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[Rose]

Okay, I am at my wits end with the dreaded topic of VA. I have been suffering with it until it got so bad that I would have used anything just to stop it. I have been cutting Vagifem 25 in half and using it every morning for the past 3 weeks. I can't use the full dosage (as I can't sleep and as I need to study) so I thought I'd extend the loading period of 2 weeks to 3 to get full benefit. I stopped using it two days ago and the symptoms are back as bad as ever. I know I can't go on using it every day so what can I do? Any suggestions/advice would help as I really am at a low ebb. Thanks x

[Trey]

I'm in US and use Estrace cream.  It is a bit stronger than Vagifem and can be used where you need it.  My understanding is that it is not available in UK.  Can you try Aquaphor ointment as it coats the surface very well and has staying power.  I hate Replens and other products with chemicals.  Pure virgin olive oil can be helpful.  I'd hate to say what I would do if I could not get my Estrace.  It would not be pretty.  Sorry you are having such a bad time.

[littleminnie]

Maybe order the Extrace that Trey recommends online?

[Dancinggirl]

I'm currently trying the Estring which gives continuous oestrogen - I've had it in for 3 days so time will tell. DG x

[Sarah2]

What is the reason you can't use the full dose?
Do you get side effects?
If you can't or aren't using the full dose then it may not be working and you may need to keep using it for twice as long.

[CLKD]

Why can't you use the full dose?  It's topical so shouldn't interfere with any other part of the body  which is why you aren't getting the relief??? speak to your GP/Practice Nurse/ Pharamist and get it sorted 

[Trey]

I think night time use is best for absorption.   You might get better effect.

[tiger74]

What 'chemicals' are there to hate in Replens, compared to the ingredients contained in topical HRT?  I'm confused by the logic.

BTW, a certain amount of a topical preparation would be absorbed into the body so do have an effect on 'other parts of the body' (hence why topical HRT is contra-indicated for people who have or have had oestrogen-positive cancers).  Just sayin'

  

[Sarah2]

This has some info which might be useful. (The use after cancer is debatable- as it says further down the article.)

http://www.patient.co.uk/doctor/hrt-topical

[Trey]

"Parabens are estrogen mimickers (agonists), with the potency of the response being related to the chemical structure (Darbre, 2008). Parabens can bind to the cellular estrogen receptor (Routledge, 1998). They also increase the expression of many genes that are usually regulated by the natural estrogen estradiol and cause human breast tumor cells (MCF-7 cells) to grow and proliferate in vitro (Byford, 2002; Pugazhendhi, 2007). Nevertheless, parabens as a class do not fully mimic estradiol as regards these changes in cellular gene expression, nor are the effects of all parabens identical (Sadler, 2009)."

I don't know much about Parabens, but I like to go as natural as possible and I personally feel estradiol is natural for me as I've lived long enough to lose the estrogen I need to feel good. 

There are bonified double blind studies showing, used correctly, Vagifem and Estrace cream have absolutely minimal absorption systemically.

Each of us has to weigh the risks vs benefits of anything including baby aspirin.

[Rose]

Thank you to all who have replied to my post. Okay, if I use the full dosage (25 here in Oz) I get terrible headaches and suffer from insomnia. It's as if I've had double expressos (racing heart, anxiety etc) but I know from this forum that there are other women who suffer these side effects also. I wish I didn't, believe me and I'm not one to give up so easily as I've tried to keep going with the full dose. It's my bladder that is really causing the problem. I could manage the vaginal symptoms with lub etc but not the bladder. I have used natural oestrogen as my gyn told me that there are fillers in Vagifem but that didn't work either as it caused me to bleed. I just wanted to know if anyone has used the reduced dosage of Vagifem (which is basically what I'm on now) and for how long did it take to be effective? I am thinking of going an extra week of the half dose, so that will be 1 month but after that I would have to use it 4 times a week to keep up. I'm getting confused and desperate sorry. I have an app with a bladder specialist in May (private) but she is the best so hence the longer wait. I don't want to overdo the Vagifem. Perhaps the ring maybe an answer?

[Sarah2]

Hi Rose
Sorry you are feeling so down.

Vagifem is oestrodiol- this is a more potent form of oestrogen than oestriol and is more likely to cause side effects ( though only a tiny bit is absorbed.)
So....have you thought about using Ovestin which is oestriol? Is this what you meant by having tried natural oestrogen?
The main risk of using any local HRT is possible thickening of the endometrium if you use a lot , over many months or years. This can be offset by taking progestogens once every 6 months ( according to my gynae) and/ or having a scan.

Looking at it logically, if the loading dose is 25mg for 2 weeks and you are cutting the dose by half then you need to continue with the dose for at least 4 weeks. I think you can only decide what to do next once you have gone through that regime, depending on your symptoms.

The other point is - can you use it at night? The reason for this is that lying down helps the cream or pessary to stay in place whereas standing up or sitting ( day time) is likely to make it fall out so you won't get the full effect. I know that if I use Ovestin in the morning then 2 hours later most of it is on my underwear!

The only risk of over-doing the Vagifem would come further down the line, and even then it could be tackled with progestins. In your case I think I'd use what I had to to get relief, then re-assess.

[ancient runner]

I'd second what Dancinggirl said about the estring -- you get 7.5mcg a day dose from that and no fillers. It's constant, so no up and down of the dose every couple of days. Try it?

[tiger74]

I also avoid parabens and there are none contained in the version of Replens available in the UK which I use.

[Sarah2]

Tiger


see list of ingredients below

Ingredients
2.5g of Replens MD Vaginal Moisturiser contains:

Purified water Ph. Eur. 78.82% w/w, Polycarbophil, mineral oil, glycerin, hydrogenated palm oil glyceride, Carbomer Homopolymer Type B, sorbic acid, methylparaben, sodium hydroxide.