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[Sunnyangel]

After a lot of effort plus private consult letter, my GP practice is now prescribing me 5x week estradiol 10 mcg vaginal tablets and estriol 1mg cream (for exterior use). I know I am lucky but....

Here's the background, by the way, I don't take systemic HRT
I used a much longer than normal loading dose of estradiol tablets and then, following advice went to 6x week estradiol tablets for about two weeks and then tapered off to 5x week on 12th October. Initially on 6x week it was ok so I felt confident that 5x would be alright but actually over the last few days, I am starting to get that slight urgency to pee again and waking during the night.

So, here's the question, do I persevere on 5x week and hope that it will settle down? Is that likely? Should I just up the dose again?
OR
As suggested by consultant as alternative options, should I try Estring instead or Estriol cream which she says may have a better result for bladder issues which are my main problem. I don't really like the idea of using a cream, it sounds messy but I don't like the thought of symptom return either. She suggested up to 5x week of estriol, is that enough?

I would welcome any thoughts experiences.

[Ayesha]

The best advice from me is that I use seven day treatment of pessaries, a smear of Estriol cream twice a day every day and this is what keeps my symptoms under control.
I would say do the same and see if it works for you. I also use a moisturiser too.

[Sunnyangel]

Thank you Ayesha. You are always around with a reassuring message.

 I am keen to use the lowest possible dose but I'm increasingly not sure that is going to work for me. I may have to supplement my prescription of estradiol and go back to once a day.

I've never been a person who takes medicine, especially at a higher than licensed dose, so I guess I'm just finding it difficult to come to terms with my new reality and it is definitely a worry for me when it comes to increasing the dose to the max.

[Sunnyangel]

By the way Ayesha, I forgot to ask-I think I read somewhere on here that your consultant (or maybe it was your GP?) is happy for you to be on that dose? If that isn't you then apologies for the mistake. Essentially, I'm on here for reassurance if I'm honest!

[Ayesha]

I was lucky enough to have a GP who is a Gynaecologist. When I told her the dose of two a week Vagifem wasn't having any affect, she told me to use it seven days and also prescribed Estriol cream. When I looked shocked at what I thought then was a very high dose, she just looked at me and said its perfectly safe, also telling me that she is on seven days treatment herself. I have done lots of research since and learned so much and I can honestly say to you that the only treatment for your symptoms is oestrogen, of course I am assuming anything else has been ruled out.

You just need the confidence and the patience to start using the amount you will need to control symptoms, it took me a year to be symptom free on seven days treatment using both Vagifem and Estriol cream. 

[Sunnyangel]

Thanks yet again Ayesha. Yes, everything else is ruled out following 2 examinations, one by GP and one by consultant, so I guess I just need to start using more estradiol again. Your GP 's comments are reassuring and comparing the amount of oestrogen in the tablets  to that in a systemic HRT dosage really does show how miniscule it is in reality.
I hear what you are saying about how long it took you to get symptoms well under control. Perhaps I have expected amazing results too quickly and just need to relax a bit and be consistent. I think I'm a bit on edge about it all as I 'm also caught up in a tragic family situation which is very upsetting and may have contributed to a flare-up of symptoms due to all the stress.
It's so positive and hopeful to hear from people like you who have had success in controlling symptoms.

[sheila99]

I wouldn't worry about the NHS imposed 'maximum dose', it's still a microscopic amount that's absorbs. Imo it's more about cost control than appropriate treatment (I am incontinent on their max dose). And it's much, much lower that the bucketfulls of oestrogen you used to produce yourself.

[Ayesha]

I thought this post by Snowcat in the link kind of sums it all up nicely, should reassure you more.  And yes, stress will bring on flare ups.

https://www.menopausematters.co.uk/forum/index.php/topic,73520.msg984953.html#msg984953