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[deebarnes]

I saw a new young female Doctor today and she advised that I should take a break from using Vagifem every 6 months for a couple of months.  I wanted to scream and shout at her.... "WHAT, do you know how awful it was before I started using it? What do I do when the symptoms come back, how am I meant to cope etc etc..." 

I didnt say anything....however I am going to see a specialist at a private hospital in a couple of weeks and will ask for a second opinion.  It might have something to do with the fact that my half sister had breast cancer last year but we know that this was caused by extreme stress in her life over the past 4 years, there is no other family history of breast cancer in my family.

Has anyone else been given this sort of advice from their GP?
Thanks Dee

[Kate50]

They are just so fearful of it it's a tiny amount in comparison to full hrt.  More worried about being sued than the welfare of the patients.  Scary times!

[CLKD]

It should be OK to use Vagifem 4 Life  .  Also, it depends upon what type of cancer a close relative was treated for.  As someone who has had breast disease I would shout and carry on should I require HRT!  As it is I use Ovesting1mg which states very clearly in the leaflet that I shouldn't have it but Quality of Life Girls, QoL!!!!

I wouldn't even mention it to a Gynae but continue as necessary.  Particularly as these products are used locally and unlikely to migrate far enough to cause problems ;-)

[Kate50]

My friend had hysterectomy at 36 and waa on oestrogen til 2 yrs ago when she made a decision to come off being 48 and her mum having had breast cancer.  She lasted just over a year and last summer spent the whole time walking around with no pants on cos of severe VA. She back on it cos like CLKD says quality of life you gonna die one day best do it with a lubricated vagina!

[dahliagirl]

I think I have read something somewhere in the past (when 25mg was around) that a break should be considered after 6 months to see if it was still required.   This was in line with the lowest dose for the shortest time instructions that came out just after they stopped the millennium woman trials.

This advice seems to have melted away.  It is not very practical.

[Dorothy]

I've been on Ovestin for over 6 months and had an unintentional 'break' a couple of weeks ago when I forgot to use it.  It left me in no doubt that it is 'still required'...Owwwwwww!  Definitely get a second opinion - you shouldn't have to experience this discomfort just because of a young doctor's bright ideas!

[CLKD]

I do the same occasionally Dorothy ………. owwwww covers it really well!

[linz57]

A couple of years ago a gynae told me I could take Vagifem constantly so long as I had 6 monthly scans. VA won't go away so it seems madness to leave off the treatment and let it get worse

[babyjane]

No, no, no, wild horses would not part me from my Vagifem.  I have now been using it for 6 years with my GPs blessing. Before VF I had repeated bouts of thrush and cystitis all the time.  Since VF I have not had one single episode of either and I am comfortable all the time.

VA does not go away, VF is not a 'cure', it is a management.  The only effect I have had since going on it (apart from the obvious benefits) is that I went up a bra cup size from B to C 

[linz57]

Have you ever been advised that if you're taking it long term you might need a progesterone? When I saw the gynae the other day I told her I had been thinking if trying going back to using just Vagifem and no hrt patch. She said if I intended staying on it for life I would need the mirena coil too. Other doctors say no progesterone needed even long term . Very confusing.

[Tinkerbell]

My private meno gynae has said using Vagifem every day was only equivalent to one oral HRT tablet a year and said it would never cause a problem and that scans etc were not needed.....she put this in writing to my GP practice.
The awful male gynae I saw on the NHS before her wanted to do a hystercopy and insert a mirena because I had used it for more than 2 years.
Over the last couple years I have seen different doctors at my GP practice, never can see the same doctor twice!
And have been told...
Maximum use is two years
Break every two months
Yearly course of progesterone tablets
Twice a week is sufficient, if not, it is not VA.
There really needs something to be put down in writing for doctors to all follow....I think current Nice guidelines say it can be used long term with no need for progesterone.

[Hurdity]

Totally wrong linz57 - you do not need progestogen if using Vagifem long term., Systemic absorption is minimal especially once "plumped up" ie after initial loading - and if you keep plumped up. Very very rarely there is endometrial thickening but this is not the norm.

Please read the first paragraph at this link on this site:
http://www.menopausematters.co.uk/dryness.php

"Low dose vaginal estrogen preparations can be used long term without causing any known systemic effect, and without needing any progestogenic protection of the lining of the womb."

This is what the NICE Guidelines say:

Urogenital atrophy

1.4.9 Offer vaginal oestrogen to women with urogenital atrophy (including those on systemic HRT) and continue treatment for as long as needed to relieve symptoms.

1.4.10 Consider vaginal oestrogen for women with urogenital atrophy in whom systemic HRT is contraindicated, after seeking advice from a healthcare professional with expertise in menopause.

1.4.11 If vaginal oestrogen does not relieve symptoms of urogenital atrophy, consider increasing the dose after seeking advice from a healthcare professional with expertise in menopause.

1.4.12 Explain to women with urogenital atrophy that:

symptoms often come back when treatment is stopped

adverse effects from vaginal oestrogen are very rare

they should report unscheduled vaginal bleeding to their GP.

1.4.13 Advise women with vaginal dryness that moisturisers and lubricants can be used alone or in addition to vaginal oestrogen.

1.4.14 Do not offer routine monitoring of endometrial thickness during treatment for urogenital atrophy.

https://www.nice.org.uk/guidance/ng23/chapter/Recommendations#managing-short-term-menopausal-symptoms

I'm surprised that local oestrogen would cause such a difference in boobs babyjane - has your overall weight conicidentally increased generally over the same time period? Mine have increase in cup size but I am on systemic HRT medium dose as well as Vagifem - but not overweight generally.

Hurdity x

[Tinkerbell]

Thanks for that Huridity...I knew I had read it somewhere.

[linz57]

Thanks Hurdity, I knew I'd read that and I mentioned it to the gynae but she  wouldn't listen.Think I'll just sort things myself as they never listen to us or take note of guidelines. Makes me so angry when I go to see a professional and they just dismiss everything that's in print about hrt and Vagifem

[babyjane]

I don't have a womb so wouldn't need progesterone anyway.

Twice a week since the change from 25mcg to 10mcg wouldn't do diddly squat for me.  My GP said I can use it every day but I find every other night just right. I am so grateful for my very supportive and totally clued up GP