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[Suzysheep]

So I’ve been using Vagirux pesseries daily for around 3 years now. They help me with fissures, VA etc really well and I don’t want to stop using them daily.  I’ve never had a problem getting a prescription on repeat for them… until now. The dr said they are not recommended for every day use and I’m to stop using them this way.
I’m panicking now because even if I miss one day I’m sore both vaginally and anally. I can’t/wont risk going back to repeated fissures and being dry, sore and uncomfortable.
Any advice? What can I do?

… I can’t tolerate proper HRT… I really didn’t get on with it and had a complete mental breakdown when I stopped, so never again with that!

[Katejo]

So I’ve been using Vagirux pesseries daily for around 3 years now. They help me with fissures, VA etc really well and I don’t want to stop using them daily.  I’ve never had a problem getting a prescription on repeat for them… until now. The dr said they are not recommended for every day use and I’m to stop using them this way.
I’m panicking now because even if I miss one day I’m sore both vaginally and anally. I can’t/wont risk going back to repeated fissures and being dry, sore and uncomfortable.
Any advice? What can I do?

… I can’t tolerate proper HRT… I really didn’t get on with it and had a complete mental breakdown when I stopped, so never again with that!

  I was assured by a urogynaecologist and her support nurse that using Vagifem 5-6 times a week was fine. The dose of local oestrogen is tiny comparaed to systemic.

[Ayesha]

Your doctor is wrong and the advice is out of date, don't stop your daily treatment and give her/him some facts.

A quote from Dr Currie last year stated "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 haven't been confronted in a while about my daily Vagifem dose, plus Estriol cream but when I have been I always say I am not on systemic HRT and a box of Vagifem is equivalent to one systemic HRT tablet a year. I also mention if I leave out a dose by the following afternoon my symptoms will start to return. I have stopped many a confrontation by giving the facts of a very harmless but effective treatment.   

[Suzysheep]

Thanks for the advice.

Ayesha, who prescribed it daily for you?

This dr was pretty flippant and adamant he couldn’t prescribe against the recommended guidelines. Ugh. It was a very frustrating phone call…. In the middle of Asda! 

[Ayesha]

It was a previous GP who is a gynae and when I told her the two a week dose was not having any affect on my symptoms she told me to use the pessaries every day, she in fact is also on daily Vagifem.

When I moved area's I did have to explain my daily use to my new GP and once I gave him the history he was ok with it. Most GP's don't know enough about the treatment (unless you are being fobbed off due to costs) but if your practise has a menopause nurse you could speak to, I always recommend make them your first approach on all things menopause, they really are the experts.

Don't give up on this because I know your GP is wrong.

[Suzysheep]

Thanks. I will ask if there’s a menopause specialist and speak with them.

I have found there is a similar product available to buy called Gina. Superdrug sell them, so if I have no joy with my drs then I’ll just buy them anyway. I know I shouldn’t have to, but at least it’s an option available to me.

[Ayesha]

Gina is exactly the same as Vagifem, just different names. I always buy a back-up supply from Superdrug for any flare ups that might occur. Buying them gives you that lovely sense of freedom from all the hassle, but very expensive if needed every day.

[sheila99]

My GP won't prescribe it more than twice a week either. I'm sure they know perfectly well it's safe and this is just about cost control. You can ask for a referral to an NHS meno clinic who often will prescribe more though mine would only do it for 3 months then back to twice a week. Still, it's worth trying as many will. The other options are Gina otc or go private but before you do that I would ask your GP if they will prescribe what they suggest, if they won't it's a waste of money.

[Minusminnie]

Thanks for the advice.

Ayesha, who prescribed it daily for you?

This dr was pretty flippant and adamant he couldn’t prescribe against the recommended guidelines. Ugh. It was a very frustrating phone call…. In the middle of Asda! 

Can you not take this up with your surgery or ask to see a different GP.
You have after all been using Vagifem daily for 3 years.
I would try standing your ground first.

Ayesha did post a helpful link to Position Statement for Manangement of GSM of the menopause which I can’t find at the moment maybe she will get back.

I’ve printed it off in case I need it.

[Ayesha]

Many of my confrontations have been because of the out of date leaflet that comes in the box, but as long as no one gives a damn we have to learn everything about topical oestrogen ourselves and pass the message on. It shouldn't be a battle but if its down to costs they will always look to the leaflet as proof to the correct dosage.

The link, as mentioned, is full of very useful information
https://bssm.org.uk/wp-content/uploads/2023/02/GSM-BSSM.pdf

[Dierdre]

My GP won't prescribe it more than twice a week either. I'm sure they know perfectly well it's safe and this is just about cost control. You can ask for a referral to an NHS meno clinic who often will prescribe more though mine would only do it for 3 months then back to twice a week. Still, it's worth trying as many will. The other options are Gina otc or go private but before you do that I would ask your GP if they will prescribe what they suggest, if they won't it's a waste of money.

Is there another doctor in your surgery you can see or if not another surgery you can transfer to?
If I was only allowed 2 vagifem per week I can't describe the mess my genitals and bladder would be in. However do you manage?

[Suzysheep]

I’ve requested to see a doctor who is a menopause specialist at the surgery.  I have also reached out to the specialist menopause clinic I was referred to a few years ago. 
I just simply can not be taking only 2 a week. I will be a mess.

Thanks for all your helpful advice and support 

[Ayesha]

An update on how you get on would be really helpful. Women shouldn't have to fight for treatment because of costs and chronic symptoms being ignored.

[sheila99]

My GP won't prescribe it more than twice a week either. I'm sure they know perfectly well it's safe and this is just about cost control. You can ask for a referral to an NHS meno clinic who often will prescribe more though mine would only do it for 3 months then back to twice a week. Still, it's worth trying as many will. The other options are Gina otc or go private but before you do that I would ask your GP if they will prescribe what they suggest, if they won't it's a waste of money.

Is there another doctor in your surgery you can see or if not another surgery you can transfer to?
If I was only allowed 2 vagifem per week I can't describe the mess my genitals and bladder would be in. However do you manage?

I gave up and went to Newson. I'm now on enough systemic hrt that my other meno symptoms have resolved along with va (more than the 100mcg NHS limit). I'm fortunate I can afford to do so. It really bugs me that we're expected to be in pain and incontinent just because we're menopausal women. Anyone else and they'd bend over backwards to find a solution.

[Dierdre]

I'm glad you're ok now but you shouldn't have to pay for treatment others get on the NHS depending on what doctor you get. Can you imagine that scenario with heart medication etc.