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[Cherly]

Hello everybody, I have just posted on another thread, but as my problem is very specific I thought I would start a new thread.  I have had vaginal atrophy for a couple of years since I got breast cancer.  My GP started me off on Replens, which didn't work, then after she received a letter from my oncologist saying it was okay for me to take topical oestrogen she prescribed Vagifem which has been great.  A few months ago she switched me to Ovestin because she is worried that as a breast cancer survivor I am taking ANY topical oestrogen.  This is despite the letter and me telling her I am ER negative.  The Ovestin was a disaster; it didn't work and had horrible side effects.  Fortunately I have a supply of Vagifem left and I have an appointment with my oncologist in a few weeks.  I don't like having to fight with my GP, especially when the breast cancer specialists say it's okay.  Has anybody else experienced this and do you have any suggestions for me?  Thanks!

[ancient runner]

I don't have experience of this personally. My thought is though that Vagifem and Ovestin are basically the same thing but one's a pessary only and the other is a cream - same active oestrogen ingredient though. So your GP's reasoning for making this change is a bit puzzling. As for the rest of it - well, if your Oncologist is happy and that's what you want, I think the NICE guidelines are on your side.
Best of luck.

[CLKD]

Your GP needs to get proper information!  Topical treatment for atrophy are un-likely to cause any problems.  Also, quality of Life is important. 

I would ring the Oncologist and tell him/her that your GP is reluctant to prescribe. 

It may be down to money and she is using your breast disease as an excuse! [stranger things hav been known  ].

What side-effects did you get from Ovesting1mg?  I have had no problems.  I certainly needed something as I couldn't have lived with the feelings of razor blades up there!!!

I don't understand : ER Negative : ?

[Hurdity]

Hi Cherly

 


Yes it should be OK to use Vagifem and especially if your cancer was not oestrogen receptive! If your oncologist has written to your GP to this effect then you should really stand your ground and insist that you want Vagifem for the reasons you gave - that you had a reaction to Ovestin.

Here is what it says 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.

ancient runner -  Vagifem contains estradiol and Ovestin contains estriol - although they are both oestrogens they are a different type and bind to different oestrogen receptors - but yes you're right they do the same job for VA and bladder issues! Estriol binds preferentially to the Beta receptor and only weakly to the alpha receptor which estradiol binds to - and there are some differences in the distribution of receptors throughout the body. That's a bit simplistic as I don't have the full information ....

Good luck with the doc Cherly - please don't give up and be fobbed off - remember it is your body! If necessary go to a different doc in the practice and explain, and refer to the letter from the onco.

Hurdity x

[Cherly]

Thank you all so much for your replies and especially your support.  I will look up the Menopause Matters piece about this.  ER negative, for the person who asked, means that I am Oestrogen Receptor Negative, a good sign and it means I don't have to take Tamoxifen.  My side effects of the Ovestin were stomach pain, diarrhea, headaches, breast soreness and, worst of all, anxiety!  Thank you for the very good explanation of Estriol and Estradiol.  It seems as though the response to these oestrogens does vary among women.  I will stick to my guns!  It's just been so stressful.  Thanks again. 

[Cherly]

Sorry, one quick question.  Ancient runner, can you tell me what the NICE guidelines are that you were referring to?  Thanks.

[ancient runner]

Nice brought out guidelines on the treatment of menopause earlier this year - which, very simplistically, reminded GPs of the benefits of HRT and to prescribe it in not just an absolute last resort way any more. I think if you look at the main MM website rther than the forum you'll find lots on it there!

[CLKD]

Morning Cherly - I started a thread a while back about why ladies aren't being told to have a double mastectomy if HRT is supposedly dangerous ……… might be a question to ask when you go for an appt.?

[lorrapaw]

The amount of oestrogen in the ovestin cream is far higher than in the vagifem pessary.

[Hurdity]

Yes that's right lorrapaw but as I said they are different oestrogens so not comparable - and also different preparations - one is a concentrated tablet that stick to the vaginal walls and the other is a cream that is just inserted loosely into the vagina.  Even different preparations containing the same oestrogen - estradiol - are not comparable eg tablet,  patches and gels. As I said they (the Ovestin, estriol and Vagifem) are designed to do the same job at approximately the recommended doses.

Hurdity x

[Cherly]

Thanks again ladies!  Will definitely check out the main MM site, check the NICE guidelines and talk to the GP as suggested.  Your support and encouragement is most appreciated!  Cherly x