local treatments
There is no single format that suits everyone. Your clinician will consider your symptoms, current HRT, preferences and medical history.
| Treatment option | How it fits |
|---|---|
| Blissel | Contains estriol 50 micrograms/g in a water-based vaginal gel. One 1 g applicator-dose delivers 50 micrograms of estriol. |
| Estriol 0.1% cream | Also contains estriol, but at 1 mg/g and in a cream formulation. The concentration, measured dose and product-specific instructions differ, so the products should not be treated as interchangeable dose-for-dose. |
| Gina or Vagifem | Contain estradiol rather than estriol and are supplied as pre-measured vaginal tablets. The format and active oestrogen differ from Blissel. |
| Intrarosa | Contains prasterone rather than oestrogen and is supplied as a vaginal insert. It is a different medicine that may be considered for vulvovaginal symptoms where clinically appropriate. |
| Moisturisers and lubricants | Non-hormonal options can provide moisture or reduce friction. Your clinician can explain where they fit and check any other products you use inside the vagina. |
Blissel has its own prescribing instructions, including a restriction on combining it with systemic oestrogen. Do not copy the dose or schedule from another vaginal treatment.
Realistic expectations
Improvement is usually gradual. The aim is for vaginal dryness and irritation to become less troublesome with consistent use. People respond differently, so there is no guaranteed timescale for symptom relief.
You may not notice a clear change immediately. Some local itching or irritation can occur when treatment begins. Contact LIVVE if it is severe or getting worse.
Use the prescribed daily dose for 3 weeks. Notice whether dryness and irritation begin to ease, and ask for advice if symptoms are not improving.
The recommended maintenance schedule is one applicator dose twice weekly. Keep to your prescribed routine rather than adding extra doses when symptoms are troublesome.
Your clinician will assess your response, side effects and whether treatment should continue.
Your LIVVE pathway
We check that Blissel fits your symptoms, current treatment and medical history.
Tell us about vaginal symptoms, bleeding, current HRT and your medical history.
Your clinician checks whether symptoms are likely to be linked to low oestrogen and whether Blissel is suitable.
If appropriate, Blissel is prescribed with clear application instructions.
We explain what to expect, how to use the gel and when treatment should be reviewed.
Dose and schedule
Follow your dispensing label and the patient information leaflet. The recommended Blissel schedule is set out below.
Application guidance:
See the video and individual instructions in our application guide.
| Dose and schedule | Details |
|---|---|
| Starting phase | One applicator dose once daily for 3 weeks, preferably at bedtime. |
| Measured dose | One applicator filled to the mark contains 1 g of gel, providing 50 micrograms of estriol. |
| Maintenance | One applicator dose twice weekly, preferably at bedtime. Your clinician should evaluate whether treatment should continue after 12 weeks. |
| Missed dose | Use the missed dose when you remember unless it is more than 12 hours overdue. If more than 12 hours late, skip it and use the next dose at the normal time. Do not double the dose. |
Review and support
Keep track of changes in your symptoms and contact LIVVE if you need help using the gel or have concerns about treatment.
Treatment continuation should be evaluated after 12 weeks. If treatment continues or is repeated, review the benefits and risks at least annually, with earlier checks where needed.
Suitability and safety
Tell your clinician about your personal and family medical history, current medicines and HRT before starting Blissel. The following conditions are listed as reasons not to use it in the product information.
Blissel is not intended for use during pregnancy or breastfeeding. It is not contraception. Vaginal infections should be treated before Blissel is started.
Current, previous or suspected breast cancer, or a known or suspected oestrogen-dependent cancer.
Unexplained genital bleeding or untreated thickening of the womb lining.
A current venous blood clot, a previous unexplained venous blood clot, or a known clotting disorder. Tell your clinician about any past clot.
Active or recent disease caused by blood clots in the arteries, such as angina or a heart attack.
Acute liver disease, or previous liver disease where liver function tests have not returned to normal.
Porphyria or an allergy to estriol or any ingredient.
Side effects
Blissel can cause side effects, although not everyone gets them. Local irritation may occur at the start of treatment while vaginal tissue is still thin and sensitive.
Itching
Itching in or around the vagina, at the application site or elsewhere is listed as common.
Local irritation
A feeling of warmth or irritation can occur. Speak to LIVVE if it is severe, persistent or getting worse.
Pelvic pain
Pelvic discomfort is listed as uncommon. New or persistent pain should be assessed.
Genital rash or thrush
Genital rash and vaginal thrush are listed as uncommon.
Headache
Headache is listed as uncommon. Seek urgent advice for a new migraine-type headache.
Allergic reaction
The preservatives sodium methyl parahydroxybenzoate and sodium propyl parahydroxybenzoate can cause allergic reactions, sometimes delayed.
LIVVE provides discreet clinician-led care, UK pharmacy dispensing, clear treatment instructions and ongoing support when you need review or repeat treatment.
Helpful vaginal health resources
Explore clear, clinician-led guidance on vaginal, vulval and urinary symptoms during perimenopause and after menopause.
Vaginal dryness during menopause may also cause soreness, painful sex and urinary symptoms....
Compare lubricants, vaginal moisturisers, vaginal oestrogen tablets and cream, Intrarosa and other options...
Learn why UTIs and UTI-like bladder symptoms may become more common during perimenopause...
Your LIVVE clinician can help you understand whether Blissel or another vaginal treatment may be appropriate for you.
Medical disclaimer: This page is for information only and does not replace individual medical advice. Blissel is a prescription-only medicine through LIVVE and is supplied only if clinically appropriate after assessment. Always read the patient information leaflet and follow your prescriber’s instructions. Seek medical advice about unexplained bleeding, new breast or pelvic symptoms, severe irritation or any symptom that concerns you.