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[Nix]

So, I’m taking HRT (had a hysterectomy/oophorectomy at 53, 1 year ago) and have been advised that symptoms should dictate the amount of oestrogen I need to take. My question is, if I’m suffering from vaginal dryness and soreness, and haven’t gone beyond the safe limit, would it not be wise to increase the dose of my oestrogen patch and see if that helps rather than using Vagifem or Ovestin?

[Dramy3]

Hey

I had a hysterectomy 5 years ago and developed terrible vaginal dryness and soreness and itch despite my systemic oestrogen being in the normal range (kept my ovaries). After researching, a lot of women seem to need localised oestrogen and systemic for VA trouble--this was my issue. However, others do fine on just localised or just systemic. Everyone is so different.

Personally, I'd try something like Vagifem before upping your HRT because that might throw other things off that are stable for you right now. Vagifem is easy to use and if your symptoms are mainly vaginal (not vulval), it's a good place to start. There's also estriol cream (formerly Ovestin) that I find works a bit better on vulval symptoms. Some women use both (me).

Good luck.

[CLKD]

Because vaginal atrophy is a separate issue so treatment can be along side replacement or used: as I do : to ease symptoms.  Get some appropriate VA treatment i.e. vagifem with estriol/ovestin.  The former is inserted into the vagina with the latter smeared around the labia/vulva.  Let us know how you get on, do read the 'bladder issues' and VA threads on the Forum. Make notes ;-)

[Nix]

Thank you both. I’ll stick with the Vagifem and Ovestin.

[CLKD]

Let us know how you get on, will U use for 2 weeks to plump up the vaginal tissues?

[bombsh3ll]

This is a matter of debate among experts.

Whilst it is absolutely ok to use vaginal estrogen alongside systemic, my personal view is that if someone has a healthy level of estrogen in their body, their vagina shouldn't be atrophying, unless there is another condition eg neuropathy or poor blood flow due to previous surgery, radiotherapy etc.

Studies were done in the 1990s on plasma estradiol and VA by Sarrell et al, which found it was much more prevalent below a threshold level of 50pg/ml, and less common as women got above this.

(Note US units used. UK measures in pmol/L)

I find it biologically implausible that my vagina would be uniquely withering whilst every other tissue in my body thrives, and the likelihood is if one organ is protesting, my bones, heart and blood vessels etc are probably not optimally estrogenised either.

Whilst I realise that some of the very small risks associated with systemic estrogen are avoided with vaginal therapy, I am also slightly uncomfortable with the practice of only treating, or only treating adequately, the part used to potentially have penetrative intercourse with men, rather than the woman as a whole.

My view on this may be coloured by personal experiences and I am in no way suggesting vaginal estrogen isn't an extremely valuable therapy or that anyone shouldn't use it.

At the very least though I believe the ongoing presence of VA despite systemic therapy should prompt a review of the dose/absorption, that way you can make an informed decision whether or not to increase, with or without vaginal estrogen.

[CLKD]

Which 'experts' ....... and how many of those have required HRT/VA treatments?

However bombsh3II: your other tissues are unlikely to be 'thriving', i.e. obvious chicken neck, bat wings because of the loss of oestrogen = lack of elasticity.  If you haven't any of these conditions then your vagina should be fine too.

Personally I have never required systemic HRT but need VA treatment due to urine infection-type symptoms when samples didn't grow any bugs = VA which my GP diagnosed during a phone call.  It is reported on the Forum that many need nightly VA treatments and others can keep the condition under control with regular applications but not systemic. 

[Ayesha]

Whilst I realise that some of the very small risks associated with systemic estrogen are avoided with vaginal therapy, I am also slightly uncomfortable with the practice of only treating, or only treating adequately, the part used to potentially have penetrative intercourse with men, rather than the woman as a whole.

I find this statement extraordinary. If you have a systemic HRT regime that is working perfectly to relieve the many other symptoms of the menopause then why gamble with possible side effects by increasing dosage.  HRT is a minefield, if you have found a regime that works then don’t mess with it.
GSM (Vaginal Atrophy) treatment can and is used in conjunction with systemic HRT to relieve symptoms and certainly not for the pleasure of men but for the woman alone to relieve the crippling symptoms caused by it.

[SundayGirl]

Whilst I realise that some of the very small risks associated with systemic estrogen are avoided with vaginal therapy, I am also slightly uncomfortable with the practice of only treating, or only treating adequately, the part used to potentially have penetrative intercourse with men, rather than the woman as a whole.

I find this statement extraordinary. If you have a systemic HRT regime that is working perfectly to relieve the many other symptoms of the menopause then why gamble with possible side effects by increasing dosage.  HRT is a minefield, if you have found a regime that works then don’t mess with it.
GSM (Vaginal Atrophy) treatment can and is used in conjunction with systemic HRT to relieve symptoms and certainly not for the pleasure of men but for the woman alone to relieve the crippling symptoms caused by it.

I totally agree Ayesha.
Below is a quote from Dr Currie expressing exactly the same from a previous thread (coincidentally in a reply to you Ayesha)

For vaginal and bladder symptoms, vaginal estrogen should be the focus as stated. There are a range of different types and it is usually possible to find one that suits, and it can take several months, as Ayesha explains, to have the full effect. Increasing patches at this stage is unlikely to help and is more likely to cause side effects.

I would rather take advice from Dr Currie who is an expert than some random person who likes to post things trying to make out that she's an expert in everything.

[CLKD]

There are no experts in any field anywhere in the World !  Too many thinking that they are 'experts' have made horrendous claims and mistakes that have affected people, even to those now dis-credited ideas related to HRT. 

It's about sharing experiences which others can take, ditch or store for later. 

[bombsh3ll]

Your other tissues are unlikely to be 'thriving', i.e. obvious chicken neck, bat wings because of the loss of oestrogen = lack of elasticity.  If you haven't any of these conditions then your vagina should be fine too.

For me there is a distinction between cosmetic issues and health/function of the body, and no amount of estrogen can rewind the clock or take the place of sunscreen, resistance training and adequate protein intake.

I am not saying vaginal estrogen is bad, just that it sometimes props up subtherapeutic doses of systemic therapy, causing people who could otherwise have reaped the full benefits of bone protection, heart health etc to miss out on these.

It is universally accepted that vaginal atrophy is caused by lack of estrogen. If you apply it topically and it has negligible absorption, you are still lacking estrogen, even if that specific symptom is controlled.

This is absolutely fine if the only objective of treatment is symptom control, which many, many people including clinicians believe should be the only reason hormone therapy is given.

[SundayGirl]

There are no experts in any field anywhere in the World !

I'm sure all the people that are still alive thanks to treatment provided by one of these experts would strongly disagree with this comment.

Too many thinking that they are 'experts' have made horrendous claims and mistakes that have affected people

I hope you're including random postings on the internet in that comment.

It's about sharing experiences which others can take, ditch or store for later.

Whilst I wholeheartedly agree that shared experiences are invaluable, one has to be careful when posting or reading posts on a forum. Not everything posted by total strangers can be taken as being accurate.

[SundayGirl]

For me there is a distinction between cosmetic issues and health/function of the body, and no amount of estrogen can rewind the clock or take the place of sunscreen, resistance training and adequate protein intake.

I am not saying vaginal estrogen is bad, just that it sometimes props up subtherapeutic doses of systemic therapy, causing people who could otherwise have reaped the full benefits of bone protection, heart health etc to miss out on these.

It is universally accepted that vaginal atrophy is caused by lack of estrogen. If you apply it topically and it has negligible absorption, you are still lacking estrogen, even if that specific symptom is controlled.

This is absolutely fine if the only objective of treatment is symptom control, which many, many people including clinicians believe should be the only reason hormone therapy is given.

So someone who has no symptoms of anything whatsoever should go to their GP and demand treatment, or replacement, for something that may or may not happen at some random unspecified date in the future??
 

[Ayesha]

I agree SundayGirl, where would we be if it was not for the medical professionals, ‘experts’ in their field who study for many years, as in my son’s case and to then be told your advice is worthless, your years of study means nothing.
They say you shouldn’t Google your symptoms, some of the comments seen on this forum would confirm this.
Thank you for speaking out!   

[Mary G]

HRT is very emotive isn't it?  I've been a member of MM for years and I've noticed HRT can be divisive which I find strange.  Personally, I think it makes sense to use HRT but nobody is forced to and if women are genuinely happy with their non HRT choice, I'm not sure why debate becomes so heated.

I originally started using HRT for early menopause symptoms but I also take it as a precaution against some of the later post menopause symptoms like bone issues, bladder issues etc.

When people say they don't need HRT how do they know?  You may think you have escaped the worst of it by not having early symptoms like hot flushes but remember the menopause comes in two halves and you won't know if the later, postmenopause symptoms will surface for years so why take the risk?  Fear perhaps?  Not being able to face it for some reason?

My partner's grandmother told me how she "sailed through" the menopause and then went on to tell me about a whole host of other conditions she developed in later life that were clearly causing by oestrogen deficiency.  The point is, she didn't associate them with the menopause.