"Hi, I’ve been on vagirux since a year ago using every other day (4-5 times per week). Daily since end of November for 3.5 months. I’ve used ovestin daily for 3 months too.
Blood test January, estradiol of 159. I asked to increase to more pumps than 3 and was told that I’d have to double up my utrogestan (progesterone intolerant so impossible). Mirena not an option as it’s right near bladder and can cause bladder issues. Utrogestan vaginally, again no, same problem."
This is so silly of your doctor. With estradiol of 159, you are very very low. You need a minimum of 250 for bone health and all the protective effects of HRT. So you are basically not on any HRT at the moment, as far as what your body is aware of.... It might not fix your vaginal symptoms - but it might(!) - and anyway, it's going to protect your bones, heart, brain etc etc.
I think your best bet is to see a private menopause clinic really. They will be prepared to allow you to remain on the same utrogestan because your serum estradiol is only 159, so you really don't need more. (NHS GPs look at dosage and not at what you are actually absorbing because they are a bit "Computer Says No" and don't really understand things well enough to make subtle complex decisions.) You can also be monitored in terms of an ultrasound just to check your lining isn't building up so you don't need more progesterone than you really really need, for that purpose. (By the way, your lining of 2.3mm is not thick at all.)
Another idea is to use a combined patch with a synthetic progestin in it, which isn't going to need to go up your vagina obviously. Again, NHS GPs won't like increasing your E above the 50 in that combined patch but a private clinic will be prepared to give you top up E patches or gel - perhaps again whilst monitoring with ultrasound occasionally.
And then there are other ideas like using desogestrel at double the POP dosage or using norethisterone, again at a higher than POP dosage - again, all things either a specialist NHS menopause clinic or private clinic will offer. There are many 'thinking outside the box' solutions but your regular NHS GP isn't going to know about them.
Getting systemic estrogen does help GSM symptoms in the vagina for sure. I don't need local estrogen anymore, since getting my systemic over about 350pmol (which isn't high). And as I said, all this will offer protective benefits for the future. You for sure don't have 'high' estrogen if these are your levels. And whilst your own ovaries can contribute more, they can't take away from what you are getting from HRT.
