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[fiftyplus]

Glad you are sorted Ayesha 

I am following with interest as I will be having an assertive and knowledgeable conversation with my GP at some point as she is another GP who doesn't understand that I need both ...

BIG Thanks to Jules, deirdrie & clkd and anyone else I have missed for sharing your experiences as hopefully I shall avoid the shrinkage and wasting away part as I have started early enough and I will advise my GP of this after  learning from you lovely ladies - and she should be a bit more educated by the time I leave, in fact she will be ... just a pity we have to really help ourselves when it is actually them we go to hoping for help with whatever issues we have x

[Jules]

Are we in the minority here, the women who reach out to forums looking for answers. I am still mindful of my new GP who said it is rare to need both treatments, Estriol & Vagifem, if that's in his experience I have to respect that, with my previous GP being a gynae, it made life so easy with no issues to prescribing both to be used daily.  Will say though, once I explained fully in a calm manner exactly how I use the Estriol there was no problem with me getting the prescription, perhaps a different story if I was on any other form of HRT, it might have been more difficult to obtain.
This is a condition that we ourselves have to be in control of because there is so little known about it, and it doesn't help that the leaflet attached is out of date which doesn't help our cause at all!

My advice from now on once you get your VA regime under way, don't mess around with it. Yesterday I had to apply three doses of Estriol to get my symptoms  back under control which is much better today thankfully.

Maybe we are rare, I don't know anyone at all personally, other than this forum, that suffers with atrophy.

I do, they don't use forums though. And there are surely others who suffer in silence not wanting to say

[Dierdre]

Maybe there's a lot of women on systemic HRT from an early age now so atrophy never becomes a problem.

[fiftyplus]

Yes, maybe deirdrie - all my younger friends who are peri are on hrt now.  Whereas in my day (haha) my gp wouldn't even discuss until meno (1 year without a period) and then still fobbed me off with nothing ...

[Dierdre]

It will probably protect them now but if they come off it post menopause when their symptoms may reduce that could be a problem and some still need local estrogen even with systemic. I never needed HRT during peri, one of the lucky ones, not so lucky post meno with atrophy.
I wish they would do more research why some women get this and others don't, why some sail through menopause and others suffer so badly. I know we're all different but what is the difference in this case?
I know the adrenal glands have something to do with it as they take over after the ovaries stop producing estrogen. Maybe we should be targeting and stimulating these glands.  I'll perhaps start a thread on this or check there's one already.

[Jules]

My younger friend is on systemic hrt and that didn't stop the VA, she's having to treat all that separately.  I would imagine more women than you think have it, they just won't talk about it.

[MrsMitch]

This is a condition that we ourselves have to be in control of because there is so little known about it, and it doesn't help that the leaflet attached is out of date which doesn't help our cause at all!

Below is a quote from GSM BSSM which is guidance for all the issues & treatment for what they are now calling Genitourinary Syndrome during Menopause (formerly VA) it's co written by Dr Louise Newson. GPs need to read it and as I hope to move in the future which will mean a GP, I will have no qualms about giving a new GP the link to the PDF paper so they are well informed about the condition.  It is now recognised that the info in with the medication is outdated. My meno specialist even told me to ignore the leaflet info. It really seems we have to educate ourselves and then educate the medical professionals we see.

"Women should also be advised that the information packaged with vaginal hormone preparations is out of date and
factually incorrect. This needs to be changed by the MHRA."

[Ayesha]

How did VA treatment ever get to the stage that it became available to buy over the counter, albeit for the over 50's, or if you lie, online. Someone knew but forgot to tell us!
I remember reading research papers with conclusions of 'surgeries should be prepared as more women come forward. But then also reading papers with surveys saying too many women will not come forward and giving the reason why, too embarrassed, my business, its private.

The whole subject is bewildering as to why some women have to fight for the treatment and some don't but its a condition that can't be lived with once at the chronic stage.

[Ayesha]

This is a condition that we ourselves have to be in control of because there is so little known about it, and it doesn't help that the leaflet attached is out of date which doesn't help our cause at all!

Below is a quote from GSM BSSM which is guidance for all the issues & treatment for what they are now calling Genitourinary Syndrome during Menopause (formerly VA) it's co written by Dr Louise Newson. GPs need to read it and as I hope to move in the future which will mean a GP, I will have no qualms about giving a new GP the link to the PDF paper so they are well informed about the condition.  It is now recognised that the info in with the medication is outdated. My meno specialist even told me to ignore the leaflet info. It really seems we have to educate ourselves and then educate the medical professionals we see.

"Women should also be advised that the information packaged with vaginal hormone preparations is out of date and
factually incorrect. This needs to be changed by the MHRA."

Thanks for this updated view on VA, I will be making a note of the correct terminology for future reference.

[SaraUK]

It will probably protect them now but if they come off it post menopause when their symptoms may reduce that could be a problem and some still need local estrogen even with systemic. I never needed HRT during peri, one of the lucky ones, not so lucky post meno with atrophy.
I wish they would do more research why some women get this and others don't, why some sail through menopause and others suffer so badly. I know we're all different but what is the difference in this case?
I know the adrenal glands have something to do with it as they take over after the ovaries stop producing estrogen. Maybe we should be targeting and stimulating these glands.  I'll perhaps start a thread on this or check there's one already.

I’d love to know this too.

I learned something like cholesterol makes pregnolenone, which makes dhea, which then makes estrogen, progesterone and testosterone.

But cortisol caused by stress uses up pregnolenone (called cortisol steal) which causes sex hormones to dip. No wonder we go worse when stressed.

 So I read some women are on pregnolenone as an hrt alternative but under supervision of a functional medicine practitioner. Their approach is to provide the body with the “grand mother” hormone to help the body make the sex hormones it needs, instead of simply adding estrogen because there are certain metabolites that estrogen alone can cause.

Something like that anyway. I may be wrong with the details.

[Dierdre]

It all sounds very complex, no wonder so much can go wrong and definately when stress is involved. I was told to reduce my cholesterol which then had a knock on effect on my hormones and worsened my atrophy. It doesn't take much to upset the balance but takes an awful lot of time to put right.

[AngelaH]

I was told to reduce my cholesterol which then had a knock on effect on my hormones

It means to reduce bad cholesterol, but you can eat plenty of good cholesterol. Anyway your liver makes all the cholesterol your body needs, so no way reducing bad cholesterol in your diet will have an effect on your hormones.

Menopause is still not properly studied subject, that contains more questions than answers.

[Dierdre]

It was the treatment that messed up my atrophy. I was taking plant sterols which did reduce my cholesterol but also reduced my estrogen by attaching to receptors and mimicking estrogen.so blocking the real thing. 

[AngelaH]

It was the treatment that messed up my atrophy. I was taking plant sterols which did reduce my cholesterol but also reduced my estrogen by attaching to receptors and mimicking estrogen.so blocking the real thing.

OK, sorry, I misunderstood.

When we are young, we have normal level of total cholesterol, because estrogen keeps it under control. In menopause, when estrogen falls down, cholesterol rises. But I can’t see how good cholesterol can be related to estrogen receptors. In fact my good cholesterol level is higher, than normal, mainly because I like nuts and seeds and other foods, which is rich in good cholesterol. The same time I have very high level of sensitivity to sex hormones. High level of good cholesterol doesn’t block my receptors at all, I also used to be estrogen dominant, and  suffered from severe symptoms of too much estrogen.

[Dierdre]

It was the plant sterols blocking the receptors not the cholesterol. I couldn't understand why my atrophy had come back with a vengence after taking the plant sterols for months.  A few others on the forum had the same problem after trying to reduce cholesterol with Benecol, i researched it, the doctor told me to stop taking it and it eventially improved. We had a thread about it. Maybe lowering my cholesterol didn't help then either, it's probably gone back up now lol.