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[Conolly]

Hello CLKD,

I understand you didn't have another choice and I'm absolutely fine with it. However, this thread is about Vagifem, Ovestin and cancer risk, which is exactly what's being discussed.

If alternatives (lubricants) are not enough to control symptoms, I want to know as much as possible what topical oestrogen can do for me, both the pros and cons.

I'm genuinely interested in trying this route, but I still have some time to investigate 

Conolly X

[suzysunday]

It's sensible to make an informed choice.  I took tibolone without looking into it and I wish I hadn't as it caused thickening .  But now I am worried about ovestin but I need something for VA as moisturisers are nother enough. I was off hrt for 3 months with biopsy and for the last 4 months have struggled with uti symptoms as a result.  Still trying to get back on track with ovestin.  Other hrt will also have risks, so they are difficult choices.

[CLKD]

As far as I am aware there is very little cancer risk.  Being locally applied it shouldn't be absorbed in any great quantity to cause a risk.

[suzysunday]

Do you worry about womb lining thickening?

[CLKD]

Never.

[suzysunday]

OK thanks.  As you say it's quality of life and without  local hrt I won't have any.

[CLKD]

I have learned a lot by reading threads here but don't apply much to me unless I have symptoms that have been discussed with a GP.  Who is I have to say is very supportive.  Then I come here to check, ask, share ..........

........ and breath!

[Hurdity]

Hello again,

Are you saying that the BMS 2016 'guidelines' (I don't know what is the right term) contradict NICE guidelines? https://bnf.nice.org.uk/treatment-summary/vaginal-and-vulval-conditions.html

I'm worried about the confusing information regarding leaflets, NICE guidelines, surgeries and now BMS 'guidance'. Shouldn't they all speak the same language? Are BMS and NICE independent from each other? I understand that the so called Menopause Societies (BMS and NAMS in the US) have many menopause 'experts' but I don't know exactly what is their 'official' role.

I might need vaginal atrophy treatment in the near future, so I'm trying to learn as much as I can.

I'm not from the US, but I go there often.

Conolly X

The NICE Guidelines we refer to on here are the NICE Guidelines on menopause which may be more detailed re the use of local oestrogen for vulval and vaginal atrophy, not the ones you linked to. I don't know when they were written but although not incorrect they do sound alarmist! All HRT including local oestrogen should be reviewed annually.

The NICE Guidelines on Menopause were drawn up following extensive review of the current research literature and the evidence base is given in some detail in the full guideline. I don't know which parts you find contradictory ref the BMS 2016 recommendations on HRT (paper with Women's Health Concern)?

You can read about BMS and NICE and their roles on their respective websites. Of course BMS is independent of them - it's a specialist academic society like any other....

It was your use of "math" that puzzled me - we Brits don't use this term, which is used by Americans and in US - we say  "maths" !!! If you go there often perhpas you've picked up some of their lingo!!!

suzysunday - no-one need worry about womb lining thickening when using local oestrogen although everyone should be vigialnt re unexpected and unexplained pain or bleeding. Cancer risk is very very low indeed - hence the NICE Guidelines (on Menopause) stating no need for progestogen and no need for endometrial scans as precaution - although personally I think all women on HRT should get an annual U/S scan but this is never going to happen!

Hurdity x

[suzysunday]

Yes that is a good idea.

[Conolly]

Hello Hurdity,

I'm aware of NICE guidelines, if you're referring to NG23. The link I have posted is from the British National Formulary available in NICE website https://www.nice.org.uk/about/what-we-do/evidence-services/british-national-formulary

If the information on vaginal and vulval conditions (including the use of the same medication) is different from the information on vaginal and vulval conditions in menopause, it appears to be an inconsistency.

'Math' was just a typo  My iPhone (bought in the US) is probably set to default American English and I can't  be bothered to correct the autocomplete tool.

Regarding womb line thickening when using local oestrogen, I wonder why Besins product for vaginal atrophy, Trophigil, has progesterone, besides estriol and Lactobacillus.

Conolly X

[suzysunday]

That's a bit worrying.

[CLKD]

Sounds like over-kill to me  especially as we have two well documented products available on the NHS. 

[Saffy]

I think I've read that there is some evidence that progesterone can be beneficial for VA independent of Oestrogen. Of course I can't find the reference I'm thinking of anywhere  .

[CLKD]

As well as many ladies having bad reactions to progesterone 

[Hurdity]

That's a bit worrying.

What's worrying you suzysunday - there is nothing to worry about? Do not fret!

Hurdity x