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Author Topic: Too much oestrogen?  (Read 3937 times)

ancient runner

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Too much oestrogen?
« on: August 18, 2017, 02:42:17 PM »

Feeling very shaky after a phone call from a GP at my practice (not my usual one) who was unhappy about my repeat prescription request including both Femoston 2/10 and the estring - I get very bad VA and this combination seems to finally be working.
She thought it was too much oestrogen and there were risks, and wanted me to replace the Femoston with progesterone tablets. This really puzzled me at the time but have now worked out that would be to lessen the risk to the womb, yes?
I was horrified and explained why and she agreed to leave it as it was but mention our conversation to my usual GP, saying I was due for a review (only been on the current combo for 3 months) and BP check (had one four months ago).
Of course I get that there are elevated risks but now I am feeling very upset by the whole conversation. I've never heard of taking progesterone tablets alongside local HRT - wouldn't this in itself slightly elevate the breast cancer risk??
Please reassure me that Femoston and the estring isn't a completely over the top combination for bad VA/bladder problems that nothing else I've tried (local HRT alone, Femoston 1/10 alone) seems to touch? Or tell me I'm in the wrong. I am worried that I went off on one a bit, though I did keep on apologising to her :(
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Sweetscarlett

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Re: Too much oestrogen?
« Reply #1 on: August 18, 2017, 03:21:37 PM »

Hi AR - I'm no expert but isn't progesterone already  in femoston ?

❤️Ssx
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ancient runner

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Re: Too much oestrogen?
« Reply #2 on: August 18, 2017, 03:22:54 PM »

Yes.
But what the GP wanted was for me to use the estring and progesterone only.
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Annie0710

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Re: Too much oestrogen?
« Reply #3 on: August 18, 2017, 04:13:34 PM »

The estring is localised and insignificant dose wise for oestrogen as in systemic hrt isn't it ?

A nurse took me off vagifem as she thought I was 'too oestrogened up' using it alongside my hrt.  Needless to say everything flared up again so now I use hrt, vagifem as much as I personally want and ovestin for the flares.  No one will take this off me again !

Apparently one vagifem taken every day for a whole year is equivalent to one hrt tablet, surely the estring is similar ?
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CLKD

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Re: Too much oestrogen?
« Reply #4 on: August 18, 2017, 04:22:18 PM »

You probably need progesterone if you still have a womb. 

Are you still using Vagifem or Ovestin1mg for atrophy on a regular basis?  Some ladies find that they require a combination every which way to remain comfy., so as well as local oestrogen may also need to use another moisturiser to keep the area supple. 
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ancient runner

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Re: Too much oestrogen?
« Reply #5 on: August 18, 2017, 04:23:29 PM »

Using the estring CLKD - v similar to vagifem/ovestin.
And using progesterone as part of full systemic HRT.
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Sweetscarlett

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Re: Too much oestrogen?
« Reply #6 on: August 18, 2017, 04:29:27 PM »

I'm also on Femoston and  vagifem - I know the combination of both is the only ease for VA

As this was not your usual doctor - maybe she is unaware of the severity of your condition ?

💙Ss x
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Annie0710

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Re: Too much oestrogen?
« Reply #7 on: August 18, 2017, 04:38:47 PM »

Using the estring CLKD - v similar to vagifem/ovestin.
And using progesterone as part of full systemic HRT.

Then it sounds like that gp is uneducated x
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Hurdity

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Re: Too much oestrogen?
« Reply #8 on: August 19, 2017, 07:30:51 AM »

It is quite scary how many GPs are still quite ignorant about HRT - worse that they are like this when the information is easily found out there. This is what it says about Estring product info:  "Estring vaginal delivery system is a local therapy and in women with an intact uterus, progestogen treatment is not necessary". As already said you are taking a progestogen as part of your HRT and therefore this should easily be sufficient to deal with the minute amount of extra oestrogen from the Estring.

While gynaes (and the latest HRT recommendations) state that it is fine to use local oestrogen long term and without a progestogen - there is acknowledgement that there are no long term studies on this.  Very occasionally someone who is only using vaginal oestrogen will experience endometrial hyperplasia - as we have seen on this forum - but it is very rare, and this would be a woman who is not taking any progestogen at all.

I also experienced this response from a doc once a couple of years ago - went to GP with symptoms of something (can't remember what now) and she said maybe you've  got too much oestrogen (was using the discontinued orthogynest (estriol) pessaries as well as long cycle HRT with medium dose oestrogen patches). Needless to say my oestrogen levels came out as they probably have been for years - somewhere between 200 and 250 pmol/l! She didn't even appreciate that one was estriol and the other was estradiol!

I would challenge the doc and say - OK rather than take progestogen - please could she order a scan if she thinks you are in danger of endometrial thickening - this would need to be done immediately following your bleed to give an accurate picture.

Oddly the instructions for the estring do say this: " The maximum recommended duration of continuous therapy is two years." but I am thinking this is out of date?

I can understand why you feel frustrated - the most important thing is to find a regime that works for you and is associated with fewest side effects and health risks, so I hope it continues to work for you :)

Hurdity x

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ancient runner

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Re: Too much oestrogen?
« Reply #9 on: August 19, 2017, 11:15:02 AM »

Thank you for that Hurdity. The scan is a good thought if this comes up again - hadn't considered that (and silly me, I thought she was offering the progesterone to help with my VA symptoms to start with - which is why I was so confused).
I think Sweetscarlett is right that the GP didn't realise that VA was such a severe problem for me - but since it's the only menopausal symptom I've ever sought medical advice over, and have seen another GP several times for this in the past few months, I am very surprised that this would not have been apparent from even the briefest look at my notes. 
It has left me feeling very anxious though, as I've just had two of the best VA weeks since last autumn, when the ring alone stopped working and I've gently worked up through the possible doses since then, as it were. I'm running, walking and working without pain (mostly).
I know there are risks - but that was all she could see - but that has kind of highlighted them once more. And it does worry me that she might try to interfere with the treatment her colleague is giving me which we've discussed, have taken a step at a time, and does now seem to work. :(
Rant over. I don't want to diss the GP as I am sure she was well-motivated and very busy.
And it has made me think that perhaps on 2mg femoston, it might be possible to drop from the estring at 50mcg to say two or three vagifem a week - once things have stabilised, that might be something to try. But in the scheme of things I think that's probably a very small change.
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Maryjane

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Re: Too much oestrogen?
« Reply #10 on: August 19, 2017, 12:25:34 PM »

Not going to repeat what's said , as I am trying to remain calm these days 🙄 my gynae has ladies in there 70s using the estring for many many years ....the two year thing is ignored.

We are living longer and our vaginas are really suffering 😕
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ancient runner

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Re: Too much oestrogen?
« Reply #11 on: August 19, 2017, 05:47:08 PM »

Not just vagina Maryjane - our sanity too with all this stuff thrown at us!!
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