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[Hurdity]

Hurdity and JuJu are on regimes that are probably not approved on the NHS and would certainly not be routinely offered by a GP.

Just catching up on threads - Dancinggirl - just for the record I have never seen private consultant nor been to a meno clinic and all my treatment is on the NHS. I am lucky in that I live in the SW and also have an enlightened doctor at local practice who women go to for gynae issues as she specilialises in them - although isn't titled as such.  She is also 60 or 61. I got what I wanted (Estradot patches, Utrogestan , on a cycle up to 2 months) by doing research and then asking for it, and demonstrating that I understood the reasons. She prescribed Cyclogest (progesterone pessaries) for HRT for years before Utrogestan was available, and is happy for me to be on a longer cycle (knowing my history). It is possible to get it all on the NHS but you sometimes have to work a bit harder! It shouldn't be the case and I understand your frustration as I feel the same when I read some of the stories on here that women experience at the hands of ignorant GPs!

Hurdity x

[Hurdity]

Another thing to think about is that women using vagifem or estriol only, daily, are already using unopposed estrogen, dosage 10-25mcg. Some can and do have some systemic effects of bloating tummy, tender breasts and sometimes headaches.

There is is no talk of opposing this therapy with progestin or progesterone even yearly.

Menostar is only 0.14mcgs a week! I think that must be less.,

DG Menostar is a patented hormone therapy made by the drug companies its just not on the list in the UK or sanctioned by the NHS.

Some more info  http://www.webmd.com/menopause/news/20040610/low-dose-estrogen-patch-gets-fda-nod

I need to clarify for everyone - this is incorrect, and it is important to understand what the different dosages mean.

The dosage given for patches is not the total amount in the patch, but the amount that is designed to be delivered into the system (on average) in 24 hours.

A  Menostar patch delivers 14 mcg oestradiol per 24 hours, (just as my 50 mcg patch deliver 50 mcg in 24 hours). so about 100 mcg per week. The actual patches contain more oestrogen than this. The Menostar patch contains 1 mg oestradiol so a lot of what is in the patch is lost ( 1 mg = 1000 mcg),

Vagifem is completely different - a Vagifem 10 mcg tablet contains only 10 mcg in total which is 20 mcg per week, and only a fraction of this is absorbed ( haven't looked this up recently).  The same goes for Vagifem 25 mcg. (a total of 50 mcg per week of which a fraction will be absorbed).

They also can't be compared (ie oestrogen patches and vaginal oestrogen patches) due to the mode of delivery - once vaginal tissues are plumped up then there is very little systemic absorption (which is as intended). whereas patches are designed specfically to allow systemic absoprtion.

Once this is understood you can see why no progestogenic opposition is necessary with Vagifem - although  a few authorities do recommend a progestogen challenge now and again to be ultra cautious (or so I have read).

Since in the case of Menostar progestogens are recommended by the manufacturer (as I reported below), then I imagine those in US prescribing it do so on this basis.

Hurdity x

[Dancinggirl]

Thank you for clarifying things Hurdity.
I think this thread has made me wonder that if there was an easy way to give a very low dose of oestrogen without the problems of progesterone will we one day see this as a standard preventative treatment for many age related problems?
I have to say my GP has been very supportive of me trying various oestrogen treatments for my VA but I doubt she would allow me to pursue a more alternative HRT regime without some specialist advice. As she did the prescription for the Estring she did mutter that it could only be for 2 years - I will fight to keep on this treatment and will possibly have to see a gynae privately to make sure I can continue - I certainly don't want to go back to all that pain and burning. As you have mentioned, I may just suggest to her that I use some progesterone, maybe once a year, to protect my uterus.
I envy you your more enlightened doctor and can only hope that, when the new guidelines come out next year, GPs will get their act together. As you have a science background you are better able to put forward your case for the regime you wanted - the best most of us can do is quote what we have learned from this site and sadly many GPs will just not sanction this.   
I am feeling so dreadfully tired at the moment - I have to say posting on this site does keep me going at times. I wish I could totally blame the lack of HRT as the cause of my fatigue but I know there are other factors at work - I had a nasty tummy virus a couple of weeks ago and haven't had a chance to really rest up and recover - that's life!!! 
Off to bed.  Sweet dreams to you all.  DG xxx

[Hurdity]

Hi Dancinggirl

if you can tolerate taking it annually ( ie progesterone) that seems to be a good compromise if it enables you to carry on with the Estring - I don't think there are any long-term studies of this are there?

The other thing is if women are having problems with their less enlightened GP is to pay £25 to have an e-mail consulation with Dr Currie - much cheaper than going privately, and a way of endorsing the decision a woman might have made on what product to use. I know this requires confidence which many do not have at this time so perhpas also take a partner or friend along when you have this conversation with your GP!

Yes I will be interested in seeing the new NICE guidelines and no doubt there will be a draft for consultation before the final form and I am sure Dr Currie will post this on here at the appropriate time and we can comment.

Hurdity x

Hurdity  x