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[dahliagirl]

I had this with my last prescription.

From what I understood (and I'm afraid it made no sense to me at the time, so I may have things wrong), the small pharmacies are only given a certain amount every week, then they have to fax through (somewhere?) any extra orders.

Put mine in on Friday popped in on Saturday and got it on Monday.

I was surprised and would have thought that with the demographics of my local area, vagifem is probably in high demand, so well supplied.

I think it is a supply/wholesaler bureaucracy problem, rather than manufacturers.

[Nervousnel]

Hi Hurdity,  I have been ordering a bit in advance.  Ordered last Sunday evening by email and will use my last tablet next Saturday.  I'm using one every other day.  I'm 68, 69 in February, so don't pay for medication now.  My local chemist is a small branch, so maybe the larger ones are given more.  However, I believe in my area there is quite a large porportion of older people so there must be quite a few ladies needing Vagifem around here.  I've only needed to use this since 2012 and its in the last 6 months or so this problem seems to have come up. Maybe I was just lucky before. 
Thanks for the replies everyone xx

[Nervousnel]

Hi Hurdity , Yes, I have been ordering a bit early.  I'm 68 so don't have to pay for prescriptions now.  My local chemist is quite a small branch so maybe the larger ones get more.  However, there does seem to be a lot of older people in this area, so there must be quite a few needing Vagifem.  I've only needed to use this since 2012 and its in the last 6 months or so this problem seems to have come up.  Maybe I was just lucky before.
Thanks for the replies everyone xx

[scriv]

I think the problem could be because a lot of us are having to double up to keep comfortable and some ladies have to keep re-loading - all because of the very silly decision to reduce the dosage from 25mcg to 10mcg following a very unrepresentative report telling us all that 10mcg will suffice. Not!!!

I haven't had a problem yet, but thank you for warning me. I will re order in plenty of time.

[Nervousnel]

Hi, I'm having a bit of a blip at the moment.  Think its because i'm anxious about a possible confrontation with someone during the new year holiday together with the possible difficulty of the chemist filling the prescription.   Definitely find that anxiety affects me.  Am using extra tablets to try and fix it .Don't like doing that as it makes me anxious in itself because I'll use up my presciption more quickly.  Have also used a dose of replens today.  Think that has made me a bit more comfortable.  Anybody using more than one every other day all the time?  xx

[scriv]

I am using 2 every 3 days, but sometimes add in an extra one.

My GP doubled the prescription for me, so I now get 2 packs of 24 tabs at each prescription. This is usually every 2-3 months.

Can you ask your GP to double the prescription? Or can you order early? I should think you have a valid reason to order  to keep you going over Christmas...

Or failing all that, can you try the bigger pharmacists?

Good luck. x

[Nervousnel]

Thanks for that info.  I had wondered if I might be able to have 2 packets at once.  Have to see GP in April for repeat blood pressure tabs so may ask him then.  After all, you'd have to use 5 a week to be equivalent  of 2 x 25mcg before the 10mcg was introduced and then some were using an extra one sometimes.    See how I get on.  I don't feel too bad today so hoping I'll settle down again for a while.  I had wondered if it would help to use 2 at once when I get a blip. 
I really appreciate this site and being able to hear other ladies' experiences. 
Happy Christmas x

[Hurdity]

I can't see anything wrong with using 2 x 10 mcg at once since the old dose was 1 x 25 mcg - but it might be better to spread out the dose ie one day and then the next?

Hurdity x

[Nervousnel]

Hi Hurdity,  Yes, that's what I've been doing so far.  Just thought it might be an option to try if I get desperate. xx

[scriv]

I use two at once.... twice a week.  It works for me. It is the nearest I get to the old dose of 25mcg twice a week.

I definitely feel the benefit of the higher 'shot' and have no discomfort from using 2 tablets at once.

I guess it depends on the severity of your condition and how much other oestrogen you have in your body. I have very low levels.

[Morwenna]

Weren't the 25 mcg version tabs withdrawn because they were deemed to be too high a dose? My GP refuses to prescribe more than the equivalent of two 10 mcg tabs per week. I can just about get away with one every three days if I submit my repeat prescription early.

[scriv]

No, I'm sure Hurdity will come along soon with the exact details and wording, but it is my understanding that on the basis of a survey of about 270 women across the USA and by their own admission, very few over the age of 65, researchers found that the 10mcg dose was just as effective as the 25mcg for keeping discomfort at bay.

if you think about it, in those 270 ladies, many could be at the early stages of the menopause, could be on good dose of HRT, could have high levels of oestogen naturally and could be using other methods which help them, so are not as dependent on the vaginal oestrogen as some of us.  And these are just a few scenarios for the ladies who participated in this study.

No one said 25mcg was too high a dose, just that a 10mcg was just as efficient.  Well it wasn't for me and a lot of ladies, that's for sure. In my mind, it's like saying that all people with heart or blood pressure conditions should have the same strength medication which should work for all.

[Nervousnel]

For about a year when I first started to use Vagifem 2 a week was enough to keep me perfect.  Then I guess I must have taken a big drop in my own oestrogen, had a lot of discomfort again, used one a day for nearly 3 weeks then 4 a week, then cut down to one every other day.  Had 2 or 3 'blips' since then but thankfully have have come good after using one a day for a while.  Hope that will happen this time.  Don't want to use more than I need, but have to be comfortable.  Am concerned about possible future risk, but got to have quality of life now. As you say, everyone is different and GPs should be willing to prescribe what is needed, as long as they have warned the patient about possible risk. The decision should be up to the patient if they have all the relevant information.    May have said this before, but if I get something on the 'risk' list, I won't know if its because I used this medication, or whether I would have got it anyway.  xx

[scriv]

Yes, I agree. And it's also about getting the associated UTIs and other bladder issues. These immediately kicked in with me when they suddenly reduced the strength.

[Hurdity]

Hi scriv

I haven't looked at the paper recently but that was the conclusion. It was also based on statistical significance ie a statistically significant number of women (in the study) found that 10 mcg was effective and from what I recall effectiveness was measured both subjectively (how the women perceived their dryness etc  or whatever the Qs were) and objectively (through cells, pH etc - bit hazy about the details but something like that).

Even without having the data to hand - say there were 200 women out of 270 for whom 10 mcg was effective, and this was statistically significant - then there would still be 70 women for whom it wasn't. I can't remember what the exact numbers/measures were but it was not 100 %.  There were several studies looked at. Therefore there will always be women for whom it is insuffcient. I can't remember whether the women were taking other HRT or not. Sorry not time at the mo' to look it all up. I'll see if I can find the ref for others to look.

Here it is just found it - it's not quite as I said but the idea is the same - it is based on the trials being statistically significant which doesn't mean it will work for everyone. Also 25 mcg was shown to be more effective.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3234898/

I did look at this in detail about 18 months ago and wrote some notes but would need to re-read to comment properly

The upshot is that the only possible issue (that I remember) is that during the first two weeks loading period for those who have VA (and probably not taking other HRT),the study showed that systemic estradiol levels briefly went above the post-menopausal range, but then after the loading period they were maintained within the post-meno range. I'm talking from memory here and it might be another paper not this one! Also there were never any safety concerns about 25 mcg.

The whole study I think was prompted by the view that women should be on the lowest dose of hRT for the shortest possible time, but which many disagree with now.

Hurdity x