Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[Snowcat]

Hi all.  So, I saw my gynaecologist yesterday, having last seen her in May with severe Vulval atrophy, after coming off systemic HRT 2 years ago but keeping on with vagifem, which has served my vagina well for years! 

I was so relieved to be told that the vulval skin was beginning to look better and not as thin (thanks to the use of estriol cream & Estraderm patches for the past 2/3 months) but that I still have some lichen sclerosis areas and some red skin that’s still in recovery.  The following is what she has told me to do and I’d really appreciate any views on it before I do anything.

She explained that as we get older the skin takes longer to recover from a trauma like VVA, (approximately 80 days., hence the 3 month wait to reassess patients). I’m not arguing that point.  She said I should carry on with the 75 mg patches but, although they will definitely help with the vulva, older women have a poorer blood supply to that area than younger women, so they alone are unlikely to resolve things completely.

Then she told me to stop the vagifem and use estriol cream internally and externally instead, with the reasoning being that vagifem is great for the upper vagina but not so much the lower bit or the vulva, so if I insert that instead of the vagifem it will run down and treat the whole vaginal area, and to add some more to the labia, along with hydromol on the lichen bits.  I’m happy to try anything that might work but my worry is that I’ve been on vagifem for years and I was led to believe that estradiol is stronger than the  cream which is estriol.  When I said this she said that it would be ok as my vagina looked very healthy (apart from the bottom bit - but surely that’s because the vagifem has been working for years!) she said that I shouldn’t use both or I would quite possibly be overdosing on estrogen … is that even possible with local estrogen cream?

So, do I do as she says and swap the vagifem for estriol cream or can I use both and if so how? Has anyone else done this? She seems very knowledgeable and is kind & pleasant but I wasn’t expecting her to say stop the vagifem … maybe rge cream will also work .. I’m still trying to decide so any experience would be much appreciated.  Thank you!

[Ayesha]

There hasn't been enough, or any research on using two products and the BMS do not recommend using both together, that's where I imagine your GP is coming from.
Those of us using two separate treatments and finding this is the only way it keeps symptoms under control, are really doing our own research and finding that it works well and then passing this information onto our own medics is why we are allowed to carry on, if symptom free why change things.

Give it a try and see how it goes, if you experience symptoms returning, which will be quick, you can then go back and ask to be prescribed both treatments together like many other women do.

[sheila99]

I wouldn't trust anyone who suggests you might overdose on local oestrogen, the amount absorbed systemically is absolutely tiny. There seems to be an edict within the NHS that says you can't have both, I tried to get vagifem for the inside and estriol cream for the outside and was told I can't have both. I think you can buy estriol creme online so that may be an option for you if you want to keep the vagifem. I solved it by going private and now have enough systemic oestrogen (200mcg estradot) that I no longer have va  and I don't need any local oestrogen now. I'm 64 so probably in the 'older women' category

[Ayesha]

Not all surgeries are against using two treatments. I have been with two different surgeries in different areas and both are fine with me using Vagifem and Estriol together.
It has to be explained to them because some surgeries know very little of the treatments available and how to use them. My new surgery learned from me what was needed, you have to have the knowledge and be assertive when you explain what you want and need to control symptoms.

Systemic HRT for one reason or another is not wanted by all women suffering with GSM and topical treatment is enough to control symptoms, I am symptom free using two treatments and very happy not to be involved in the minefield that comes with using systemic HRT.

[Snowcat]

Thank you Sheila & Ayesha.  I’m taking your comments on board as always.  I’ve never had anyone not happy to prescribe me both Ovestin and vagifem but then I’ve always used the ovestin on the outside only. 

Now the gynaecologist wants me to use it inside as well, but instead of the vagifem.. I’m just wondering if there is any benefit to inserting both the vagifem and the estriol cream … I too felt disappointed when she started saying about overdosing on estrogen … she agreed that some women need both but in different places! And some need systemic HRT as well and some don’t, and some need it for life and some don’t. 

[Ayesha]

Because the Estriol will be enough as it will treat the inside as well as the outside without the need for two products. When using Vagifem, Estriol is used as a smear on the outside only.

I would follow your gynae's instructions and see how it goes, you can always revert back to Vagifem and ask for Estriol to treat the outside if necessary. Try not to overthink things, it will only get confusing for you.

[Snowcat]

Thanks Ayesha, yes, I think I’ll do that - at least if it doesn’t work out for me then I can say I tried it! Hopefully it will.

[Dierdre]

I've been prescribed both for years initially by my gynaecologist and also carried on by my surgery. Had recent review with no problem about using vagifem and Estriol daily. Vagifem internally and Estriol externally.

[Snowcat]

Hi Dierdre.  Thank you very much.  I haven’t had a problem getting both either and have been using vagifem internally and estrogen cream externally.  It was just at my last gynae appointment she said to stop the vagifem altogether and use the cream both internally & externally instead.  I just wondered if anyone has had as much success using the Ovestin internally as they had with the vagifem.

[Ayesha]

The problem with your question is that we are all very different in how the treatments work for us.
But one way or another you will prove your Gynae right or wrong in her approach to your treatment as she is obviously following the guidelines suggesting only one treatment allowed unlike others who are more experienced and know two treatments are fine to use.  Why I suggested you go through the process and see what the end result is, it might be ok for you, it might not but you will have learned a lot from the experience and then pass on your knowledge to others 

[Snowcat]

Thanks Ayesha. Yes I know what you mean.  Thank you :-)