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[Konijntje]

Vaginal estrogen seems to be a bandaid at the moment, more than a treatment. I have an appointment in 3 weeks to see if there is more going on like prolapse or anything (I’m unsure, I thought I might have a prolapse, but now I wonder if my vaginal tissue is just swollen so much that it feels full in there?).

If there is no prolapse and it is VA (I’m constantly slightly sore and itchy), I’ve been looking at treatment options. Right now I’ve been using synapause suppositories and cream (I’m in the Netherlands, I’ve not seen this brand mentioned here), these are both with estriol. There is also Vagfem and Vagirux available here, so I’m going to ask to try one of those as maybe I might respond better to estradiol (the dose of estriol in the suppositories is higher to account for the weaker estrogen, research says it should work the same, but I’ve seen many women say estradiol works better for them).

Being me, I like to think 5 steps ahead, so I want a plan for if my plan isn’t working ;-). And I’d like to try intrarosa, also because there are some reports about it increasing libido and that would be very welcome once I feel better overall (I’m hoping I have finally found a progestin that is agreeing with me, so when the side effects pass, I’m hoping I’ll feel a bit better). Intrarosa isn’t available here, because it’s not in the medicine database, so I’m wondering as the title says if it is available over the counter anywhere?

[Mary G]

Yes, it's available over the counter and without a prescription in Spain!

[Konijntje]

Oh thank you so much, Mary G. So, can anyone just buy it or do you have to be female and of a certain age? Because of my children (both have disabilities) we don’t go on holiday outside of the country (or at all actually) right now (maybe in a few years when our son (17) doesn’t live at home anymore), so I’d need to ask family or friends to get some if they go to Spain on holiday.

[Ayesha]

The document in the link should be helpful to you, it lists all the treatments available to treat GSM symptoms. Scroll down to find all the info you will need to help with your plan of action 

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

[Konijntje]

Thanks Ayesha, that is a helpful document, I hadn’t seen it before. Some of these treatments like the ring, gel and intrarosa aren’t available here. My synapause pessaries come close to Imvaggis, only mine are a slightly higher dose, 50 mcg instead of 30.

[Mary G]

Koni, anyone can buy it.  Have you tried buying it there? 

[Konijntje]

No, it isn’t available at all in the Netherlands. If I search for it in Dutch, I do get hits for Belgian pharmacies, but it is prescription only there (and you have to pick it up in person, so even if I could manage a prescription (probably not, here doctors can’t prescribe anything that isn’t in the database, or if they can, it’s not easy), it would be still a hassle to get it).

I did buy a cream with DHEA in it for transdermal use, but haven’t used it yet (I’m hesitant to add anything at this point, before my side effects from the dienogest have subsided). A few reviewers of the cream did say they use it vaginally (on the outside) and had good results, so I might try that first before asking vacationing family/friends to buy intrarosa for me in Spain. It’s just nice to know that there is the option to buy it otc in Spain.
How much does it cost in Spain?

[Mary G]

Koni, it's a long time since I bought it and it was for someone in the UK before it was available there but I'm pretty sure it was less than €20.00.  it's wonderful to be able to buy things over the counter.

I can ask at the pharmacy on Wednesday when I go to collect my oestrogen and progesterone gels. 

[Konijntje]

It’s not too important, but if you are going to be there anyway, that would be nice. It’s more that I can pay people beforehand if someone is going to Spain (depending who it is, family members I’d probably just pay back afterwards ;-)).

[bombsh3ll]

I take sublingual DHEA which you can buy without a prescription.

I use the life extension brand, 25mg and buy it from iherb.

This has increased my testosterone levels from close to zero to the top quartile for healthy females.

I appreciate you are looking for vaginal products but this may be a good and more accessible alternative.

[Konijntje]

Thanks Bombshell, I did read that you were using those before in another topic and I was interested, so I looked up the life extension sublingual DHEA.
The sublingual dhea isn’t available for the Netherlands on iherb (I can see it, but not order it). I read some articles about subligual and transdermal being quite equivalent, which is why I opted for the cream that I could find online. Because I read in the reviews some people did use it vaginally, I was wondering about that, but I mainly bought it to increase testosterone too if my dr won’t prescribe testosterone. I’m now on dienogest, which is anti-androgenic, so once I’m past the side effects and I’m sure both the dienogest and oestrogel are working well, I do want to boost testosterone levels, as I could definitely use some energy and some brain fog relieve (which is probably more low testosterone than low estrogen for me).

Upside, I do think dienogest is agreeing with me mood wise, I’m almost 2 weeks in and my side effects (extreme fatigue, nausea and mild headache) are getting a bit better, so I’m pretty hopeful they will go away completely eventually. It might contribute to my vaginal discomfort though, because that is a known side effect and so far systemic estrogen doesn’t seem to do much for that symptom (I’m sure I’m absorbing enough, because it does help with hot flushes, night sweats and dizzyness).

[sheila99]

Just in case it's easier to get hold of you can also stop your va symptoms with sufficient systemic hrt. I'm on 150mcg estradot and am no longer incontinent (my GP would only prescribe vagifem twice a week and this didn't control it). It shouldn't be necessary though, enough topical oestrogen should do it too.
  If you do have a prolapse some people find the ring good as it can hold the prolapse up.
  Another thought is that if you're swollen inside perhaps you have an adverse reaction to your current prescription.

[Konijntje]

Thank Sheila. I don’t think I need more than 4 pumps of oestrogel and I don’t think it will be accepted here at all (Dutch guidelines are very conservative). I think getting the ok for more topical estrogen will probably be easier.

Getting an adverse reaction is good food for thought, it would explain why it only helps a little bit and I do have very sensitive skin. Going to put on my list to discuss at my appointment.

[Mary G]

Koni, I asked at the pharmacy today and Intrarosa costs €25.00.  I could have ordered it for next day delivery so very easy.  This was for a box of 28 capsules.

I've never tried it myself but a lot of women think it's very good.

[Konijntje]

Ah, thank you so much Mary G. That’s affordable enough, so I could ask someone to get 6 boxes for me if I want to try it (I read somewhere that it takes multiple months before it is working fully).

Right now, I’m using my synapause pessarries and cream (both estriol) daily for a few weeks to figure out if upping the dose helps and if I get adverse effects from some of the ingredients (thinking back, the swelling might have started when I started the treatment, before it was mostly itching as a symptom). I’m going to ask to try vagifem at my appointment first.
Backup plan will be intrarosa. ;-)