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[joziel]

But presumably you were originally on the higher loading dose of vag E? In which case, you need to increase the dose back again. Many women need to stay on it daily. It is a tiny amount.

If your doctor doesn't support that, then find a new doctor. But you can also buy it without a prescription - it's called "Gina". You can get it from the pharmacy or online. However you shouldn't have to pay for meds like that, you should be getting them on the NHS - but if you get temporarily stuck between GPs.....

[Anabelle31]

But presumably you were originally on the higher loading dose of vag E? In which case, you need to increase the dose back again. Many women need to stay on it daily. It is a tiny amount.

If your doctor doesn't support that, then find a new doctor. But you can also buy it without a prescription - it's called "Gina". You can get it from the pharmacy or online. However you shouldn't have to pay for meds like that, you should be getting them on the NHS - but if you get temporarily stuck between GPs.....

I was on a two week loading dose (which I continued for another week). Doc said 2x a week after that but I stayed at 3x a week. Am reloading now. She didn’t say it could flare up again, I thought if I took the pessaries I’d be fixed! Also I’m 41, not sure I can get Gina until I’m 50 without prescription. Thanks for replying. It means a lot.

[joziel]

Yes, you're right about Gina there. Although you could tell a porkie...

You'll need to take the pessaries forevermore at whatever dose works for you. Unless you start an adequate and high enough dose of systemic estrogen and then don't need the local anymore (this is what happened to me).

Look up Dr Felice Gersh on YouTube and there's a podcast called Hack my Age which interviewed her very recently. Her position on local estrogen is that if you are taking 'enough' for all your body parts, your vagina will also have enough(!) and if your vag doesn't have enough, it's likely your brain/heart etc etc also won't....

[Ayesha]

Buy Estriol online if you can, it will supplement the measly dose of Vagifem you are allowed, smear some on the outside.
Also are you using a moisturiser, the oestrogen treatments are of a very dry consistency, the moisturiser will help with lubrication.

I am very, very much older than you. My regime is Vagifem daily, Estriol smeared on the outside twice a day and I wouldn't be without a moisturiser for lubrication. I am not on systemic HRT and as much as these so called experts say, I am extremely healthy for my age with my heart and brain very firmly intact, probably down to my life long healthy lifestyle, which is very important as we age.

[CLKD]

GPs still don't get it!  The leaflet in the box is incorrect.  To keep symptoms under control many require VA treatment nightly. 

[Patchsmama]

So interesting and helpful reading this thread. Thanks to everyone for all your comments. I sometimes wonder how I survive without the helpful people on this forum.

I had a flare up on GSM starting three weeks ago, as always urinary frequency and burning down below. I’ve been on Vagifem twice weekly and a tiny smear of Ovestin externally, no other HRT since a surgical menopause 10 years ago.

When this happens I feel clueless and, again, GPs are absolutely useless.  Last year when this happened, they just kept sending MSUs which were always negative. My own GP said he was at his wit’s end with me!  So I felt I was a nuisance and abnormal too!! 

I’ve continued with the Vagifem twice a week (I’ve requested a repeat prescription to increase the dose but it seems to have been ignored) and I’m wondering what to do regarding the Ovestin, which I’m using between every other day and 2-3 times per week .  I’m using Epaderm 2-3 times a day which I’m finding makes me more comfortable than the Yes OB which seemed to irritate but I’m also wondering whether the barrier cream is not helping absorption of the Ovestin. I try to rinse off the Epaderm in the shower before applying the Epaderm.

Hope all of this makes sense. Thank you so much.

[SundayGirl]

If I were in your position, I'd use an applicator full of Ovestin a couple of times in-between the Vagifem doses. If you increase your use of local oestrogen and feel better, go back to your GP and tell them how you now feel.

To steal a link from Ayesha (Thanks Ayesha)

https://bssm.org.uk/wp-content/uploads/2023/02/GSM-BSSM.pdf

Print off and show to your GP, especially the bit in the Management section that states you can use Vagifem/Ovestin more than twice per week.

[CLKD]

GPs need    Is there a Nurse Practitioner at your Practice who has more knowledge than the GP seems to have?  Get a copy of Me and my Menopausal Vagina, read then pass to the Nurses at the Surgery.  ;-)

Get Vagifem up there for the next 3 nights with 'ovestin' each morning and evening in the applicator to the red line.  Then ovestin/estriol every night for at least 2 weeks.  Make the appt with the Nurse for next week - I can get an appt with 1 within 24 hours and can see my GP in about 3 weeks.

Let us know how you get on.  When symptoms niggle I swallow Nurofen 3 times a day for 2 days to ease the nip as the urine flow shuts off. 

[Patchsmama]

Thank you SundayGirl and CLKD. That’s all really helpful. There is only one nurse practitioner at our surgery and I wouldn’t say she’s much better than the GPs.  It’s a 3 week wait for any of them. Sadly all of the good GPS retired last year.

I’ll increase the Ovestin and see what happens from there

[CLKD]

We can't overdose which is what many medics still worry about  .  If symptoms easy you can alter the regime to suit.

[Ayesha]

There's no need to feel clueless, the only way to treat a flare up is to increase the dose of oestrogen until you start to feel better again, its really as simple as that. Your surgery is making it all so ridiculously complicated.

[MrsMitch]

the only way to treat a flare up is to increase the dose of oestrogen until you start to feel better again

But what if you are experiencing a horrendous flare up and using estradiol nightly and ovestin twice daily? That's my current position and I have no idea what more I can do.

[Ayesha]

I recently had a severe flare up after the Covid vaccine, it took me right back to the beginning when my symptoms were chronic.
I am already on daily treatment but I increased my dose to two Vagifem daily and a good smear of Estriol cream three times a day. The increased Vagifem I used for a few days but kept with the three times daily of Estriol until the symptoms eased, it took about two weeks to be symptom free. 
It’s the reason I like to keep a back up supply in cases like this and it’s the first time in four years I have experienced such a bad flare as normally I am symptom free on my usual daily regime.

[MrsMitch]

That's interesting Ayesha, I used estradiol x2 per day for about 2 weeks prior to having a TVS last year and it was tolerable.  I was wondering if it was OK to use that amount but thought what the heck!
My GP called last week as my smear is overdue and I told her no way would I have it. She then went back over my notes from.the gynae from a few years back and said she thinks maybe I do have vulvodynia, which was in my opinion incorrectly diagnosed, too.
So I'm seeing her next week and she want to use local anaesthetic to examine me and do the smear if possible. I'm dreading it.
I may go and buy some Gina because I won't have enough and I imagine not even a meno specialist would prescribe estradiol x2 per day. Or are you able to get that dose?

[Ayesha]

I think a meno specialist would but only for the short term until symptoms eased.
I have never asked a GP if I can increase my dose and to be honest I don't want to because I feel they don't know enough as it stands now. I really prefer to be in charge of my own treatment because I know its safe to do so. Topical oestrogens are low dose but I would only want to do this in the short term, I would hate it if I had to continually increase dosage too many times.