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[Tinkerbell]

I have a lot going on at moment, husband and our youngish child have both been seriously ill over last 20 months and don't know if I am being over sensitive.

Diagnosed with VA 3 years ago and since January have been having a real problem with it. I have found a lovely female doctor at our surgery ,who after I spoke to hear at beginning of July ,told me to use Vagifem every day and in the meantime  she would refer me to consultant gynaecologist who runs a NHS one stop clinic in next town once a week.
I am 52 and have had 3 periods in the last year, two of them were a bit shorter and lighter though.

I had my appointment with gynaecologist last week and it has left me very upset and unable to sleep.

As soon as I got talking to him, he lectured me on my weight ( carrying 3 stone extra)  told me Vagifem always works and I am at risk of endometrial cancer....I was aware of excess weight being a risk factor.
He then examined me roughly and said I had no atrophy, well I have been on topical HRT for 3 years!
He then told me the following , didn't ask how I felt about any of it.
They will under a GA do a skin biopsy, Hysterscopy and fit a Mirena.
I got really upset at this point as I have had a bad experience of a GA in the past. I left clinic in tears.

I realise the importance of the skin biopsy, but on doing research this is done under LA.
At the clinic they had an onsite scanner, most ladies were going into that room, so if he was worried about womb thickening why wasn't I offered that first?

Also really cross that I wasn't asked how I felt about Mirena, I did ask about full HRT and his reply was ....'  Once the Mirena is in you can use it every day'  so he contradicts himself there...one minute I do not have VA and then I am told that!

Where do I go now? I have decided there is no way I can see him again and I will not be able to see my lovely GP until September.

Thanks for reading.....I am shaking again, just typing this out.



He then said if Vagifem is not working he needs to rule out Lichen Sclerous.

[Dancinggirl]

Oh dear, what a dreadful experience!!!!    You poor, poor thing.
I don't blame you being upset. Why exactly did you get referred to this gynae? I assume it's VA but what are the real issues - dryness, UTI type symptoms, rashes etc.  Are you using Vagifem 2-3 times per week?
You are clearly not getting problematic bleeding - you are just getting the classic peri symptom of the occasional bleed/period so I don't know why this gynae is suggesting such invasive stuff when it's not needed. The Mirena might be a good idea if you want to add some extra oestrogen to help with flushes etc. as you can then use as little or as much oestrogen as you need. I'm wondering if he thought you were already using full HRT? It sounds to me as though this is his standard way of dealing with all meno ladies.
If you can hold out to see your lovely GP to discuss this further then I would.  Perhaps ask to be referred to someone else. Keep us posted.  DG x

[Tinkerbell]

Thanks for replying.

My lady doctor referred me as she said it was a new service and she said I shouldn't have to live with the discomfort... She is really empathetic.

I was using Vagifem 3 days a week but she told me to up it to 5 earllier in the year, and try and cut back again. But every time I did that the burning, feeling a need for a wee in the night all comes back, skin  has also got a bit red again, a bit drier but not to the extent pre Topical oestrogen.

She told me she has recently been on some menopause conference and said higher dose would not cause any problem in short term but she did ask how I felt about full HRT.
I am still using it every night as she suggested, don't know if I should continue on that amount until I get an appointment with her....am going on holiday soon and don't want to be sore and miserable for that.
He mentioned the Lichen Sclerous , but on googling I have not got the symptoms. That is treated with steroid cream, not topical oestrogen, so surely it wouldn't mprove when I upped the Vagifem if that was what it is!

[CLKD]

Maybe if you continue to be sore and dry that Vagifem isn't for you, there are other products. Have a read of the menus, top of screen and make notes.
 
Does using it 5 nights a week help, is this 5 consecutive or on alternate nights?  You can use a lube on the outer lips too to keep that area moist and less itchy.  KY, Vaseline ……. even LIVE yoghurt applied can ease any dryness.

Also ask your GP to see a copy of the letter which she sent to the Consultant, you and she can read this on the screen.   Maybe she left some details out or perhaps the Consultant failed to read the letter!  He sounds like the kind of Consultant who has no bed-side manner  (I've worked with a few of those  ).

If the examination was in your opinion 'rough' then maybe you need to ask your GP for an explanation.  Was there a Nurse present at the exam.? Why has a biopsy been suggested? 

If the Consultant is worried about womb thickening I believe that an ultra sound scan using a probe can give a measurement 

Make a double appt. with your GP as soon as you can so that you have time to talk - make a list of your worries to take with you!

[Dancinggirl]

Tinkerbell
I have had this dreadful burning in my urethra - like a UTI - which improved with Vagifem but has been a lot better since I went on full systemic HRT as well - I still use Vagifem once a week alongside.
Your experience with this gynae was unacceptable and you need to talk things through with your lovely GP.  If you are getting relief from the daily Vagifem(or perhaps every other day) then I would continue until you see the GP - it's unlikely to cause long term problems.  Ask you GP about the Mirena - do look it up on this site as it could be good option for you but there are other options for systemic HRT which you may like to try first. 
I think it was really out of order that this gynae made such a big issue around your weight but it is a good idea to keep your weight down if you do try HRT as carrying a bit of extra weight brings more risks.
You might like to try using some lubrication as CKLD suggested - I've been using Multi Gyn Actigel every day for years as this soothes the burning and helps to keep the whole vaginal area healthy.
Keep us posted.  DG x

[SadLynda]

As I have not had my first appointment on the matter yet I have no experience as the others.

BUT - just wanted to add you were not over reacting at all.  What an awful experience for you.  Hope you are feeling better now and the above advice can help.

[CLKD]

You certainly were not over-reacting, sorry forgot to answer your initial query  ! 

[Hurdity]

So sorry to hear about your unpleasant experience Tinkerbell.

Many of us would continue to get symptoms if only on local/topical HRT like Vagifem - and need to use this as well as systemic HRT just to keep things comfortable and symptoms at bay.

I agree with Dancinggirl - I can't understand why you have to have the biopsy and hysteroscopy, nor the Mirena at this stage! I had a hysteroscopy and biopsy due to post - sex bleeding and thickened womb lining - but I had no anaesthetic at all.  This is your choice but some areas will only do it under GA - I chose a hospital where I could have LA or none as I've never had a GA. I could have had a local but it wasn't worth the bother as it was so quick (at the recommendation of consultant). I know some consultants are better at this procedure than others. Also I agree why haven't you had a scan first to see if your lining is thickened - the biopsy is usually carried out if the lining is found to be thickened following an ultra-sound scan and generally also a trans-vaginal scan, and/or if there are indeterminate abnormalities or irregularities noticed on the surface of the womb lining (as in my case).

As for the Mirena - I have oestrogen and separate progesterone and was offered the mirena while they were doing the hysteroscopy - but I declined this. There is absolutely no way you can be forced to have this.

I also agree with Dancinggirl that now is also a good time to try to begin to lose some of the excess weight - but not be intimidated into doing so - because excess weight is a risk factor that seems to be associated with cancer and other health problems.

Personally I would make an appt asap with your lovely GP (for Sept) and continue to use Vagifem every day if she has sanctioned that - of course you want to be able to enjoy your holiday! Sept is only a few weeks away....

Try not to worry and enjoy your holiday - perhaps use the time now to think more about full HRT and if that's what you want.

Hope this helps

Hurdity x

[CLKD]

Good advice Hurdity - use the Vagifem every day, go on holiday then review with your GP! (we have a holiday thread too  )

[MrsMopp]

That sounds awful.

Only a dermatologist can diagnose LS.  I've had it for years but recently a gynaecologist tried to tell me that I don't have it at all 

[CLKD]

  Mrs Mopp

[Tinkerbell]

After waiting weeks to see female doctor, only managed to get appointment yesterday!! I am still not happy and don't know what to do.

She took time to explain things, but basically I feel backed into a corner now as she thinks the Hysterscopy, Mirena and vulva biopsy is the way to go. Although she did say she was happy to refer me to a female gynae's list, but I guess the treatment will be the same.
I have to have this all done under a general, but I can have a spinal block if I am against the GA.

Things going through my mind

I thought hysterscopies didn't need GA/spinal and I no a Mirena doesn't .
Research shows a vulval biopsy is done normally under local.

I have not been offered a scan to check lining...I  pointed this out yesterday, but she said they could give a false negative.

I have been on Vagifem since January, but using more than the twice a week dose, before that I was using Ovestin for about 2 years. I am on no other HRT
I have had 3 periods in the last year, last 2 more scanty but NO other bleeding.

I am so stressed with all this, feel I have to accept these suggestions and have a GA or spinal and that will mean an overnight stay and a catheter.

Can I see another consultant privately for a second opinion and if any investigations are still needed can i be referred to the NHS for this?

[CLKD]

I would see the Consultant Gynae if your GP will refer you.  Take a list of your symptoms and ask for advice.  You don't have to 'go' with that advice! Going privately shouldn't be necessary, you may see the same Consultant anyway.  Why does your GP think you need a vulva biopsy ? 

Why did you stop the Ovestin?  Does the Vagifem help at all, you may need to use it more often.

Sorry not making much sense as I have a head cold 

[Tinkerbell]

I would like to see the female gynae as she was my obstetrician 12 years ago and labour wise she was very pro-choice!
My problem is, doctor yesterday didn't know whether  she would just put me on her theatre list of whether she would see me first....I would like to discuss things with her., but doctor said that would start process from the beginning again.
They want to do a vulva biopsy as I am needing to use Vagifem 5 times a week......consultant said that after initial loading, 2 doses a week is enough......what I have read, I don't believe that! And they need to check for lichen sclerosis if the Vagifem is not adequate.
I changed to the Vagifem as Ovestin was not adequate on advice of doctor back in January.

Sorry you are feeling rough CLKD, but thanks for replying.

[CLKD]

I would think that an NHS or Private Consultant would see you in an appt. to discuss options first!  :
and it isn't is not starting the process from the beginning, but getting an opinion by a SURGEON!  That's why GPs are doing what they do.  I would expect to be able to tell the Consultant my symptoms and how they affect me on a daily basis, for the Consultant to examine me if necessary and to discuss the options.  Then go away to consider.

I would NEVER go for Surgery without discussion, after all it is my body .  I wouldn't trust a Surgeon who went in with surgical intervention without an initial appt..

"2 doses a week is enough" - change your GP  …….. she doesn't seem clued up much. Some of us need to use the product initially for the 2 weeks loading every night, then 3/4 times each week every few nights and if necessary, several nights in succession to keep symptoms at bay.

Ring the Surgery and ask for the referral letter to be sent to the Gynae and ring the appropriate Dept. to see how long the waiting list for initial appts. is likely to be. 

You need to see a Dermatologist if your GP suspects lichen sclerosis as this is a separate issue. 

(still coughing  )