Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Nxdavies on August 28, 2018, 07:24:34 PM
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Hello all,
I've had bladder issues - soreness, irritation - plus soreness around my urethra for a few months.
A Urogynaecologist has diagnosed vaginal atrophy and has prescribed vagifem with a 14 day, daily loading dose followed by 3 tablets per week after that. I'm due to go back and see him after 3 months to check progress.
I started to see an improvement in symptoms during the first 14 days but I've been on the three time per week dose for two weeks and symptoms are getting a bit worse again. Do I need to persevere for longer with the three times per week dose or go back and see him sooner to increase the dose or try something different?
He's also recommended the Juliet treatment which involves lasers in your vagina to rejuvenate it all. Does anyone have any experience of this? He only been doing it for a year and has only treated 25 patients so I'm a little wary.
[commercial link removed]
Thanks in advance.
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Some people need to use Vagifem daily to keep symptoms under control. The dosage in the pessaries nowadays is only 10 mcg estradiol, whereas it used to be 25 mcg. I would try upping your dose, maybe see if 5 per week does the trick, and if not try daily.
I don't know anything about the Juliet treatment, but it sounds a bit like the MLT (Mona Lise Touch) which a few MM members have had. Maybe someone else will be along to answer this part of your query.
JP x
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Thank you JP x
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I too would be wary. Give the atrophy treatment a good trial first. As Joaniepat mentions, the dose is much lower these days so ladies may need to use it nightly. For ever.
I use Ovestin, same idea different delivery.
Have a read round of the various atrophy, bladder and Mary Janes [I think :-\] thread about laser treatment.
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OK makes sense thank you.
I just don't know how long to persevere with the three times per week before increasing it again myself or going back to the Gynae. I want to give it a chance but I'm also concerned that the atrophy will worsen (and need longer to recover) in the mean time.
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I need to use Vagifem every day along with systemic HRT to control my VA.
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Increase yourself. Every night if necessary. Some ladies use other products as well as, i.e. Sylc and Yes - do a 'search' here to see what is suggested.
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Hello all,
I've had bladder issues - soreness, irritation - plus soreness around my urethra for a few months.
A Urogynaecologist has diagnosed vaginal atrophy and has prescribed vagifem with a 14 day, daily loading dose followed by 3 tablets per week after that. I'm due to go back and see him after 3 months to check progress.
I started to see an improvement in symptoms during the first 14 days but I've been on the three time per week dose for two weeks and symptoms are getting a bit worse again. Do I need to persevere for longer with the three times per week dose or go back and see him sooner to increase the dose or try something different?
He's also recommended the Juliet treatment which involves lasers in your vagina to rejuvenate it all. Does anyone have any experience of this? He only been doing it for a year and has only treated 25 patients so I'm a little wary.
https://juliet-laser.com
Thanks in advance.
Did you try increasing the frequency of vagifem? I am in the same.e position now. Took it daily for 2 weeks with positive results and then reduced to twice a week but now have burning and increased loo visits.
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I messed around for a couple of years on two, three a week, then every other day, it didn't work for me and I struggled all that time. Now I just use everyday, morning or night, makes no difference whichever you prefer. I also use Ovestin on the outside daily too, but use this at night so it has chance to absorb better as not going to the loo all day. Use the YES water based moiturisor, this is organic and don't sting at all and I am super sensitive. You have to keep this up all the time but it will get better and then becomes routine.
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I emailed my gynaecologist and asked him what to do and he said keep to three days. I did that and gradually things have got better and better over the weeks. It's not completely resolved as I'll get the odd day of soreness. I'm going to see him next week for a 3 month review so I'll see what he says then about how to fix that.
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Oh and an important aspect for me is to try to relax the whole area by deep breathing and trying my best to unclench! I think I hold a lot of emotional tension in that area as well as clenching against the discomfort. There are a whole host of muscles and nerve endings there so relaxation techniques can't hurt.
I hope you feel better soon. X
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I don't really understand why anyone with atrophy would hesitate to use Vagifem daily. Your body gives out very accurate distress signals I find! Its all about quality of life ladies.
Yesterday I searched for the NICE statement which says it is safe to use every day but didn't find it. I want to have it available before I speak to the GP. She was helpful but didn't appear to know much about it and I suspect that she might resist. Do you happen to know? I can't search now because I am at work.
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I haven't increased it myself as it is oestrogen after all, all be it a small amount, so I would prefer the dosage to be medically prescribed taking in the overall view of the other HRT I'm using rather than me deciding myself.
Also those of you taking more than your doctor has prescribed - how do you get enough for you to use, say 7 days per week, if your doctor has only prescribed 3 times per week?
Don't you run out of vagifem too soon or does your doctor give you a new prescription regardless even though it's much sooner than they would expect?
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I haven't increased it myself as it is oestrogen after all, all be it a small amount, so I would prefer the dosage to be medically prescribed taking in the overall view of the other HRT I'm using rather than me deciding myself.
Also those of you taking more than your doctor has prescribed - how do you get enough for you to use, say 7 days per week, if your doctor has only prescribed 3 times per week?
Don't you run out of vagifem too soon or does your doctor give you a new prescription regardless even though it's much sooner than they would expect?
I am not using any other HRT but suspect I will have problems convincing a GP that I might need to use it more frequently. That's why I am looking for NICE guidelines to support my argument. I had a previous encounter some time ago with a GP (whom I have since avoided) who shouted at me for suggesting that it was safe to use Estriol cream for more than about 3 months.
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This might be the guidelines you're looking for
https://www.nice.org.uk/guidance/ng23/evidence/full-guideline-559549261
(page 120)
There are also other links on our homepage
https://www.menopausematters.co.uk/index.php#nice
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This might be the guidelines you're looking for
https://www.nice.org.uk/guidance/ng23/evidence/full-guideline-559549261
(page 120)
There are also other links on our homepage
https://www.menopausematters.co.uk/index.php#nice
Thanks Emma. I will have a closer look later.
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I have VA and began on vagifem then later to ovestin which I found better, but we are all different. The main thing is that it's a really slow process. It was maybe a year for me to really benefit. It's very stressful but you just have to plod on.
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We have to take control, if we require more of the product then GPs should accept that fact. We know our bodies! ;-). If symptoms niggle then use it more often.
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I totally agree CLKD but I suspect my nice GP won't give me more Vagifem just on my insistence, he'll want it prescribed by my gynae.
I think it's limited just how much control you are able to take sometimes unfortunately.
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I use Vagifem every day, found a GP who is happy to prescribe whatever helps to make me comfortable, my named GP is a stickler to the two a week prescription so I avoid him.
I saw a gynaecologist a couple of years ago and she was involved with meno clinics and said it was quite safe to use every day.
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MayB your GP will want it prescribed by a Gyane due to the cost to his Practice? I haven't seen a Gynae since 1998. My GP or Nurse Practitioner are good at making suggestions and following through with prescriptions.
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I am yet to see the response from my GP. I am going to try to arrange a phone call tomorrow when I go for my flu jab appt. and check my urine test result. My discomfort from the weekend has calmed down a bit since inserting a Vagifem this morning so I will wait and see how it is by tomorrow. It may still be the effect of the painkiller. I will do it daily for this week if it continues to improve.
How many of you order treatments like Sylk or Yes online? Just interested. I have always held back from ordering any prescription medication online.
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I have always ordered Sylk and Yes online. They don't require a prescription so it's not a problem. However, I believe both can be prescribed on the NHS if your GP will do it.
JP x
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I'm not taking more than my gynae has prescribed me and 2 boxes of vagifem last me about 7 weeks on repeat prescription. I also get the YES products on prescription but have also ordered on line before the VM moisturiser was on NHS. I wouldn't be able to go to work on two vagifem a week, I wouldn't be able to sit down and i still struggle sometimes on the daily dosage. People probably managed on 2 a week a few years ago when the dosage was 25mcg a tablet but not now it's only 10mcg.
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I have always ordered Sylk and Yes online. They don't require a prescription so it's not a problem. However, I believe both can be prescribed on the NHS if your GP will do it.
JP x
I had assumed that they required a prescription as for Vagifem. Do you order them from Boots online?
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I expect you could get them from Boots online, a click and collect order might be the quickest way to get them. However, I have always ordered directly from the Sylk and Yes websites.
JP x
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I went back to see the gynaecologist a month ago after three months on vagifem, three times per week.
At the time I told him that things were feeling a fair amount better but not completely resolved. He told me to keep to the three times per week and to use Yes OB (the oil based version) every other day.
A month in and I'm still uncomfortable in (what I think is my bladder) with spasm type feelings and discomfort. If anything it's gone worse.
I'm not sure whether to back and see him or to try my GP to see what they recommend as I'm fed up of the constant discomfort. Perhaps I should just do vagifem daily for a couple of weeks to ‘prove' that it would resolve my issues or not.
Also, do any of you find that constipation makes your bladder and urethra symptoms worse?
Sorry for a bit of a ramble!
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I went back to see the gynaecologist a month ago after three months on vagifem, three times per week.
At the time I told him that things were feeling a fair amount better but not completely resolved. He told me to keep to the three times per week and to use Yes OB (the oil based version) every other day.
A month in and I'm still uncomfortable in (what I think is my bladder) with spasm type feelings and discomfort. If anything it's gone worse.
I'm not sure whether to back and see him or to try my GP to see what they recommend as I'm fed up of the constant discomfort. Perhaps I should just do vagifem daily for a couple of weeks to ‘prove' that it would resolve my issues or not.
Also, do any of you find that constipation makes your bladder and urethra symptoms worse?
Sorry for a bit of a ramble!
Hi Nxdavies I saw your question over lunch and wanted to reply. You might have seen my other recent comments about seeing a urogynaecologist. I am currently trying Vagifem daily to see how it goes. I took it daily for 2 weeks with good results. I then returned to twice weekly or alternate days (due to insufficient supply). A GP had agreed to daily over the phone but, when I requested a further supply, I wasn't given enough so I had to ration it.
I found that it helped the day after application but the effect wore off the next day.
Last week I had the urogynaecology appt. The doctor willingly agreed to supply enough for me to try it daily for up to 4 weeks (a bit reluctant to go further) and gave me a prescription. I went to the hospital pharmacy to get it but wasn't allowed any. The hospital authority (not my home one) has decided that its pharmacists are only allowed to prescribe Ovestin, not Vagifem. The doctor who saw me was new there and it seems that she didn't know this. I have written her a short letter to let her know. I have to go back to my GP and persuade them to let me have more. I have the prescription document from the doctor but I suspect that I will have problems with it.
In the meantime I am using it daily but have only been doing this for 3 days. Too early to see if it is going to help. I don't know about Juliet so can't help there.
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Thanks for replying Katejo. How frustrating! They don't make it easy for us sometimes do they!
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I am frustrated reading these struggles with gp/gynae/prescriptions. The stress only makes this condition worse. I have had bladder problems since being off hrt following post meno bleeding, triggered by a boutique of cystisis. I am just using ovestin now and still struggling and you just can't get on with your life. The gynaecologist I saw seemed to think I could have a break from local hrt "when symptoms abate". What a prat! If I stop they will get worse again and it will take months to get any normality back. I can't express what a moron this man was. I'm back in the care of my gp, so hope not to have future problems about adequate prescribing. Yes, constipation will make bladder symptoms worse. I always keep prunes in the cupboard now just in case! Oh the glamour of my life! Also scared to have red wine, coffee, a bath or sex until things settle down.
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Do you know why constipation affects it Suzy?
I took a Senokot a couple of weeks ago to resolve my constipation and it seemed to make my bladder much, much worse. Burning inside etc.
I don't quite understand why constipation affect the bladder and atrophy symptoms.
I've since been eating bran based cereals to help things along but I wonder if that makes it worse as my bladder feels quite spasmy and my bowel is just not right either.
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I think it's because straining puts pressure on the bladder and triggers the nerves. I know what you mean about the bladder and bowel not feeling right. I don't have constipation much but it does trigger those awful feelings. I drink plenty of water and find prunes to be quite gentle on the bowel. I buy those dried ones in resealable bags. It's what works for you and trial and error. I know it makes you feel horrible and can't think of anything else but your boring bits that refuse to behave themselves!
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I think it's because straining puts pressure on the bladder and triggers the nerves. I know what you mean about the bladder and bowel not feeling right. I don't have constipation much but it does trigger those awful feelings. I drink plenty of water and find prunes to be quite gentle on the bowel. I buy those dried ones in resealable bags. It's what works for you and trial and error. I know it makes you feel horrible and can't think of anything else but your boring bits that refuse to behave themselves!
I also don't have a constipation problem but, when the bowel is full, there is a feeling of pressure on the bladder.