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[Sunnyangel]

I've just finished my loading fortnight of Estradiol 10 mg vaginal tablets and am now supposed to reduce the dose to two a week. The loading does has helped a lot but, looking ahead, I'm worried about what will happen if I find that 2 tablets a week, instead of a daily one, prove to be insufficient to control the symptoms- I know that this happens to some women.

 My GP has already said that I'll have to live with that situation, if it happens, until 3 months has passed before she will consider doing anything. Frankly, that seems to me to be at best unsympathetic and at worst medically unsound. What do other ladies think of that?

Can I get OTC Gina if I already have a GP prescription for Estradiol just so that I could supplement, if needed, until I get to the three month mark? Should I just instead go back to the GP before that if things get worse in spite of what she said? I would not like to have to do that.

Just to be clear, I'm prepared to give the 2 pill a week regime a go and I'll be delighted if it works for me, I just just don't want to start feeling awful again if it doesn't work.
I would much appreciate advice.

[sheila99]

If you have your prescription sent to one pharmacy I'd go to a different one to get Gina (and tell them what they want to hear. There are some enlightened pharmacists and many ignorant ones).

[CLKD]

Don't even consider dropping the dose yet.  Your GP needs to stick her/his head down the loo and pull the flush.  A LOT!     Another 1 to report to the BMA?

Change your GP too.  Buy a copy of 'me and my menopausal vagina' read then hand to her, with the words "your turn will come'.  GPs wouln'dt be doing this to any other speciality!?!?!

Many ladies require every night use for Life.  As well as adding when necessary a moisturiser.  Commonly ladies will use 'vagifem' internally with estriol smear on the outer labia area.  Your GP needs to get up to date, fast.


We should not be buying products OTC that are available on the NHS 

[Sunnyangel]

Thanks CLKD, I just want to check with people more informed than I am, that I'm not being unreasonable only apprehensive and wanting to feel better so I can get on with my life.

[CLKD]

Of course.  MayB there is a Nurse Practitioner at the Surgery?  We apparently have a GP that is our 'menopause doctor' but she doesn't advertise the fact 

[sheila99]

I don't think it's unreasonable to expect you to try twice a week, many women are absolutely fine on this dose. To me the unreasonable part is to expect you to wait 3 months if it isn't enough for you. Personally I would see the GP again as soon as it starts to deteriorate, they can't expect you to put up with the pain just to satisfy an arbitrary timescale. The 3 months is normally for hrt not local oestrogen as this does carry on improving symptoms for 3 months.

[MrsMitch]

You can buy it online from Boots, it's easier often than going into a pharmacy. You'll have to fill in a form & just put on iylt that you are already prescribed it by your GP. That's what I did & can get it easily. I got fed up of having to sit face to face with a pharmacist as they didn't seem keen to allow it when I already get it from the GP so online was simple.
I use it daily & need 2 daily for 3 - 4 days a week to keep my symptoms at bay. I can go back to 1 a day for a couple of months before I need the Gina as a top up to prevent a flare-up.
All you can do though, is try the 2 per week to see if your symptoms return. Personally I'd be telling the GP I refuse to live with any of the symptoms full stop. So certainly get some Gina so you can increase your dose quickly should you need to. I'm sure you've read lots on here about the difficulties we have getting enough treatment. Plus a lot of GPs won't prescribe the pessaries x7 week & say you need to be referred to a menopause specialist in order to get it. That could be an 18 month wait - that's how long I waited.

[Ayesha]

Dreadful to read that this kind of attitude from GP's continues, the only way to combat this is to educate yourself by gathering all the information about treatments and dosage and pass on the knowledge learned to those professionals who should know better.

A post from Dr. Heather Currie on a thread two weeks ago:
"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."

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

Your Nurse Practitioner is probably well up to date on all things HRT, I would ask to see her and not the GP.   

[bombsh3ll]

If the prescribed treatment is not adequate then I would go back and see a different GP, and if they can't help, ask for a referral to the local NHS menopause clinic.

This often results in treatment being made available without you having to actually wait for, or attend, an appointment.

If course you can buy Gina in the meantime if you can't access NHS treatment but you shouldn't have to pay for your own treatment long term.

Other options that can be considered are estriol cream, or the estring. The former, being a cream, is harder to gatekeep as it comes in a tube rather than a set number of units. The ring delivers a low dose continuously, however having seen a demo sample it is humongous, like something I used to throw for my dog to fetch actually, but some women do seem to be able to manage it.

Finally what about your systemic estrogen levels? VA that is severe/difficult to treat is typically seen with either subtherapeutic or absent systemic treatment.

[Ayesha]

Plus a lot of GPs won't prescribe the pessaries x7 week & say you need to be referred to a menopause specialist in order to get it. That could be an 18 month wait - that's how long I waited.

Once you are symptom free on whatever dose you are on, there should be absolutely no need to be referred to a menopause clinic. The two surgeries that prescribed my seven day treatment of Vagifem never once mentioned a referral. I just wanted to make it clear request the treatment you are rightfully due and if working refuse any talk of referrals. 

[Sunnyangel]

Thank you so much everyone who has replied to my post. You have all given me useful points to consider and information to arm myself with but more than this, I feel less alone in reaching a decision about what to do after reading other people's experiences.

 If I need to go back to the doctor, I feel as though I will be much better informed.
 To be honest, I would like to have an appointment at a menopause clinic since GP appointments are only 10 minutes at best and how can anyone be expected to understand all the necessary information or explain relevant problems in such a short space of time?

If there is any more advice out there, keep it coming!

[CLKD]

I never feel rushed in our appts. with the GP.  Nurse Practitioners get 15 mins I believe.

Do let us know how you get on as all experiences shared are useful.