Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Tinkerbell on August 10, 2015, 11:34:17 AM
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I have a lot going on at moment, husband and our youngish child have both been seriously ill over last 20 months and don't know if I am being over sensitive.
Diagnosed with VA 3 years ago and since January have been having a real problem with it. I have found a lovely female doctor at our surgery ,who after I spoke to hear at beginning of July ,told me to use Vagifem every day and in the meantime she would refer me to consultant gynaecologist who runs a NHS one stop clinic in next town once a week.
I am 52 and have had 3 periods in the last year, two of them were a bit shorter and lighter though.
I had my appointment with gynaecologist last week and it has left me very upset and unable to sleep.
As soon as I got talking to him, he lectured me on my weight ( carrying 3 stone extra) told me Vagifem always works and I am at risk of endometrial cancer....I was aware of excess weight being a risk factor.
He then examined me roughly and said I had no atrophy, well I have been on topical HRT for 3 years!
He then told me the following , didn't ask how I felt about any of it.
They will under a GA do a skin biopsy, Hysterscopy and fit a Mirena.
I got really upset at this point as I have had a bad experience of a GA in the past. I left clinic in tears.
I realise the importance of the skin biopsy, but on doing research this is done under LA.
At the clinic they had an onsite scanner, most ladies were going into that room, so if he was worried about womb thickening why wasn't I offered that first?
Also really cross that I wasn't asked how I felt about Mirena, I did ask about full HRT and his reply was ....' Once the Mirena is in you can use it every day' so he contradicts himself there...one minute I do not have VA and then I am told that!
Where do I go now? I have decided there is no way I can see him again and I will not be able to see my lovely GP until September.
Thanks for reading.....I am shaking again, just typing this out.
He then said if Vagifem is not working he needs to rule out Lichen Sclerous.
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Oh dear, what a dreadful experience!!!! :hug: You poor, poor thing.
I don't blame you being upset. Why exactly did you get referred to this gynae? I assume it's VA but what are the real issues - dryness, UTI type symptoms, rashes etc. Are you using Vagifem 2-3 times per week?
You are clearly not getting problematic bleeding - you are just getting the classic peri symptom of the occasional bleed/period so I don't know why this gynae is suggesting such invasive stuff when it's not needed. The Mirena might be a good idea if you want to add some extra oestrogen to help with flushes etc. as you can then use as little or as much oestrogen as you need. I'm wondering if he thought you were already using full HRT???? It sounds to me as though this is his standard way of dealing with all meno ladies.
If you can hold out to see your lovely GP to discuss this further then I would. Perhaps ask to be referred to someone else. Keep us posted. DG x
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Thanks for replying.
My lady doctor referred me as she said it was a new service and she said I shouldn't have to live with the discomfort... She is really empathetic.
I was using Vagifem 3 days a week but she told me to up it to 5 earllier in the year, and try and cut back again. But every time I did that the burning, feeling a need for a wee in the night all comes back, skin has also got a bit red again, a bit drier but not to the extent pre Topical oestrogen.
She told me she has recently been on some menopause conference and said higher dose would not cause any problem in short term but she did ask how I felt about full HRT.
I am still using it every night as she suggested, don't know if I should continue on that amount until I get an appointment with her....am going on holiday soon and don't want to be sore and miserable for that.
He mentioned the Lichen Sclerous , but on googling I have not got the symptoms. That is treated with steroid cream, not topical oestrogen, so surely it wouldn't mprove when I upped the Vagifem if that was what it is!
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Maybe if you continue to be sore and dry that Vagifem isn't for you, there are other products. Have a read of the menus, top of screen and make notes.
Does using it 5 nights a week help, is this 5 consecutive or on alternate nights? You can use a lube on the outer lips too to keep that area moist and less itchy. KY, Vaseline ……. even LIVE yoghurt applied can ease any dryness.
Also ask your GP to see a copy of the letter which she sent to the Consultant, you and she can read this on the screen. Maybe she left some details out or perhaps the Consultant failed to read the letter! He sounds like the kind of Consultant who has no bed-side manner >:( (I've worked with a few of those :( ).
If the examination was in your opinion 'rough' then maybe you need to ask your GP for an explanation. Was there a Nurse present at the exam.? Why has a biopsy been suggested?
If the Consultant is worried about womb thickening I believe that an ultra sound scan using a probe can give a measurement :-\
Make a double appt. with your GP as soon as you can so that you have time to talk - make a list of your worries to take with you!
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Tinkerbell
I have had this dreadful burning in my urethra - like a UTI - which improved with Vagifem but has been a lot better since I went on full systemic HRT as well - I still use Vagifem once a week alongside.
Your experience with this gynae was unacceptable and you need to talk things through with your lovely GP. If you are getting relief from the daily Vagifem(or perhaps every other day) then I would continue until you see the GP - it's unlikely to cause long term problems. Ask you GP about the Mirena - do look it up on this site as it could be good option for you but there are other options for systemic HRT which you may like to try first.
I think it was really out of order that this gynae made such a big issue around your weight but it is a good idea to keep your weight down if you do try HRT as carrying a bit of extra weight brings more risks.
You might like to try using some lubrication as CKLD suggested - I've been using Multi Gyn Actigel every day for years as this soothes the burning and helps to keep the whole vaginal area healthy.
Keep us posted. DG x
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As I have not had my first appointment on the matter yet I have no experience as the others.
BUT - just wanted to add you were not over reacting at all. What an awful experience for you. Hope you are feeling better now and the above advice can help. :-*
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You certainly were not over-reacting, sorry forgot to answer your initial query ::)!
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So sorry to hear about your unpleasant experience Tinkerbell.
Many of us would continue to get symptoms if only on local/topical HRT like Vagifem - and need to use this as well as systemic HRT just to keep things comfortable and symptoms at bay.
I agree with Dancinggirl - I can't understand why you have to have the biopsy and hysteroscopy, nor the Mirena at this stage! I had a hysteroscopy and biopsy due to post - sex bleeding and thickened womb lining - but I had no anaesthetic at all. This is your choice but some areas will only do it under GA - I chose a hospital where I could have LA or none as I've never had a GA. I could have had a local but it wasn't worth the bother as it was so quick (at the recommendation of consultant). I know some consultants are better at this procedure than others. Also I agree why haven't you had a scan first to see if your lining is thickened - the biopsy is usually carried out if the lining is found to be thickened following an ultra-sound scan and generally also a trans-vaginal scan, and/or if there are indeterminate abnormalities or irregularities noticed on the surface of the womb lining (as in my case).
As for the Mirena - I have oestrogen and separate progesterone and was offered the mirena while they were doing the hysteroscopy - but I declined this. There is absolutely no way you can be forced to have this.
I also agree with Dancinggirl that now is also a good time to try to begin to lose some of the excess weight - but not be intimidated into doing so - because excess weight is a risk factor that seems to be associated with cancer and other health problems.
Personally I would make an appt asap with your lovely GP (for Sept) and continue to use Vagifem every day if she has sanctioned that - of course you want to be able to enjoy your holiday! Sept is only a few weeks away....
Try not to worry and enjoy your holiday - perhaps use the time now to think more about full HRT and if that's what you want.
Hope this helps
Hurdity x
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Good advice Hurdity - use the Vagifem every day, go on holiday then review with your GP! (we have a holiday thread too ;) )
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That sounds awful.
Only a dermatologist can diagnose LS. I've had it for years but recently a gynaecologist tried to tell me that I don't have it at all ::)
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:thankyou: Mrs Mopp
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After waiting weeks to see female doctor, only managed to get appointment yesterday!! I am still not happy and don't know what to do.
She took time to explain things, but basically I feel backed into a corner now as she thinks the Hysterscopy, Mirena and vulva biopsy is the way to go. Although she did say she was happy to refer me to a female gynae's list, but I guess the treatment will be the same.
I have to have this all done under a general, but I can have a spinal block if I am against the GA.
Things going through my mind
I thought hysterscopies didn't need GA/spinal and I no a Mirena doesn't .
Research shows a vulval biopsy is done normally under local.
I have not been offered a scan to check lining...I pointed this out yesterday, but she said they could give a false negative.
I have been on Vagifem since January, but using more than the twice a week dose, before that I was using Ovestin for about 2 years. I am on no other HRT
I have had 3 periods in the last year, last 2 more scanty but NO other bleeding.
I am so stressed with all this, feel I have to accept these suggestions and have a GA or spinal and that will mean an overnight stay and a catheter.
Can I see another consultant privately for a second opinion and if any investigations are still needed can i be referred to the NHS for this?
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I would see the Consultant Gynae if your GP will refer you. Take a list of your symptoms and ask for advice. You don't have to 'go' with that advice! Going privately shouldn't be necessary, you may see the same Consultant anyway. Why does your GP think you need a vulva biopsy ?
Why did you stop the Ovestin? Does the Vagifem help at all, you may need to use it more often.
Sorry not making much sense as I have a head cold ::)
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I would like to see the female gynae as she was my obstetrician 12 years ago and labour wise she was very pro-choice!
My problem is, doctor yesterday didn't know whether she would just put me on her theatre list of whether she would see me first....I would like to discuss things with her., but doctor said that would start process from the beginning again.
They want to do a vulva biopsy as I am needing to use Vagifem 5 times a week......consultant said that after initial loading, 2 doses a week is enough......what I have read, I don't believe that! And they need to check for lichen sclerosis if the Vagifem is not adequate.
I changed to the Vagifem as Ovestin was not adequate on advice of doctor back in January.
Sorry you are feeling rough CLKD, but thanks for replying.
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I would think that an NHS or Private Consultant would see you in an appt. to discuss options first! :-\ :
and it isn't is not starting the process from the beginning, but getting an opinion by a SURGEON! That's why GPs are doing what they do. I would expect to be able to tell the Consultant my symptoms and how they affect me on a daily basis, for the Consultant to examine me if necessary and to discuss the options. Then go away to consider.
I would NEVER go for Surgery without discussion, after all it is my body . I wouldn't trust a Surgeon who went in with surgical intervention without an initial appt..
"2 doses a week is enough" - change your GP :-\ …….. she doesn't seem clued up much. Some of us need to use the product initially for the 2 weeks loading every night, then 3/4 times each week every few nights and if necessary, several nights in succession to keep symptoms at bay.
Ring the Surgery and ask for the referral letter to be sent to the Gynae and ring the appropriate Dept. to see how long the waiting list for initial appts. is likely to be.
You need to see a Dermatologist if your GP suspects lichen sclerosis as this is a separate issue.
(still coughing :( )
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Hi Tinkerbell
So sorry to hear about your experience.
It needs to be explained to you:
Why you need a skin biopsy ( is this the vulva?)
Why you are having a hysteroscopy?
Why they want to fit a Mirena?
From what you've said there seem to be so many things wrong with all of this.
OK let's just say you do need a hysteroscopy - for good reasons (and I presume they would explain these to you), then you do not need to have a GA. I would point blank refuse this. I said in my earlier post below that I had a hysteroscopy with no anaesthetic at all. Having said that I was given a choice of hospitals to go to - a local town one and a further city one (both 30 mins drive away). The local town one would only do this procedure under GA but the city one would do either. It may be that the consultant at the hospital they want to refer you only carries out this procedure under gA. If so ask to go elsewhere where you can do it without anaesthetic, or LA if you prefer!
Re being tested for lichen sclerosis - I know nothing about this. I presume you have read up on it? However if the only reason they are suggesting this is because you need to use Vagifem for 5 nights per week then again this is rubbish! Previously women were able to use 2 x 25 mcg twice a week and then this was withdrawn to less than half the dose. The gynae has not read the sceintific paper if s/he says it works. What the research showed was that a statistically significant sample of women showed improvement on various indicators ( vaginal ph, epithelial cells - something like that - can't quite remember) - compared to placebo or no treatment. The results did not show a 100% improvment. The research also stated that greater improvement was found with 25 mcg dose than 10 mcg ie it is dose dependent. You are one of those women - as you have read on here there are others.
Several of us on here use local oestrogen ( ie 10 mcg Vagifem twice a week) in addition to systemic oestrogen so we are in effect getting more oestrogen.
You do not need a hysteroscopy initially to look at the thickness of the uterus if they are worried about the lining thickening on the Vagifem (and this is quite unusual anyway - you would have bleeding if this was the case). The lining is usually first tested using ultra-sound scan amd then transvaginal scan if necessary. As far as I know the hysteroscopy is not needed to measure thickness but to look at the surface of the womb lining for abnormalities, especially if the lining has been shown by scan to be thickened, and if irregularities might be seen ( as in my case). Maybe they are concerned about this?
You do not need to go privately for a second opinion but you do need a second opinion. This would not have happened in my area and please don't be pushed into having a GA if you don't need one.
As for the Mirena - what's this supposed to be for?
I've probably repeated myself as I haven't read though my other post and out working in a bit - but hope this is helpful!
Hurdity x
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It's the thought that any Surgeon would 'operate' without an initial consultation that bothers me :-\
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Sorry my previous ramblings are not that clear!
I was referred to consultant gynae by female GP because I was having to use Vagifem more than twice a week. I saw consultant in August who, rather abruptly, told me that I needed a Hysterscopy because I was overusing Vagifem...5x a week and because I am overweight ( I have lost 10lbs over the summer though)
I asked for a scan first but this has been refused, have been told they are not that reliable.
I have not had any bleeding between periods......last period was March but that was a light one, last proper one was September 2014.
The vulva biopsy is suggested to rule out lichen Sclerous ....I have researched it, and I do not have the symptoms of that!
Consultant said VA always responds to Vagifem and if it does not, other skin conditions need to be looked at...hence the skin biopsy.
Mirena was suggested to stop womb lining build up due to my over zealous use of Vagifem and because of my weight.
Doctor is happy to refer me to female consultant, as I do not wish to see him again, and I feel uncomfortable seeing a male as well due to something that happened when I was a young adult.
If I am referred to female gynae, do you think she will change the plan he suggested or will she be unable to change it, I am worried by this as the hospital is the same one.
I do not want a GA or Spinal block.....I have found out female gynae runs a one stop Hysterscopy clinic....do you think this means she does it without GA?
I now don't know what to do, I am so fed up and got the impression that female GP won't budge and give me the full HRT I want to try.
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Other problems need to be ruled out I suppose, we shouldn't blame every thing on menopause ::). You are entitled to a Nurse when you see a Consultant/GP ……… I often stood with patients (male and female) if the Nurses were busy ;).
'always responds' ::) wonder where she read that! I rarely believe GPs when they begin pulling ideas out of thin air!
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Thanks for filling us in on the details Tinkerbell. it is really worrying how treatment differs from area to area.
What I said in my long previous post below about Vagifem still stands. I don't like to disagree with a consultant but it is shown on here that women don't always respond to Vagifem at the dose of 10 mcg twice a week - I mean as I said in earlier post - the research paper shows this!!!! Many women used 25 mcg twice a week in order to stay comfortable. As I also said some women are using 10 mcg twice a week in addition to full HRT - like myself. Your GP did not need to refer you on this basis as she (the GP) does not understand that some women need more than 10 mcg twice a week. There are women on here who have been prescribed double this amount ie using 2 x 10 mcg twice a week or as you say 5 x per week (which is the old dose).
You most certainly do not need a Mirena because you are using Vagifem!!! That is ridiculous! Endometrial thickening while using Vagifem is very unusual. Some gynaes recommend an annual progestogen challenge just to see if it has thickened - if it has there would be a small withdrawal bleed. If you want to use full HRT though, you could have a Mirena for the progestogen part of HRT and then use a patch or gel oestrogen. This should be your choice though!
You certainly don't need spinal block nor GA for hysteroscopy - if my experience (and others on here) is anything to go by.
There is no reason not to have a scan first to see if there is thickening - I mean there is no evidence of this is there ie thoikening? It's like saying I need to have a hysteroscopy because I use a medium dose oestrogen on a long cycle - which is way more than you are using.
You could find out if the female gynae does the hyseroscopy under LA or none?
From what you've said, you really really should not have to do all of this - and you need to tell your doc this or someone before it goes too far?
Rather than go to see a private gynae, could you write all of this in an e-mail consultation with Dr Currie (costs £25) and see what she says. Info on the home page of this website. Then take it from there.....
Hope this helps :)
Hurdity x
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Good idea :)
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Just to say that our local hospital offers GA for hysteroscopy if you feel you need it and you are then a day case patient but NHS advice is that not even a local is needed - as Hurdity says - it all depends on preference I suppose. Some people get too anxious to have the procedure carried out without any form of anaesthetic and others sail through it. http://www.nhs.uk/Conditions/Hysteroscopy/Pages/Theprocedure.aspx
Taz x
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:thankyou: