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[flo69]

Sorry if this uncomfortable for anyone, but I really want to find out about the difference between the blood supplies to the upper part of the vagina and the lower part.

I have read it on here before, years ago, that the two blood supplies take whatever medicine to different parts of the body first. Thus how to avoid too much progesterone getting to the brain directly by placing the pessary either high up or low down.

I'm even confusing myself here, sorry, I just can't remember which place is better for avoiding side effects in the brain.

Can anyone help clear my confusion?

[CLKD]

Not completely but I'm sure that using VA treatments in any part of the vagina won't alter how much uptake there might be. R U going to be using a specific treatment? 

[bombsh3ll]

It doesn't really work like that, if you insert progesterone into the vagina and it gets into the bloodstream, it is getting to the brain regardless of how high up you manage to shove it.

The rationale behind vaginal use being better for the brain is a) it avoids first pass conversion into unphysiological metabolites and b) theoretically a lower dose can be used vaginally however the evidence for this is not sufficient to change guidelines.

There is also evidence that vaginal progesterone doesn't reverse the vascular benefits of estrogen like oral progesterone does in terms of flow mediated dilatation, and what's good for the blood vessels is also good for the brain.