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[Cab6]

Hi, I'm using estriol cream for VA pain, nurse at GP surgery told me to use every night for 2 weeks and then use twice a week, when I try to reduce the usage the pain comes back. Tried Replens but doesn't really help with the pain very much. I'll try to get another GP appointment but could be a while. Has anyone had similar symptoms or can recommend a better moisturiser in the meantime?

[Ayesha]

Posts like yours make me really angry, the nurse is totally out of date with her instructions on the use of topical treatment for GSM (VA)
Moisturisers won't help relieve the symptoms, they just help to lubricate.

Please read below the latest information from the GSSM position statement.

"Women should also be advised that the information packaged with vaginal hormone preparations is out of date and factually incorrect.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.
The dose of vaginal oestrogen is very low, for example, using 10mcg oestrogen pessaries regularly for one year is an equivalent dose to just one 1mg of oestradiol HRT tablet.
If symptoms do not improve with vaginal oestrogen, consider increasing the dose, changing preparation (and consider DHEA) or using an additional treatment such as systemic HRT or two local treatments.
The frequency of using these preparations can be increased in women who have persistent symptoms as the doses of these preparations are very low.
Vaginal oestrogens can often improve urinary symptoms, including urinary infections.
Some women use vaginal oestrogen preparations more frequently than the recommended dose to improve symptoms sufficiently, for example Vagifem alternate days instead of twice a week. It is safe to use the treatment in this way as the dose is very low.
Women should be reassured that it is safe for topical oestrogen to continue in the long term (medication should be on a repeat prescription). Women should continue to be reassured about the long- term safety of vaginal oestrogen preparations."

[CLKD]

There should be less info in the leaflet in the box so that medics don't think that women might need to use every night.  Dr Newson is trying to get the leaflets up-dated.

Use as necessary, 1 cannot over dose on oestrogen. 

Replens may make the problem worse. 

Some use 'vagifem' internally with a little 'yes' or 'sylc' or 'estriol' on the outer areas to keep them soft and less itchy

I have ovestin/estriol internally twice a week.  When symptoms niggle I up to every night for a week.  When I feel the need2P symptoms I swallow two 'nurofen' 3 times a day, to ease the nip as the urine flow shuts off.  This helps for 24 hours with the extra VA treatment. 

There is a very good book Me and My Menopausal Vagina - written by a member of the Forum several years ago.  Worth a read, then pass to the Nurse Practitioner and any1 else that will benefit from up2date info. ;-)

[Cab6]

Thank you both for replies, the information you've given is really helpful

[CLKD]

Let us know how you get on.

[rferdi]

I was diagnosed with the beginning of VA a few months ago, I'm still in perimenopause. The doctor told me to first try some vaginal moisturizers and if after a couple of months things didn't improve I could try Blissel (an estriol vaginal gel) once a week for a couple of months only.

I knew this wasn't right, and then I went to a different gynaecologist who directly prescribed the estriol gel to be used 3 nights a week indefinitely, she said this is so the VA can be restored and to avoid further damage. So far I've been feeling lots of improvement, I don't know if the atrophy that was already present can be fully healed or not, but all the VA symptoms I had have almost completely vanished.

[CLKD]

And rferdi - U can use every night 4 ever if required and VA doesn't resolve without replacing the loss of oestrogen.  The sore/thin tissues will be plumped up with regular treatment = less symptoms.

[rferdi]

Thank you CLKD, I'll definitely increase frequency of use if/when symptoms reappear or there's a new one. I suppose as I progress into post menopause I'll notice some changes, since estradiol levels will really start to plummet then. I started HRT recently so I hope they don't drop as much as they would without it.