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[bombsh3ll]

The NHS will invariably try to covertly shrink your dose any time you switch between products, so it is a good idea to know roughly what strength patch corresponds to what dose of gel etc, both according to commonly used conversion charts but also for you as an individual, as we don't all absorb or metabolise estrogen equally.

[Minusminnie]

If it's the outside that's the problem you might use estriol 0.1%cream on the outside as well as vagifem. Vagifem does nothing for me outside (v. painful urethra).

Sorry to read in your recent posts that you are now in the burning club that noone really wants to join.

Did this start happening to you with having to use Estraderm rather than Estradot because of the shortage ?  I have this homespun theory that changing HRT lets the VA start up. 
I have never been on systemic myself my VA came about with age and lack of oestrogen.
Don't reply if you don't wish to.

Feel all round that VA/GSM needs more research .....

I had it mildly before but it got very much with the change to estraderm along with other meno symptoms returning. I don't think I absorb very much from estraderm but even 100mcg estradot isn't enough now to control either va or meno symptoms. Having resorted to 2x100mcg estraderm patches (still not enough) I'm now using 2xestradot and finally I can walk without wetting myself.  I have an appointment with Newson soon as the only option for a decent quality of life seems to be going private. The NHS meno clinic thought they'd replace 100 patch with 2 pumps lenzetto 

 

[Minusminnie]

The NHS will invariably try to covertly shrink your dose any time you switch between products,

Seriously to what aim ? cost ?

[JanS]

As I’ve said on other posts I have the same problem sore on the outside and not being able to pee properly this has been going on for over two weeks now I am now going to use Imvaggis every other night because I’m absolutely sure it’s a lack of oestrogen going to monitor it for the next two or three days and if there is no improvement, I’ll be going back to the doctors and I’ll be asking if they can prescribe me estriol cream as well for the outer.  I too have been going through tubes of Yes.  I did use estriol 1.00 cream but it has been stored at over 25c and in all honesty it is very thick so not so easy to apply not like estriol 0.01 which is a more spreadable! 


I also read the GSM paper that was given to me in a link very informative.


I was also told that a year of using topical estrogen cream is equivalent to one HRT tablet!! 

[Katherine]

I use Vagifem twice a week and once increased the dose without checking with my GP and she said it's ok to occasionally take for 1 week but then to go back to twice a week. Turns out the itching and soreness were due to wiping too roughly and once I stated dabbing again the itching and burning went away after a few days. Apparently you do have to follow GP guidance in terms of dosage for vaginal oestrogen even if you have symptoms..

[Ayesha]

Apparently you do have to follow GP guidance in terms of dosage for vaginal oestrogen even if you have symptoms..

On systemic HRT absolutely, definitely follow your GP's advice.

However, topical oestrogen is completely different and after five years of experience of using Vagifem and Estriol daily I follow my own guidance and not the advice from my GP, in fact it was me who gave him guidance on how much I needed to control my chronic condition which is now well under control.
I have found medics to be ignorant of what is needed to treat each individual woman with GSM symptoms, you have to find out for yourself what works and be assured its a very safe treatment, if it was not safe we would not be able to buy over the counter.

[Katherine]

Hi Ayesha, this isn’t what my gp told me - I’m sure everyone has different experiences but my gp was excellent and one of the two specialists in HRT at the surgery so I trust and follow her advice. I find two tabs a week to be enough but would consult her if I had new symptoms.

[Ayesha]

I am on daily Vagifem and Estriol cream used on the outside twice a day. Atrophy is a degenerative condition that gets worse with age which I believe is where I am right now and the need for more treatment.
Women need to know that its ok to increase the dose if the need arises and without fear.

[Katherine]

One may well be able to increase the dose, it’s not about fear or saying one can’t increase the dose but about being sensible and checking with your gp first if it’s ok to increase. Meds like paracetamol are also available over the counter but we wouldn’t exceed the dosage if it didn’t take the pain away. I don’t understand why you think it’s not ok to check with your gp unless it’s a worry they will warn against it. Anyway I’m leaving this thread as I’ve passed on my knowledge and hope it helps.

[Dr. Heather Currie]

A few points to pick up on on this discussion--
Vaginal estrogen is minimally absorbed, but we do not know the effects of using more than one preparation at a time, or using higher than licensed doses. As with HRT doses, if a licensed dose is not fully effective, then a different type could be considered but also the underlying problem may not be purely hormone related and review would be indicated.
The BMS consensus statement does not recommend adding preparations together--see  https://thebms.org.uk/wp-content/uploads/2024/04/09-BMS-ConsensusStatement-Urogenital-atrophy-MARCH2024-A.pdf
The dose increase for vaginal estrogen tablet as mentioned is reasonable because of the following--
Many years ago, we had a preparation Vagifem 25mcg--every night for 2 weeks then twice weekly. When it was taken off the market, we then used the lower dose Vagifem 10mcg (Vagirux is the same)--nightly for 2 weeks then twice weekly. So the maintenance dose of Vagifem 25 provided 50mcg of estradiol over a week, for which there was no concern about significant circulating absorption affecting the womb lining. Therefore, if needed, this can be achieved by using Vagifem 10 of Vagirux up to 5 times weekly. For many, twice weekly is enough and can be continued long term, for others using it 3 to 4 times weekly or maximum 5 times weekly works better.
If vulval and vaginal treatment needed, some find using the large volume estriol cream 0.01% applying half with a finger to the vulva and remainder into the vagina can be useful. However, other vulval conditions and sensitivity may need to be considered.
I hope that this is helpful.

[CLKD]

   Heather.

[Ayesha]

A reassuring post from Dr. Currie in particular the dosage of 5 days a week.

As much as I have tried to reduce by experimenting with my dose of Vagifem and Estriol cream I can't get below the 7 days of treatment, I am completely symptom free on this dose. I have also stopped using Estriol thinking that after five years of treatment it would not be needed but unfortunately it is and symptoms immediately return if I don't use the cream, it's become obvious I need both medications.

Perhaps its an age thing, but one thing medics have to consider, we are all so different in our needs and should be treated on an individual basis and listened to accordingly.

[Minusminnie]

Necessity is the mother of invention.

[Ayesha]

The link that Dr Currie included from the BMS is very beneficial in the fight against any jobsworth telling us we must not use more than 2 pessaries a week, although I must say my life in that area has been peaceful of late, long may it last but I always like to be prepared for the next confrontation and I will be printing off the information.
As long as that out of date leaflet in the Vagifem box exists there will always be a problem getting it prescribed to the dose some of us require.   

[Jules]

If it's the outside that's the problem you might use estriol 0.1%cream on the outside as well as vagifem. Vagifem does nothing for me outside (v. painful urethra).

It's both tbh. The constant feeling of needing to pee and the soreness at the opening.
😊

I was noticing changes externally, quite suddenly actually, almost disappearing. It's atrophy and unless you start using some estrogen cream, it will continue.  I also got sensations as though I needed the loo. After listening to Ayesha's experience, I increased my vagifem to alternate nights and began applying estriol cream to the outside areas. It seemed to halt the deterioration but since then I've had to increase the estriol cream to twice daily. I mix it with Yes moisturizer as it's easier to apply and I put some just inside the vagina.  I've not had any problems since. It's not enough to treat just the inside. It takes persistence over a few months but it worked. I can't retrieve what I lost unfortunately , if only my GP had advised me, but I got some plumpness back and Im not in discomfort.