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[CLKD]

I've said for years: when my Consultant called me back sooner than expected after a lump was removed from the breast, I said on the journey to the hospital that I would have both breasts removed.  But he reassured me that 'lady's with this particular condition do not need mastectomy.  If you change your mind in a couple of years we'll talk again'.  It never crossed my mind after, too busy getting on with treatment.

Now I equate it to That Bus.  Which might come along and hit me much sooner than any cancer will return.  But by taking medication what ever the risks, I have a Life with DH to get on with.  Something will take me off eventually  . 

So weighing up what you want to do with your Life and how to achieve good health in order to do those things, is important. 

[Conolly]

Susysunday,

I know what you mean, it's really hard to make an informed decision when you're struggling with health (both physical and mental) issues. I'm trying my best to read as much as I can during this 'break' after horrendous perimenopause and a much more bearable menopause.

CLKD,

I agree with 'quality of life', but for me quality of life includes peace of mind. I need to know that whatever I decide I had tried my best to weigh the pros and cons of something that can change my life for the better or for the worse in the long term. Does it look a bit like marriage? 

Conolly X

[CLKD]

It takes too much away from getting on though.  Everything has risks, even getting out of bed 

[Conolly]

Yep, but there are risks you can control, taking drugs is one of them.

There are many drugs out there, you have to know which one is best for you. There are 2 options: you take it and wait for symptoms and side effects or you base your decision on information that's already available regarding that drug. I choose the latter option.

Conolly X

[CLKD]

I don't think that enough is known about each individual person regarding those who have had treatment for breast disease and the risks of HRT.  My Oncologist said at my last appt. "No HRT for you" but that was in 1997-ish.  Regardless, I would need to know a lot more about certain risk if I had required treatment should symptoms have warranted it. 

[Conolly]

It takes too much away from getting on though.  Everything has risks, even getting out of bed 

Even staying in bed has risks, so that's not the point, really.

The fact is: the guidelines and the leaflets are not in synch. If something bad happens and one is not entitled to sue whoever says 'it's safe to take HRT and vaginal oestrogen for as long as it's needed' or 'one year supply of topical oestrogen is equivalent to having one tablet of standard HRT', then one will be hopeless and helpless.

By the way, I keep reading these statements in guidelines, newspapers, magazines and even scientific articles, and none has properly referenced these allegations. Can someone point me to the right direction? Who has studied and found evidence that 'one year supply of topical oestrogen is equivalent to having one tablet of standard HRT'?

Conolly X

[CLKD]

Often wonder the same Conolly which is probably why I remain cynical 

[Conolly]

Oh, I'm sorry I haven't noticed you were being cynical 

Conolly X

[Hurdity]

Worried and confused. Using ovestin every night for VA for a few weeks. Still getting frequent weeing and fed up.  Don't want to use any other hrt as had bleeding on tiboline. I'm permanently worried these days.

Some women do find that the night they use vaginal oestrogen (eg when used twice a week) paradoxically they get bladder irritation even though overall it has a beneficial effect on vaginal and bladder tissues. This always happens to me with Vagifem. Maybe cut down to using it say 3 x per week and see how you feel?

If you find this is not controlling your VA then maybe time to rethink systemic HRT which many of us need as well as local oestrogen.

Hurdity x

[CLKD]

I have found in the past that some days after Ovestin my bladder is irritated.  I take one Nurofen to settle those feelings.

[Hurdity]

Even staying in bed has risks, so that's not the point, really.

The fact is: the guidelines and the leaflets are not in synch. If something bad happens and one is not entitled to sue whoever says 'it's safe to take HRT and vaginal oestrogen for as long as it's needed' or 'one year supply of topical oestrogen is equivalent to having one tablet of standard HRT', then one will be hopeless and helpless.

By the way, I keep reading these statements in guidelines, newspapers, magazines and even scientific articles, and none has properly referenced these allegations. Can someone point me to the right direction? Who has studied and found evidence that 'one year supply of topical oestrogen is equivalent to having one tablet of standard HRT'?

Conolly X

Yikes your quotes in red are a bit glaring - when I see it I'm thinking someone has posted a warning!!!! Not very restful on the eyes!!!

Anyway good point there - yes this is often put out by gynaes as a simplistic way of trying to get over that the amount of oestrogen in Vagifem is minute compared with systemic HRT.

This is how it is calculated  - this isn't written anywhere - but if you do the calculation it's clear where it comes from. This has been quoted for quite a few years now and even on here too. It just refers to the total amount of estradiol in the different products. I would hope that wasn't quoted in scientific articles - although a journalistic article is different from a scientific report so with the former anything can be said and doesn;t need to be referenced and can be opinion!

The standard maintenance dose of Vagifem is 10 mcg twice a week = 20 mcg per week which is approx 1000 mcg per year = 1 mg = 1 standard low dose oral estradiol tablet. In fact it is very misleading because in terms of the uterus - more of the oestrogen (from Vagifem) will theoretically go through the cervix to reach the uterus compared with oral oestrogen (even though still a tiny amount). Also the 10 mcg is the total amount in the tablet not how much is absorbed anyway. Also with 1 tablet of oral oestrogen - much is lost to digestion and 1st pass liver metabolism so a smaller proportion of this will get into the system.

Hope that explains...

Hurdity x

[suzysunday]

Isn't this worrying for women who need vagifem every night?

[Katejo]

Isn't this worrying for women who need vagifem every night?

Surely no because it is a fraction of the systemic tablet?

[suzysunday]

Just in relation to what Hurdity posted, with the local hrt theoretically reaching the cervix. My gp was quite definite about ovestin being safe to use for life.  I used tibolone for 18 months and that caused my lining to thicken, so systemic hrt didn't give me much confidence to use again. I need something for VA so what to do? I will have to trust my gp and the ovestin. As ckld says, quality of life. I worry whatever I take since the tibolone gave me bleeding and biopsy. But I can't live without something.

[Conolly]

Yikes your quotes in red are a bit glaring - when I see it I'm thinking someone has posted a warning!!!! Not very restful on the eyes!!!

Anyway good point there - yes this is often put out by gynaes as a simplistic way of trying to get over that the amount of oestrogen in Vagifem is minute compared with systemic HRT.

This is how it is calculated  - this isn't written anywhere - but if you do the calculation it's clear where it comes from. This has been quoted for quite a few years now and even on here too. It just refers to the total amount of estradiol in the different products. I would hope that wasn't quoted in scientific articles - although a journalistic article is different from a scientific report so with the former anything can be said and doesn;t need to be referenced and can be opinion!

The standard maintenance dose of Vagifem is 10 mcg twice a week = 20 mcg per week which is approx 1000 mcg per year = 1 mg = 1 standard low dose oral estradiol tablet. In fact it is very misleading because in terms of the uterus - more of the oestrogen (from Vagifem) will theoretically go through the cervix to reach the uterus compared with oral oestrogen (even though still a tiny amount). Also the 10 mcg is the total amount in the tablet not how much is absorbed anyway. Also with 1 tablet of oral oestrogen - much is lost to digestion and 1st pass liver metabolism so a smaller proportion of this will get into the system.

Hope that explains...

Hurdity x

Haha, next time I'll choose blue, sometimes this subject gives me the blues, so quite appropriate. I thought red was ok to highlight a potential danger, but I agree that it doesn't suit presbyopia 


Thank you for the explanation, the math is quite simplistic and doesn't mean anything in terms of how much is being absorbed by local cells. The statement is misleading, it reassures women that topical is safer than oral but doesn't address the issue in question which is: is topical oestrogen safe in the long term? It's also disconcerting that oral estrogen is used as  comparison when oral tablets are still being prescribed and sold in large amounts.


Conolly X