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Author Topic: where to put the vagifem?  (Read 38277 times)

andius

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where to put the vagifem?
« on: October 19, 2013, 05:53:00 AM »


I did some research on where to put vagifem after years of iffy response and came up with this study done in Italy.  I'm still looking for another similar study I read previously that was done in New York.  The NY study said that deeper administrations resulted in increased uterine blood flow and DECREASED urethral/vulvar blood flow.  I think I may have been having vulvar "angina" :o ....LOL!

http://www.ncbi.nlm.nih.gov/pubmed/12861138



Because of this info, for vulvar/urethral issues vagifem should thus be placed in outer 1/3 of vagina?  This has helped me when switching from the more deeper administration as my burning seemed to get better.  Inner 1/3 adminstration of vagifem sent more blood to the uterus and had higher serum levels. Maybe this is where the progesterone should be placed??? It's an easy thing to try for those that can't get relief.

Also found this at a different site:

"Intravaginal application of estrogen plays a unique role in hormone replacement therapy because of evidence that there is preferential delivery of hormones supplied in the vagina to the endometrium. This has been termed the “first uterine pass effect.” This phenomenon is theorized to be the result of countercurrent exchanges with vein to artery diffusion. While this phenomenon is known to occur in the upper third of the vagina; it was unclear if this occurs throughout the vagina. A recent study examined this

phenomenon. Vagifem® was applied in postmenopausal women either in the lower or upper third of the vagina. Estradiol levels along with Doppler velocity measurements were made both at baseline and after 2 hours. Application to the upper third of the vagina resulted in statistically significant higher serum estradiol levels but only a small absolute difference compared to the lower third of the vagina. Also, with application of Vagifem® to the upper third of the vagina, there was a decrease in pulsatility index and resistance index which was not seen with lower third application. Thus, the first pass uterine effect appears to be exclusive to the upper third of the vagina. With application to the lower third of the vagina there was preferential delivery to the periurethral area."


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Taz2

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Re: where to put the vagifem?
« Reply #1 on: October 19, 2013, 10:03:54 AM »

What are "17 Beta Estradiol Tablets"? Are they the same as Vagifem?

Taz  :-\
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Rowan

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Re: where to put the vagifem?
« Reply #2 on: October 19, 2013, 10:22:57 AM »

 This form of estrogen 17-beta estrodiol is   bioidentical to that naturally found in the body and is used in some transdermal patches.

I am almost sure that Vagifem is estrodiol hemihydrate and also used in some patches and gels and pills.

They are all synthesised in the lab though Taz.
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Taz2

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Re: where to put the vagifem?
« Reply #3 on: October 19, 2013, 10:48:37 AM »

Thanks SL.

Taz  :)
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Dancinggirl

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Re: where to put the vagifem?
« Reply #4 on: October 19, 2013, 11:30:29 AM »

Hi Andius.  Thank you so much for your input. How very, very interesting!  Clearly there have been some studies done about our problem.  :hapij:
Some ladies who have used oestrogen creams (as opposed to Vagifem) mention that they smear it all round the entrance of the vagina - which would make sense.  I guess there would be no harm in trying to place the Vagifem pessary in the first 1/3 - 1/2 of the vagina - hopefully it would still stick well?

There is a post about the use of Vagifem on 'All things menopause' and I've been following that closely.  Many are using double doses as they used to be on 25mg and the dose is now prescribed in 100mg doses.

My other thought would be to use Vagifem in the usual way and, alongside, add a little oestrogen cream smeared around our sore areas?
I am finding that after 2 weeks of the Vagifem, my vagina excretions seem to have improved - sorry to be graphic but I'm getting more natural lubrication and it's smelling like it used to when I was pre-meno. Still getting the burning but not as bad.

Clearly 100mg Vagifem isn't enough for many ladies so perhaps using a little extra oestrogen cream around the lower vagina area might do the trick?   Your thoughts please club members.
DG x
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Rowan

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Re: where to put the vagifem?
« Reply #5 on: October 19, 2013, 12:05:48 PM »

I think you may mean micrograms not milligrams Dancingirl.

I maybe wrong but 100mgs of Vagifem sounds an awful lot and you would need progesterone to offset it.

http://www.novonordisk.co.uk/documents/article_page/document/hrt_pro_common_questions.asp

maybe I have my Math wrong.
« Last Edit: October 19, 2013, 12:09:19 PM by silverlady »
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Dancinggirl

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Re: where to put the vagifem?
« Reply #6 on: October 19, 2013, 12:34:37 PM »

You'r right SL - it's 100mcg in Vagifem.  I'm that age that still thinks it pounds and ounces.
DG x
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Rowan

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Re: where to put the vagifem?
« Reply #7 on: October 19, 2013, 02:22:55 PM »

100 micrograms still far too much for Vagifem I am sure.
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Tingly

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Re: where to put the vagifem?
« Reply #8 on: October 19, 2013, 02:33:59 PM »

I bet clkd will have an angle on this.
Ting x
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andius

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Re: where to put the vagifem?
« Reply #9 on: October 19, 2013, 03:00:57 PM »

Vagifem is 10mcg.....or for those who can get it 25mcg. 1000micrograms equals 1 milligram.

17 beta estradiol is the active ingredient in the vagifem tablet.....it is the only estradiol tablet MADE for the vagina worldwide. I think it probably is in that form when the tablet is dissolved?

Some things I copied and pasted:

VAGIFEM® (estradiol vaginal tablets) are small, white, film-coated tablets containing 25.8µg of estradiol hemihydrate equivalent to 25µg of estradiol.

The estrogen contained in VAGIFEM, 17 ß-estradiol is chemically and biologically identical to the endogenous human 17 ß-estradiol and is, therefore, classified as a human estrogen.

I have tried both the premarin vaginal cream and the estrace vaginal cream on the outside. Both burned me and caused the tissue to swell up and turn red...and they really irritate my urethra. My doctor said I am allergic to something in the creams.  I cannot use any eye cream of any sort! or my eyes swell up so maybe same thing going on.  I have tried some low dose estriol cream I ordered on the internet on the outside too.  It did not (raw) burn me or make me swell up, but it made my skin get HOT....like a sensation of immediate warmth on the inner labia kind of like hot water ...a couple days later I had itching and peeling???

Anyone else had these things happen with the creams?

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Cassie

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Re: where to put the vagifem?
« Reply #10 on: October 19, 2013, 03:05:03 PM »

I need to get a measure stick, how the hang do you know whether you are in the outer or inner areas lol, I kind of just put the progesterone in till it gets uncomfy to push any further but then again, it is mostly uncomfy even from not too deep in, so I would never be knowing :)
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Rowan

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Re: where to put the vagifem?
« Reply #11 on: October 19, 2013, 03:21:10 PM »

andius I think that's what I said in my post.
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andius

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Re: where to put the vagifem?
« Reply #12 on: October 19, 2013, 03:41:31 PM »



Yes  SL I was just confirming your post.  You were entirely correct!

When you read the studies on Vagifem, there is always a small percentage of women who still have symptoms after the study period is over.  Same for the other types of vaginal estrogen. I wonder if those of us who don't get complete alleviation of symptoms have something in common with those women. I have been on vagifem for 3 years and still have symptoms pretty often.

Maybe it is a variant of our anatomy regarding blood vessel supply, maybe the VA was too far gone before treatment, possibly extra hormones in the form of HRT are needed for us or at least a higher dose of the local estrogen?

Once I flew to Europe to go on a cruise for ten days.  I didn't want to be bothered with the burning during this trip.  I had tried Estring in the past and it didn't work to alleviate burning but I had an extra one left.  I put in the Estring and used vagifem every other day on the trip and did not have a single burning episode.  I drank wine, ate what I wanted, was out running around on excursions in the heat and probably didn't drink enough water, and even then I had no problems. Bladder and urethra were ok the whole time. I only tried this because I had some progesterone that I took also, just in case the estrogen was too much for my uterus.  I had no bleeding episodes or other side effects.  As soon as I got home I took out the Estring and lowered the vagifem back to the 2 x weekly dose.  My typical burning came back in about 2 weeks.  This makes me think it really is that I need the extra estradiol so I have since started HRT.  However, I still have burning with HRT and regular dosing of vagifem. 

I have looked for studies with higher dose of local estrogen (no HRT) and added progesterone but have not found any. It does seem that the fear of higher doses is based on the possibility of endo CA for those with a uterus so it seems a simple solution to just add prog for those who can tolerate it.  However, it is hard enough to convince docs to let you try vagifem more than 2x weekly EVEN AT the dose 10mcg in US.
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Night_Owl

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Re: where to put the vagifem?
« Reply #13 on: October 19, 2013, 05:20:11 PM »

Very interesting read, thanks for this.

The article is dated 2003 and refers to the 25mcg dose - wonder if it's still current thinking.

I use Vagifem 10mcg on alternate mornings, as recommended by the meno clinic.  They have said that I can take this indefinitely, even without progesterone (if/when I come off systemic HRT and no longer take prog).

I'm curious - how do you know where the inner and outer vag areas start/end?  I always insert the VF to the length of the applicator, assuming this is where it should go.  Would it not drop out if placed too low, more so if the whole vag/bladder area has sagged?

Wondering if the lower positioning would be better for vag Utro too, or would that irritate the bladder tissues more.

Just made a note to discuss all of this at next meno clinic appt.

The alternate days use of Vagifem 10 took away all burning, can you not push for this Andius, maybe with a yearly endo scan?
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andius

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Re: where to put the vagifem?
« Reply #14 on: October 19, 2013, 06:07:07 PM »

Night owl:

I tried 3 vagifem a week for 6 months which was refused by 2 ob/gyns, but thank goodness the urologist took pity on me and prescribed it.  I developed a buttock rash on both sides that was like deep seated pimples that hurt and took forever to heal and left scars but persisted on, I have no idea why? other than the increase in vagifem. Eventually even that didn't work anymore and now I am on patch, progesterone and 2 vagifem a week....and the rash went away.  Since I have the progesterone, I may try 3x weekly again if the lower placement of vagifem doesn't work. I am trying for half the depth I used to do when I put it in.  Haven't had one fall out yet.

I found the other site that mentioned this after much searching of my internet history.
The article from NY that I saw was actually just another published reference for the same study in Italy, so there is only one study, not two.

Regarding progesterone....since the "first pass" uterine effect they describe works in the upper vagina and not lower, I would think that you would want it in the upper so it would go to the uterus (endometrium) and not the urethra.  Of course, I don't know if the progesterone effect is the same as with vagifem. But it seems to be based on the blood flow.  The doppler Ultrasound they used in the studies measured the blood flow so I don't think that would change between 2004 and now. Decreased resistance means increased blood flow.

Just found this regarding progesterone....they used a vaginal gel: (it seems to work here too)

http://www.researchgate.net/publication/13942259_Transvaginal_administration_of_progesterone
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