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[CLKD]

I'd forgotten that Birdy.  Lack of GP knowledge is dangerous too!

[Sammiejane]

morning ladies

i still believe that guidelines are there for a reason !

if you were taking a blood pressure medication or steroid medication would you increase it without guidance from your GP or specialist ! i think majority of us wouldn't so again guidelines are there for a reason with regards to ovestin and vagifem it's like anything your body will become used to it if used to often over long periods of time to often and eventually will be inactive ! have you thought to ask yourself why was vagifem reduced to 10 ? was it not safe at the higher amount did it cause adverse effects ?
everybody should use what they feel comfortable with but this should be done with approval from those specialized in the field x

[Tinkerbell]

The reason Vagifem was reduced from 25mcg to 10 mcg was because a study was done on 230 women (so a very small one) the results from it found that the lower amount gave adequate VA relief, so it was reduced as they like drug prepartions to be lowest dose possible ,but as my female GP pointed out that is a very small study. 

She also sugggested, as did my meno specialist that it was done for monetary reasons  by the drug company ( obviously that is just their opinion) as majority of women they both saw couldn't manage on the lower dose and they had to prescribe 5x10mcg a week as that was equivalent to what those patients were on before.

My meno specialist wrote to my doctor and said even daily Vagifem was only equivalent to 3 Systemic HRT tablets a year and was perfectly safe.

I would imagine most people are going to get asked why they are putting in Ovestin/Vagifem scripts more frequently anyway and then they can have that discussion about more frequent use with GP.

My SIL is very anti HRT but continues to drink several units of wine a week, no exercise and is overweight, all those are risk factors for breast and endometrial cancer, but so many women don't worry about that.

Why do you think it will become inactive overtime?  I have taken betablockers for 18 years and they are still working!

[Whatsupwiththis]

Hi Sammiejane.  I hope you don't think our replies are being rude and judgemental.  I was dx'ed with severe VA at 68 and had ZERO info.  Perhaps due to my age, I simply would rather live without discomfort and not terribly worried about the future.  That's just MY story but we are all different.  Instead we should.be taking out our frustrations at the massive Pharma companies that seem to be more interested in making billions and sticking it to ALL WOMEN while erectile drugs are coming out fast and furious.  As well, cost of men's medications for their problems are dropping in price BY THE MINUTE while ours are INCREASING BY THE MINUTE.  So many women can't afford vagifem...very expensive in NA. 

[CLKD]

WHOOOA! 
Apparently the amounts were in mcg for 'vagifem' 

I have taken betablockas since 2002 - a few weeks after my dog died  to stop anxiety surges.  Initially 80mg 3 times a day which was dropped after 3 months to 40mg twice.  I now take 20mg at night: I cut down myself due to background headaches on waking.  They help.

I have taken anti-depressant medication since 1988.  Various types which have improved over the years.  1 'pooped' out as my brain became used to the amount of 1 drug so my GP changed the medication.  So far so good.

Localised vaginal treatments are totally different because the way the body takes them 'up'.  As oestrogen levels drop off the body may become dry : inside and out; deep in the ears  [me], eyes [me], vagina  [eventually me] , skin - I never hesitated despite having had breast treatment when my GP suggsested 'ovestin' which was initially delivered in pessaries.  Which were withdrawn due to costs. 

Now I use an applicator to introduce the measured amount as required.  I used it every night for 2 weeks as suggested by my GP then as necessary: usually every 3rd and every 6th night.  If symptoms niggle I up the dose to twice in a day with 3 hours between, followed by once every night for 5 nights.  That regime works for me.  No problems at all.  My quality of Life is improved hugely by using 'ovestin'. 

'Vagifem' was produced at 25 ?? (don't know the amount) then some bright spark  decided that women 'could do without 25 and ease symptoms with 10 at night'.  Well nope.  Actually.  If I met that 'bright spark' I would    Women all over the World were told that they had to 'make do' with 10, now some require 10 every night; some use two doses occasionally the same night and 10 every night; some manage with 10 occasionally.

It is replacing what the body used to make, that is, natural vaginal secretions according to hormones throughout the month.  Until the oestrogen drop off.

4 me it's been Trial and Error and I have found a level that keeps my vagina healthy. PHEW!

Sammiejane - don't panic.  Use the product if you want and maybe keep a note of symptoms B4 and as you go along.  Keeping the vagina healthy is imporant as symptoms mimic urine infection-type symptoms really, really well.  As I stated, some ladies have been unfortunate to have to undergo invasive surgical intervention because vaginal lips are 'fused' together due to lack of lubrication.  OUCH. 

Not that you are cynical Whatsupwiththis? 

[Emma]

I've had to remove a few heated posts from this thread.

I'll remind you of the registration agreement:

You are requested and required to keep your posts civil and in keeping with normal good manners. If a member proves to be intimidating, offensive or ill mannered, they may be required to be removed permanently from this forum.

Please be considerate of other people's sensitivities and needs when posting.

[Whatsupwiththis]

As cynical as they come.  I WANT MY VAGINA GONE!  Hasn't been used in years so....😧

[Hurdity]

Hi there - have managed to skim over most of this thread and agree with lots of what's been said on both "sides" but also disagree with some too!

***Long post alert ***

Bottom line is - yes there are guidelines and instructions which your local GP will most likely follow. However the doses may be varied after consultation with a specialist - the NICE Guidelines make provision for this. If your specialist has given you free rein to use as and when (over and above the maintenance dose) then that's great otherwise you take this responsibility yourself ( and I understand why!).

CLKD your suggestion to use as and when, is not how it should be used. There is a minimum dose below which symptoms may return so no-one should be advised to reduce (which they might do if symptoms appear to subsdie). Also using twice in one day 3 hours apart ("if symptoms niggle"). What is niggling? Are you looking for immediate symptom relief? If so this is not what estriol cream is designed for. It doesn't work immediately and if you experience instant relief then it is likely to be the moisturising effect so a vaginal moisturiser may be better in between the twice weekly dose?  Provided your doc has agreed that you can do a daily re-loading now and again - then that's great that it works for you!

Whatupwiththis  “Everyone should heed the warnings certainly but LISTEN TO YOUR BODY.  It will never let you down”.  In principle I totally agree with this sentiment! However when it comes to treatments – your body will not tell you about long term side effects or adverse outcomes so it is sensible to look at leaflets, read the research (as well as others' experience) and consult a specialist who knows your history so that the treatments can be varied sensibly!

Safety – what is it specifically that some members are worried about? The two main issues are potentially unopposed oestrogen and therefore endometrial thickening, and systemic absorption leading to the same risks as for systemic HRT.

Re vaginal oestrogens and effect on endometrium – there have been numerous studies which have concluded that the incidence and therefore risk of problematic endometrial  thickening is very small and therefore that progestogenic opposition is unnecessary. This only really applies to those who have a uterus and not taking other HRT. If you've had a hysterectomy or taking combined HRT – then you either don't need a progestogen so the risk is zero, or you are taking a progestogen as part of the combi HRT and provided you are taking a licensed (prog) dose the risk is even smaller!

If you are worried about systemic absorption – again the amount is so very small that experts have concluded that long term vaginal oestrogens can be used safely without even approaching the (small) risks associated with systemic HRT.

Sammiejane – you have no uterus so no worries on that score (re endometrium effects). You are already (happily?) taking oestrogen systemically as part of HRT and the amount that vaginal oestrogen contributes is very small – also it's a different oestrogen from HRT – estriol.

Nevertheless there have been no long term studies into the safety of long term use of vaginal oestrogen which the BMS Guidelines recognise and caution women (who have a uterus) to be vigilant and report any untoward bleeding  – but this applies to all of us anyway especially post-menopause.

Re the 25 mcg – I might post separately about this. To add to Tinkerbell's point – the main rationale was statistical significance of the efficacy (by certain objective measures) of 10 mcg Vagifem vs placebo (but 25 mcg was effective for more women than 10 mcg). The crucial flaw in this is looking at statistical significance for efficacy (compared with placebo) which can be achieved at quite low numbers with a large enough sample.  This means that in the group sampled there will be a possibly substantial minority who did not see improvement or not much anyway.  Therefore it was bound to happen that as soon as the dose was dropped there would be women who need more than 10 mcg....but annoyingly have now to go through their doc to vary from the low dose.

Re the using estriol cream on outer bits – personally  I use the generic estriol cream which is 0.01 % and therefore it can be used more freely than Ovestin because it is one tenth of the concentration whereas Ovestin is designed to be used in very small amounts. It therefore can give more of a moisturising effect without adding further estriol – if anyone wants to keep their oestrogen dose to a minimum.

A few random thoughts...! Sorry it's long!

Hurdity x

[Whatsupwiththis]

Great post Hurdity.  Well said.