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[ancient runner]

Sorry if this is a dopey question. I was put on Gynest in March, which helped my very sore and itchy undercarriage no end but I still had lots of problems. Got my lovely GP to put me on Ovestin instead (starting on the maintenance dose) but that, too, wasn't quite enough. I'm just coming to the end of a two-week reloading with Ovestin and have had to abandon my office chair because I get too sore sitting on it though lubrication isn't a problem. My outer labia don't seem to be quite what they were either - smaller, I'd say.
No other real problems to report so don't think I need full HRT.
I'm waiting to see what happens when I go back to Ovestin every 3 days, but am now concerned that while it seems to be sorting the dryness there may be atrophy going on. I understand Vagifem and Estring are the "other" type of oestrogen and stronger -- would a change to one of those make a big difference? I can't work out how much stronger/more effective they actually are from hunting round on the web.
I've got a GP appointment booked for July 18 (!) Could probably get an on-the-day appointment quicker but he's now part time. I should anyway give it a week or two back on the maintenance dose I suppose but am a bit concerned things are disappearing and I will have no padding to sit on at this rate.
Help please?

[Hurdity]

Hi ancient runner

I don't think you will be able to do anything about the decrease in size of labia despite using local oestrogen - as this is one of the consequences of menopausal oestrogen depletion, as I understand.

However you shouldn't be sore though.

I have used mainly Ortho-Gynest pessaries for years, but also sometimes ( and soon probably most of the time) Vagifem, and I find it all fine. Well lubricated (if a bit shrunken!) and not sore. However I have also used full HRT for 6 years as well so it may be you need systemic HRT as well as local?

If you have been investigated for other problems and there is nothing else wrong, and local oestrogen is not doing the trick eg every 3 days then maybe time to consider full HRT?

Although Vagifem contains oestradiol which is around 8 times more powerful than estriol ( Gynest and Ovestin) in some respects, I read recently that these two oestrogens work differently on the vaginal tissues by stimulating different oestrogen receptors.  I can find you the reference if you want. Therefore the doses are equivalent. However it is a matter of personal preference and you might want to try Vagifem although depending on how active you are in that dept, the Gynest/Ovestin may provide more lubrication.

Regarding the amounts of Estriol - unhelpfully the Gynest cream does not say how much estriol there is in one application (not that I can find), but one Orthgynest pessary contains the same as one application of Ovestin ie 0.5 mg estriol so they are definitely equivalent. Personally I think the pessaires are better as probably don't leak out so quickly as they are solid waxy things.

Hope this helps and you feel more comfortable soon.

Hurdity x

[ancient runner]

Thank you for this -- that's very helpful. If you could find the reference without too much digging round that would be useful please Hurdity.
Other problems were ruled out only insofar as I had no clue what was wrong to start with and ended up at the UTI clinic to start with as I was convinced it was thrush or cystitis!
The original ortho-gynest was the cream, which has a five times smaller amount of estriol than the Ovestin per dose. The ovestin is much better than that, but still not making me feel consistently normal, hence the reloading attempt.
I suppose as this is all very new and I don't have any other significant problems that full HRT seems a little more than necessary. But since sitting down is fairly necessary then I might need to reconsider this...

[Hurdity]

Hi ancient runner

Rather than repeat myself it's my post on May 12th on this thread.
http://www.menopausematters.co.uk/forum/index.php/topic,21767.msg329960.html#msg329960

This was the reference http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3003469/ but it was in the context of breast tissue, but I noted the info re alpha and beta receptors in passing

There are vast numbers of scientific papers out there about all of this but best usually to find a summary one if possible!

I would defo recommend Orthogynest pessaries though.

Hurdity x

[ancient runner]

Thank you so much again -- you really know your stuff and I think I am still at the point where I'm wandering round bleating: why did no-one mention that menopause could kick you in the vulva? I have the day from hell ahead so I have quickly read the bit of the thread you linked to and will go back for a more thoughtful peruse later.
Out of interest, what is it you like about the OG pessaries? I do prefer the Ovestin to the OG cream, partly because it just feels more pleasant (the other was full of arachid oil) and easy to use. It does seem to stay put quite happily as well. All advice and experience very happily accepted as at the moment I seem to be suggesting things to GPs rather than vice-versa.
(When I saw him to ask if I could switch to Ovestin he looked in his BNF and said -- that's ten times stronger. I pointed out you only use half the quantity...)

[Hurdity]

Well I haven't tried either of the creams on their own ie without any other vaginal preparation although I do have Gynest Cream which I use around the vag entrance and external parts if I get a bit sore. Therefore I can't really compare the pessaries to the creams. I just imagine the creams are messy and you have to load and wash an applicator - bit of a faff I would imagine.

Orthgynest pessaries are a small waxy think you just push up there - very small, thinner than a tampon, about 3/4 ins long. No applicator or anything.  OK they do gradually melt and ooze out overnight but the general moistness I feel is an advantage when you need it  . As I said I use Vagifem as well - during the times in my cycle that I take progesterone, because I use this (Utrogestan) vaginally so can't really put both in at once!

I can't seem to get them both on the same prescription so keep having to change! I can get the cream and either Vagifem or the pessaries.

Women who use Vagifem all the time do swear by it too so it's all a matter of preference as I think I said.

The other thread is quite specific, wouldn't give you the whole picture - there are other threads on vaginal dryness etc. Here is the  main one but others are started:
http://www.menopausematters.co.uk/forum/index.php/topic,140.0.html

Hurdity  x

[Suzi Q]

Sorry if this is a dopey question. I was put on Gynest in March, which helped my very sore and itchy undercarriage no end but I still had lots of problems. Got my lovely GP to put me on Ovestin instead (starting on the maintenance dose) but that, too, wasn't quite enough. I'm just coming to the end of a two-week reloading with Ovestin and have had to abandon my office chair because I get too sore sitting on it though lubrication isn't a problem. My outer labia don't seem to be quite what they were either - smaller, I'd say.
No other real problems to report so don't think I need full HRT.
I'm waiting to see what happens when I go back to Ovestin every 3 days, but am now concerned that while it seems to be sorting the dryness there may be atrophy going on. I understand Vagifem and Estring are the "other" type of oestrogen and stronger -- would a change to one of those make a big difference? I can't work out how much stronger/more effective they actually are from hunting round on the web.
I've got a GP appointment booked for July 18 (!) Could probably get an on-the-day appointment quicker but he's now part time. I should anyway give it a week or two back on the maintenance dose I suppose but am a bit concerned things are disappearing and I will have no padding to sit on at this rate.
Help please?

OH Love I know what your going through
Your bits get smaller and smaller and smaller
If its any help to you I had a huge OUTIE stuck out you could see it no kickers on I hated it
I had huge labias they hung down!!!!
Atrophy started I was on Ovestin for 10 years I ignored the pain the throb the suction feeling the peeeing for Britain
It took me finding this site Aug 2009 to realise what was going on
My nether regions even with Vagifem 25x2 well clitoral hoods almost vanished Inner labias almost disolved in to the skin
If you get a moirror and look I can see where they were So it means no inner labias to protect my vaginal opening
But IM still here still make whooppyy dooo Ovestihn just wasnt enough with in days of Vagifem I felt better
Feb 2010 no sex agony vaniching bits sad crying 12 postmeno (went over at 37)
By August I was making whooppe in Paris Venice Rome UK fabo
Yes I still get the odd 3/4 days when fanny acts up but more the most part Vagifems literaly saved my life
Now if only they can find a cream that could take away the irritation on my disc?

[ancient runner]

Hello Suzi, glad you're back! And not so glad your back is a problem. 
Outer labia shrinking here and I am wondering if that's why sitting isn't so good. You reckon Vagifem's better for this than Ovestin? Have GP appt booked for a couple of weeks time so may ask if I can try that. Though Hurdity reckons only full HRT would do the job on those bits.... and not sure GP'd go for that at present as this is my only problem.

[Hurdity]

Just to say that I hope I didn't give the impression that full HRT will stop the labia and all the bits from shrinking because the oestrogen dose is not high enough for that usually. There will be physical changes there.  Maybe not quite so drastic - I've never looked and don't worry about it! It still all works OK which is the main thing!!! Just that local oestrogen isn't enough for everyone, and conversely full HRT doesn't always give enough oestrogen for the vaginal area ie several of us are on both...

Hurdity x

[ancient runner]

Thank you Hurdity, I do see what you mean (and didn't intend to misquote you!)
I just want to sit down comfortably, without finding a cushion with a hole cut in it. And be able to go swimming again. And run without wondering what's happening below...

[Suzi Q]

I agree Hurdit once its starts nothing can stop it GP and GYNY said that as well
He said and gave nme a brichure that said POstmeno pausal ladies BITS can shrink to almost prepubecent age
Im still OK inside Ive not shrunk there in width or length but if we dont make whoppy at least once a week
Then ahhhhh on entry once in tickety boooooooo
I found Vagifem was enough for me I never took HRT and wopuldnt take it even if I could just a personal choice
I went over at 36/37 did cold turkey my way IT was only after 8mnths from last period I dryed on entry that I saw GP
He put me on Ortho for 2 years it stopped working then Ovestin and the mini pill till Feb 2010
The he put me on Vagifem after being on here 6mnths and being nagged at especially but 2 ladies CLKD @ TAZ xxxxx
It worked the pain went asap peeeing bit later but redness soreness itch everything went with in 5 days of my 14 days
Only you can choose though what you want to do read and decide what you feelsright for yourself me it was Vagifem xxxxxxxxxxxxxxx

[Hurdity]

SuziQ - just asking - have you had you a scan to check your bone health? I think it would be really important for your future health, maybe in relation to your back problems?  I know you said not to go on HRT was a personal choice but you had premature menopause so would have been lacking in oestrogen since then. Maybe you are taking something to protect your bones? If not I really would go and see about it...

ancient runner - do hope you can sit down comfortably soon - that must be frustrating!

Hurdity x

[Suzi Q]

BOne density of an early 40 year old im 59 next Thursday
Dont do dairy of any kind havent for 20 years or more
Dont eat red meat fast 2/3 days a week
Take no vits or suppliments

Backs a wee bit better again today still rubbish but better than last FRiday sat thought I was going to die hehehe