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Author Topic: Is my GP right?  (Read 402 times)

Mishmash1982

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Is my GP right?
« on: November 10, 2025, 03:56:55 PM »

After having progesterone tablets and then the coil fitted i suffered badly with very very dry/itchy lady garden.
I was prescribed 1x vagifem internal table per day and estroil external cream but i wasnt doing anything. I couldnt get a GP app so after reading on lots of forums i decided to up the vagifem to 2x a day as i was desperate for some relief.
Within 1 week i finally started to feel better.

Spoke to my gp today and shes not very happy with me using 2x a day but said to carry on for now and she will get advice from the local menopause clinic, i also asked if was worth increasing my patch to 125mg (currently on 100mg)
And she said no and that would be too high (started 50gm in 2023 with slow increase blood tests showed hormone level at 8.4)

Shes aaked for me to have a new blood test which is fine but says the dry/itching wont change and im too young (43) and havent been on HRT long enough (2yrs) to warrant been on such a high dose and to basically wait for the coil to settle asnits only been a few wks!!

This coming from the same dr 3 yrs was adamant i didnt need HRT and put my symptoms down ro low iron/B12

Im just not sure i have any trust in her atm

All opinions welcome
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CLKD

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Re: Is my GP right?
« Reply #1 on: November 10, 2025, 04:14:06 PM »

Every1 is different. It is quite safe to use appropriate Vaginal Atrophy every night if required, we cannot over dose on oestrogen. It is a natural hormone which because it drops, the body may become dry inside and out!  Scalp, skin, between the toes, deep in the ears, nostrils, eyes, vagina, anus .......... I don't think it's time related as to when we up/drop the HRT regime, too many forget that H-'replacement'-T. 

Sometimes it takes a while for a very dry vagina for the walls to absorb treatment so perseverance is important.  Any stinging should be relieved too.

Some find that a moisturiser i.e. Sylc or Yes might help on the outer labial area - it can be a bit Trial and Error until we find a regime to stick with. 

No-one is too young  :bang: :bang: :bang: 2 be in perimenopause.  Some girls never menstruate, others have a few periods then nowt. 

Hopefully this GP will be educated by contacting the menopause clinic which mayB quicker than asking for an appt. yourself.  There is that option though if she isn't supportive. 

The dry / itching will change if treatment is given and used when required.  The initial idea is to use every night for 2-3 weeks then as necessary: some require continual nightly insertion/application, some manage symptoms with every 3rd and 5/6th night.  Occasionally as oestrogen levels continue to to drop we need to re-load to every night to get over the feelings.  4 me it was the need2P continually when I would sit on the loo with a cuppa in one hand and glass of cold water in the other to allow the muscles to relax.

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Ayesha

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Re: Is my GP right?
« Reply #2 on: November 10, 2025, 04:41:44 PM »

They do worry about being young and needing extra HRT to relieve symptoms but life is not that simple. GSM is a very individual condition and needs to be treated as such.
This is a quote from Dr Currie a few weeks ago which I think will help you in obtaining what you need to treat down below.

"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."



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bombsh3ll

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Re: Is my GP right?
« Reply #3 on: November 10, 2025, 06:25:29 PM »

I would try to see a specialist if you can, as it doesn't sound like your treatment is being optimised on the NHS.

The progestin in the IUS is very potent and whilst most women are absolutely fine with it, either alone or alongside exogenous estrogen, it can have quite an anti-estrogenic effect on the vagina resulting in dryness and irritation.

Alternatively your genital symptoms could simply be due to systemic undertreatment, something that is especially concerning in those with relatively early loss of ovarian function.

Androgens also important for urogenital health and frequently overlooked.

Your GP sounds rather under confident and lacking in knowledge regarding hormone therapy, particularly in younger women.

Another option that you should be aware of, that can be easier to access and provide a more appropriate dose of estrogen for healthy women under 50, is to use a combined hormonal contraceptive pill/patch/ring continuously.

There are no direct safety concerns with using as much vaginal estrogen as you need - even those who believe systemic estrogen is dangerous can be reassured by the absolutely negligible absorption.

The only potential for harm is where this props up subtherapeutic or absent systemic treatment, particularly at a young age.

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Mishmash1982

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Re: Is my GP right?
« Reply #4 on: November 11, 2025, 05:13:36 PM »

Hi, thanks for your reply. I fully believe my dryness is down to the coil as the exact same thing happened a few months back with the oral progesgerone tablets but GP saying this is very strange and shes never heard this happen before.

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Mishmash1982

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Re: Is my GP right?
« Reply #5 on: November 11, 2025, 05:16:57 PM »

Every1 is different. It is quite safe to use appropriate Vaginal Atrophy every night if required, we cannot over dose on oestrogen. It is a natural hormone which because it drops, the body may become dry inside and out!  Scalp, skin, between the toes, deep in the ears, nostrils, eyes, vagina, anus .......... I don't think it's time related as to when we up/drop the HRT regime, too many forget that H-'replacement'-T. 

Sometimes it takes a while for a very dry vagina for the walls to absorb treatment so perseverance is important.  Any stinging should be relieved too.

Some find that a moisturiser i.e. Sylc or Yes might help on the outer labial area - it can be a bit Trial and Error until we find a regime to stick with. 

No-one is too young  :bang: :bang: :bang: 2 be in perimenopause.  Some girls never menstruate, others have a few periods then nowt. 

Hopefully this GP will be educated by contacting the menopause clinic which mayB quicker than asking for an appt. yourself.  There is that option though if she isn't supportive. 

The dry / itching will change if treatment is given and used when required.  The initial idea is to use every night for 2-3 weeks then as necessary: some require continual nightly insertion/application, some manage symptoms with every 3rd and 5/6th night.  Occasionally as oestrogen levels continue to to drop we need to re-load to every night to get over the feelings.  4 me it was the need2P continually when I would sit on the loo with a cuppa in one hand and glass of cold water in the other to allow the muscles to relax.

She seems to think increasing my patch to 125mg will then make my oestrogen levels too high??
So would like me to have a blood test first to check what they are currently at.

Is there any symptoms/side effects from too much oesgrogen that i maybe notiving myself
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bombsh3ll

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Re: Is my GP right?
« Reply #6 on: November 11, 2025, 06:52:01 PM »

If you are perimenopausal there is no point testing your blood estradiol levels as they are fluctuating all the time.

This is another bit of a red flag for an inexperienced clinician.

If you had excessive estrogen either endogenously or from the patch, then you might notice tender breasts or fluid retention.

You also probably wouldn't have a dry vagina, as physiological discharge is increased by estrogen.
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Mishmash1982

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Re: Is my GP right?
« Reply #7 on: November 11, 2025, 10:02:35 PM »

I did think the same. Especially about the dryness...surly wouldnt happen.

And i pressumed id need to up the oestrogen to balance out the higher level of progesterone i now have from the coil?
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bombsh3ll

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Re: Is my GP right?
« Reply #8 on: Today at 10:29:52 AM »

You never need to alter estrogen to "balance" the progestogen.

You find and take what estrogen works for you and meets your needs.

Then you use the progestogen that controls your endometrium on that.

If it is the IUS drying out your vagina and you are otherwise on a therapeutic dose of estrogen then you can either use additional vaginal estrogen or prasterone, or switch progestogens.

If your systemic estrogen is subtherapeutic then I would increase that.

Also don't forget about testosterone, this is also important for the health of urogenital tissues in women and frequently overlooked.
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