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[Bluedonkey]

Hello there

I am 46 and in peri. I have been on HRT about 12mths. Low dose patch and progesterone for 2wks every cycle.

I have been experiencing what my wonderful GP thinks is VA/GSM (if that's the correct new acronym!) - burning, a wee bit itchy, swollen feeling. Thought was thrush but swab came back negative. Also feel like need to wee a lot - clean urine sample.

She has prescribed estradiol - 1 pessary a night for a fortnight, then twice a week.

My concern is - and I intend to go back to check with her - that very sadly I lost my mum to endometrial cancer in September last year. We had no idea - it was 6wks from diagnosis to losing her. The trauma of that experience has deepened my existing tendency to struggle with health anxiety.

The pharmacist mentioned that this med increases risk of endometrial cancer and stroke - Mum had a stroke in the weeks leading up to her diagnosis we learned being caused by the cancer. I also have fibroids - the pharmacist also said that this made it riskier!

So - experienced wise women - what do you think? Any advice?

I am terrified of doing anything that will cause long-term health issues of course, but also am still completely "on edge" after losing Mum and so the slightest irritation/bleed is going to send me flying off into all directions.

I'd also be very keen to hear other experience of women still having periods who use this - does it trigger bleeding or skin tenderness/irritation? Is there another option...

Thanks so much in advance and apologies if any of the above has triggered anyone.

[buffy26]

Bluedonkey,

I am sorry for your loss and how very hard for you to navigate your own health now. My heart goes out to you. I had been nervous about HRT as I had endometriosis and I clung on to using natural supplements up until 58 then I was feeling so unwell with such low estrogen levels I went to see a very experienced specialist who lectures at the British Menopause Society. She said my quality of life was important and also the protective benefits of having back estrogen is very important. I cannot speak for your personal health but could be worth looking into speaking with someone who has menopause as their specialism? I think it is £80 for a video consult
Feel free to DM me and I will gladly pass on her information if you. I hope you find the help you need.
PS/ the pessaries are an absolute godsend for the urinary tract issues. I cannot be without them

[CLKD]

VA treatment is safe as it's a very small amount of active ingredient which is unlikely to travel through the body elsewhere.

Many require treatment every night, twice a week simply isn't enough 2 keep symptoms at bay. 

[SundayGirl]

Firstly, I am so very sorry for the loss of your Mum.


The Pharmacist you spoke to needs a slap for making you worried unnecessarily!!!

Also a hell of a lot of retraining and a refresher course on his people skills. 

Please ignore everything that he/she said to you and start the pessaries as soon as possible. Many ladies on here use vaginal pessaries and creams daily without issue. It an extremely safe way of using oestrogen.

It understandable that you're still feeling fragile but please don't worry about using something that's so safe it can now be bought over the counter without a prescription.

[Terri123]

If there is a family history of hormone driven cancer I think you should speak again to the prescriber in order to make a fully informed decision about the best treatment for you.
Well done to the pharmacist for making you aware of this important bit of information.  Random people on Internet forums such as this one are not necessarily qualified to comment on what is and isn't "safe" as regards contraindications for various medications.

[bombsh3ll]

I'm sorry for the loss of your mum, and I can understand you wanting to protect yourself from the same condition.

But that pharmacist is in dire need of some education because you would have to take about a hundred 10mcg estradiol pessaries by mouth, every day, for over a year, and no progesterone, to even begin to increase your risk of endometrial cancer.

There is no clinically significant systemic absorption of topical vaginal estrogen, and in any case you are on progesterone anyway.

If you remain worried and want the best option to minimise endometrial risk going forward, I would consider a mirena IUS as your progestogen.

This will enable you to take a therapeutic dose of estrogen with no concerns.

[Ayesha]

It's all down to that damn out of date leaflet in the box of pessaries. I got cornered in a pharmacy and told something similar about my use of topical oestrogen, it ended with me giving him a lecture on the latest recommendations which are the same as my surgery. He agreed to never question another woman on her use of the treatment again as we are all very individual in our needs with treating this condition.

This link will help to reassure you on the use of topical oestrogen.

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

[Bluedonkey]

Thank you all for your kind words and feedback, it is much appreciated

I will give it a try and fx for rapid results - the burning and stinging is getting me down.

Anyone able to share any side effects e.g. burning pain, bleeding? I am on a knife-edge at the moment and the slightest thing makes me panic. Am on Sertaline for anxiety and so doing all I can but know that sometimes changing HRT can trigger bleeds etc - just not sure if that is more/less likely when still having periods.

Thanks in advance

[bombsh3ll]

Vaginal estrogen shouldn't trigger any bleeding that wouldn't have happened anyway.

Systemic hormone therapy can lead to more erratic bleeding, particularly in perimenopause.

There are multiple bleed free treatment options that you could discuss with your GP if you prefer.