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[Angie71]

Hello,

I’m 51 and using Oestrogel and daily Utrogestan for HRT (3 years now). No periods for about two years.

I have been suffering from intense itching in the labia and groin area for about 6 months now. No discharge at all but thought it may be thrush and have done several treatments. Had some Dermovate from a skin condition son had so slapped that on for a few weeks, also used coconut oil, sudacrem and germalene due to bleeding when I can’t stop scratching! Doublebase as well.

I have actually ripped loads of underwear in that area during the night due to scratching in my sleep!

Done the usual washing with Femfresh and soaking in salt baths but nothing has helped . I started thinking it might be VA as also feels a bit tight and dry internally as well and have to use lubricant during sex.

Finally went to GP 2 months ago and on examination she said there was clearly atrophy, no sign of lichen sclerosus but said it was dermatitis and prescribed Eumovate.

I did try to argue a bit as had gone in to ask for Ovestin or similar and asked if I could just try it but she said she follow up in two weeks and review after I’d used the Eumovate.

She was then off sick so my follow up appointment was cancelled. She’s the only female GP at my practice and I was put to see a male locum.

The Eumovate gave slight relief but I was still having daily episodes of itching. He  wanted to examine me again but I refused as didn’t think it was necessary and said as the previous examination showed atrophy could I just try the topical cream.

Again told no, atrophy was not noted in my notes (quite annoyed about this as GP said it),  I needed another examination and he’d make an appointment for me to see the female GP again. Appointment was not made and I was later told I had to ring in for one on the day. Female GP only in two days a week so I tried for a month and kept being told appointments were gone.

I was finally given a telephone appointment with a nurse who said I needed a face to face appointment so had to wait again. While on the phone I asked again could I just try the topical cream and she asked if I was trained medically!

At this appointment, I had another examination, she said there was atrophy but it might be lichen sclerosus starting up and not showing yet so she’d do an urgent referral to a gynaecologist. I reminded her that I’d had itching for 6 months so surely it would be evident by now.

Again refused to prescribe cream to try it in the meantime and actually said it was dangerous to use it while I was on Oestrogel as opposed to HRT patches or pills. Apparently she’s also checked with the lead GP who said it wasn’t safe. I was pretty sure that was nonsense and said so! I saw in my notes afterwards that the atrophy was again not noted and she actually put that the lead GP had said it wasn’t safe to use a topical HRT cream while on HRT gel. No lesions were noted but there are areas of thickened skin in the areas that are most itchy (outer labia) and groin.


Could this be due to long term scratching in that area? Very surprised that if they thought it might be lichen sclerosus (which I thought a GP or nurse could diagnose), why not give me the cream to treat it rather than leave me with nothing.

I was told I could use Vaseline in the meantime.

The nurse did agree that the Eumovate could have made the atrophy worse though.

I am a little confused and concerned about the emergency gynaecologist referral. Is that normal for lichen sclerosus? Waiting time seems to be around 18-20 weeks in which time it would surely get worse!

Any ideas on what is going on?

[Dotty]

https://www.balance-menopause.com/menopause-library/vaginal-estrogens-what-is-ovestin-and-how-do-i-use-it/

This article explains that you can use both.

[Dotty]

https://www.nice.org.uk/guidance/ng23/resources/menopause-diagnosis-and-management-pdf-1837330217413

And it’s in the NICE guidelines … 1.4.9.

[Jules]

Annie I just read your post and had to say. It's appalling what you've had to go through.  That's not a health service it's a health risk. Why are we having to struggle and argue, jump through hoops and provide our own evidence in a developed country. I'd change my GP surgery if I were you though one seems as bad as another these days.

[Hurdity]

Hi Angie

So sorry to hear about this ignorant treatment on the part of your GP and practice generally.

I don't know anything about lichen sclerosis but obviously best go to the referral - but in the meantime, if you feel up to it, can you go back again to your GP and refer to the NICE Guidelines?

Also there is a more detailed consensus statement by the British Menopause Society which says in the Introduction:

 "Women using systemic HRT may still
experience symptoms of urogenital atrophy and can use vaginally delivered estrogen in
addition to systemic HRT."

It can be downloaded from here:
https://thebms.org.uk/publications/consensus-statements/urogenital-atrophy/

You could also pay for an e-mail consultation question with Dr Heather Currie - the founder of this website - costs £30, and which you could print off and take to your visit - if your practice is being sniffy about your knowledge (that is appalling - ie asking if you are trained medically, as if your view is not valid unless you are!).
https://www.menopausematters.co.uk/contact.php

It is appalling that you are having to push for this and I wish you all the best in your quest to be prescribed what is your right (provided lichen sclerosis etc has been ruled out?)

Hurdity x

[CLKD]

This is appalling and needs reporting this GP and Surgery to Dr Currie and the British Medical Society if in the UK. 

U can buy 'gina' over the counter but there are regulations around that too.  Many GPs/Medics seem to be worried that women can over dose on oestrogen! when it's a natural hormone that we carry all our lives.   Many don't like 'being told' by their patients so will dig their heels in! 

Is there another surgery that yo could register with?  I would be ringing tomorrow asking for a referral to a dedicated menopause clinic both NHS and private have waiting lists so sooner rather than later.  1 can always cancel the appt if no longer required. 

We should not be taking information which GPs should already be aware of, however:  I would also contact the Practice Manager with copies of the suggested Links.

Let us know how you get on.  I didn't expect to still be reading these types of problems this far down the line, whilst trainees don't get much menopause teaching there's no reason for them not to read up on products of which they have no knowledge!   I am raging! 

[Ayesha]

I can't add much more than the excellent advice from Hurdity and the links from Dotty. Please educate yourself here, knowledge is power and go in fully armed with information.

All I will say is, please don't scratch anymore, its making the whole area look a lot worse than it necessarily is and making the GP's think there is more going on here. You will get the VA treatment eventually and please let us know how you get on.

[sheila99]

I'd suggest buying Gina while you're waiting, at least that way you might feel more comfortable. Have youbbeen tested for thrush? There's a strain of it that's resistant to the normal treatment (there's a post by someone who had it).

[joziel]

Angie, I'm really sorry you've been treated like this. Can you change GP practice?

I was on Oestrogel, Ovestin (estriol cream) AND Vagifem (vaginal estrogen) - all at once. And every day, all of it. Ovestin, twice a day. Vagifem every night. You should use local estrogen liberally and as much as you need it. Like Sheila says you can now purchase Gina over the counter without a prescription from a pharmacy (or online if you look at online pharmacies).

IMO the referral is ridiculous - use local estrogen and see if your symptoms resolve. If they do, great. If they don't, then get a referral. But getting one now is silly. Honestly, the NHS is drowning with stuff they really need to do and doctors making silly referrals like this and creating anxiety just are not helping.

By the way, if you have any other systemic symptoms, you might want to try increasing your Oestrogel dose as well. Because when that dose is high enough, it often means you don't need local estrogen. (I am on 10 pumps of gel now and I no longer need either Ovestin or Vagifem.)

[CLKD]

If the GP won't prescribe, where does the poster go ......... the issue being that the GP think's oestrogen cream isn't safe  . 

[RebJT]

Hiya

You can buy Ovestin from Superdrug online pharmacy, just fill in a form, their doc checks it and prescribes, dead cheap and quick and really fast delivery.

Your doctor is an idiot, and more to the point cruel and incompetent.

Can you afford to go private?  Nick Pannay's clinic in London - hormone health - is great and they do zoom.  Some really nice lady gynaes too.

Reb
x

[fiftyplus]

I am really sorry you have been treated like this.  Honestly, what do they get paid for?  not for doing a good job anyhow

[MrsMitch]

Hi Angie, I'm so sorry you're being treated this way. I had vaginally atrophy for 12 years and was diagnosed with everything else but that even by specialists. I joined this forum, read about the symptoms of VA and told my GP that is what I have. I was examined and told there was little sign if it in spite of 12 years of agony. Cutting a long story short, I was given estradiol x2 per week but it wasn't enough and I had to send my GP the email from Dr Heather Currie to get her to prescribe it x7 per week. Most of my symptoms are nicely subsiding now. So you really do need them in a high dose if need be. I would second the comment about emailing Dr Currie, its really worth it because your GP has to follow her advice. 
I was also diagnosed with Lichen Sclerosis ( without biopsy) at one point but the treatment I was given was useless because I actually had VA.
I'm afraid,  as you are learning,  we have to really push and insist with our GPs to get the medication we need.
Coconut oil is very good for both a lubricant and to stop the itching, at least it is for me. I do hope you get some positive help soon.

[MrsMitch]

Also I forgot to add that I'm not sure vaseline is a good idea because it is a bi- product of the petroleum industry. So as above, coconut oil is a good alternative.

[CLKD]

I would think that Vaseline is drying  better to get KY Jelly or change surgeries.