Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Turkish delight on April 30, 2019, 08:12:58 AM
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Hi girls!
Wanting a mini poll to get an idea of the average ppl are using weekly if you don't mind sharing for us newbs :thankyou:
Can you share dose ie 1x 10mcg or 2x 10mcg and how many times you use per week?
If you would like to add how it's helped you that would be a bonus.
I need to go back to get a repeat as I'll be out soon, and was wanting to know how much to make a play for dose wise from the GP.
Thanks girls
:peace:
TD
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The British Menopause Society (BMS) recommends one every other day, or up to 5 per week. It seems we have all been underdosed and the GP's twice a week is not enough. I got this information from Jane Lewis's Facebook group. Jane keeps well up to date with things.
Personally, I use every other night at the moment, and this is with the Estring as well. I'm also on systemic oestrogen.
JP x
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Hi TD. I don't mind sharing. I take 3 x week just one each time. It was because of repeated UTI's that my GP started me on it and (touching wood now) I haven't had any since. Around two years now
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Hi Turkish Delight - don't mind at all! I am prescribed 10 mcg and I use it twice a week. I found it virtually impossible to tolerate a smear test before using it. I also found that walking was uncomfortable and sex impossible. I would say that it "keeps a lid" on things for me. I'm not 100% better but at least I can walk around comfortably now and just about tolerate smear tests. I think I could probably really do with having it 3 times per week and will discuss this on my next visit. Hope that helps.
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I use one every day, have never managed on the twice a week, I also double up on that for a couple of days if I think I am heading for a flare up of symptoms.
One GP at my surgery said she was happy to prescribe 5 a week to everyone as that was equivalent to old dose, she said a lot of her ladies had problems when the dose was reduced a few years back.
I can now sleep, walk and sit, not a lot to ask for is it!
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I've just finished my 2 week load (1x10mg), then switching to twice a week.
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I've just finished my 2 week load (1x10mg), then switching to twice a week.
You are likely to find that twice a week isn't enough. I need at least 4 a week and sometimes 5 or 6. Like Herdwick my UTI 's have stopped but only 6 months clear so far. Hopefully that will continue.
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If someone who is on my FB page can put up the 3 photos by Dr Renee onto here ( I have no idea how to) as said further up, twice a week is not enough & every other day up to 5 times a week indefinitely.
Unfortunately this information only gets to those who are interested and keep up to date such as Dr Renee, & her the information to the “ gate keepers†aka GP is hit & miss, I mean some aren't even aware of the 2015 NICE guidelines. 🥴
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If someone who is on my FB page can put up the 3 photos by Dr Renee onto here ( I have no idea how to) as said further up, twice a week is not enough & every other day up to 5 times a week indefinitely.
Unfortunately this information only gets to those who are interested and keep up to date such as Dr Renee, & her the information to the “ gate keepers†aka GP is hit & miss, I mean some aren't even aware of the 2015 NICE guidelines. 🥴
I have just tried to do so. I 'snipped' one of the photos from the FB page as a test but MM won't let me paste it here. :(
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Thanks for trying well at least you have seen the post by Renee so can confirm what I'm saying is correct. 🤗
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Thanks for trying well at least you have seen the post by Renee so can confirm what I'm saying is correct. 🤗
Yes it is correct :)
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7 x 10mg
Maryjane, what is the name of your FB group ? X
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Wow this is really helpful, keep um coming! :bouncing:
Re adding photos, I have seen posts with photos in them.
Can someone who has worked it out explain how to do it for us?
I don't even have a facebook account so wouldn't be able to see the link.
TD
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Annie's its mcg not mg 🤗 huge difference.
https://www.facebook.com/groups/1505719029448248/?ref=share
FB if it shows ? I will be able to see it as it's my group.
It's called Vaginal atrophy, there are 1300 of us, it's a green background with the silhouette of a women, not everyone can find it, but those who do are very relived. 😊
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Between 5 and 7 times a week for me.
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I used one every other day and would do the loading dose every couple of months.
I am however currently trying the estring for the first time but haven't been using it long enough to comment on its effectiveness v vagifem
Lanzalover x
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Probably wishful thinking with 10MG lol
Thanks Maryjane, I'll take a look x
Annie's its mcg not mg 🤗 huge difference.
https://www.facebook.com/groups/1505719029448248/?ref=share
FB if it shows ? I will be able to see it as it's my group.
It's called Vaginal atrophy, there are 1300 of us, it's a green background with the silhouette of a women, not everyone can find it, but those who do are very relived. 😊
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I have recently changed from twice a week to once every 3 days - to coincide with my patch change which I've also recently changed - but I'm often late with the Vagifem.
The amount you need to be comfortable is very variable!! It depends on the individual woman, and also whether you are also on systemic HRT as well and the oestrogen dose. In the week leading up to the Utro cycle I try to remember to do it weekly or every other day for a week but as I've just shortened my cycle I keep forgetting this too!
The absolute minimum dose is daily for a fortnight and twice weekly thereafter. This will be fine for many women but of course needs to be individualised as Maryjane says - the trials showed this was effectve only for a proportion of women so the rest will need more! This must be done under medical supervision.
Maryjane I can't find anything about actual dosing on the BMS website - it just gives this summary statement:
https://thebms.org.uk/publications/consensus-statements/urogenital-atrophy/ . Have they issued an updated advice recnetly that hasn't been put on the website?
I know the NICE Guidelines say that if the standard dose is insufficient it can be increased under medical supervision but I don't think it's specific.
The dose I take (which is pretty much the licensed dose of 10 mcg twice weekly) works fine for me, but along with systemic HRT of approx 62.5 mcg patch. If I didn't take HRT as well - it would be totally rubbish on that dose!!!
Estring gives a higher dose which is why it's absurd that the Vagifem higher dose was discontinued - by a different company! Lanzalaover - would be interested to hear how you get on with the Estring - another thread?!
Let us know how you get with the doc Turkish Delight!
Hurdity x
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Hurdity 😊 I believe you are on twitter? If you find Dr Renee Hoenderkamp you will find a discussion a few weeks ago, & you can question her about it.
A bigger discussion as taken place on my group on/off.
She said in my group the other day ( as someone else asked a similar Qs) a) the NICE guidelines won't be rewritten b) info takes along time to get through.
Perhaps email Prof Cardozo who have the talk on the subject in London. 😊
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Thank you everyone for sharing, it's much appreciated :tulips2:
Just so I'm clear(cz you can bet the GP won't be...wink!)
NICE guidelines say dose can be increased from 10mcg twice weekly under specialist consultation??
And BMS recommend 1x10mcg every other day??
Both include 2-week loading dose.
I'm running out of them fast, only have 6 left got bank holiday in the way and it's blinking hard getting an apmnt when I'm free to go.
Really don't want to have a hold up getting them as I'm only just having a slight improvement in the urgency to pee. It's still an issue after 2 weeks loading and 1 every other day. Been 3 weeks so hopeful it'll get better with time.
Always feel anxious going to ask for help in case computer says NO! Wish me luck
Thanks girls
:peace:
TD
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5-7 a week. My GP is great. They are now on repeat prescription and I get two boxes. My symptoms were bladder related- urgency and frequency. Not a cure but much more manageable.
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Thank you everyone for sharing, it's much appreciated :tulips2:
Just so I'm clear(cz you can bet the GP won't be...wink!)
NICE guidelines say dose can be increased from 10mcg twice weekly under specialist consultation??
And BMS recommend 1x10mcg every other day??
Both include 2-week loading dose.
I'm running out of them fast, only have 6 left got bank holiday in the way and it's blinking hard getting an apmnt when I'm free to go.
Really don't want to have a hold up getting them as I'm only just having a slight improvement in the urgency to pee. It's still an issue after 2 weeks loading and 1 every other day. Been 3 weeks so hopeful it'll get better with time.
Always feel anxious going to ask for help in case computer says NO! Wish me luck
Thanks girls
:peace:
TD
My GP still only gives me the standard prescription for new users (which says daily for 2 weeks and then twice a week). 2 weeks ago I had a follow up urogynaecology appt. and the consultant and nurse there both said that it was fine to use them daily if needed. I asked whether a further letter would be sent to my GP and, if so, would they include that so that I could get an further supply if needed ? They said yes but I don't know if the GP has received the letter yet. I have just started HRT but it is too early to see improvment from that.
I have got a flare up at the moment for the first time for 7 months. I can't be sure whether it is just VA or i might have a UTI. I applied 1 Vagifem last night and another this morning as a boost and I have taken nurofen. I always get these symptoms just as I am due to go on holiday!
Good luck for your appointment and let us know what happens.
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Anyone worry about bleeding from using local hrt. I worry about everything.
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Anyone worry about bleeding from using local hrt. I worry about everything.
Have you had any bleeding from local HRT already? I haven't but have been told that it might happen with systemic but is normal.
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No I have had no bleeding from local hrt, I use Ovestin. I am post meno so bleeding taken seriously. I had bleeding on systemic tibolone but came off it. Now I am over cautious. I use Ovestin alternate nights on gp approval. I know this thread is about vagifem. I just work myself up into panic mode after the tibolone and biopsy. Sorry to veer the thread away.
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No I have had no bleeding from local hrt, I use Ovestin. I am post meno so bleeding taken seriously. I had bleeding on systemic tibolone but came off it. Now I am over cautious. I use Ovestin alternate nights on gp approval. I know this thread is about vagifem. I just work myself up into panic mode after the tibolone and biopsy. Sorry to veer the thread away.
I am post meno too but know that with Evorel Conti bleeding is normal. I haven't had any with Vagifem. Haven't used Ovestin.
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2 a week and sometimes a few days in a row to give a mini-boost
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5 - 7 times a week, need every day when at work sitting all day but manage less when not at work.
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I'm finding this very interesting as I'm about to come off HRT and have been prescribed Vagifem; initial 2 week loading dose then 1 x twice/week - I'll see how it goes...
Love Spadger x
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5 x 10mcg a week with 0.01% Estriol cream for external bits. Not currently on systemic HRT, but needed the 5 Vagifem a week + Estriol same nights, even when on systemic (poor absorption from patches). As the other ladies have said, it varies from person to person & 2 may be perfectly adequate for many, especially on systemic HRT.
Up to 5 Vagifem rather than 2, together with the weak Estriol cream outside, recommended by menopause clinic who also suggested varying Vagifem insertion depth, saying effect is very localised, so one high, one low alternately, though I think the PIL says halfway or something similar - don't quote me though, have not read recently! Meno clinic said OK to use 2 at a time, up total of 5 a week (one high, one low on 2 nights, then a night with just one) which reduces the number of nights the area is out of action ;).
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I'm finding this very interesting as I'm about to come off HRT and have been prescribed Vagifem; initial 2 week loading dose then 1 x twice/week - I'll see how it goes...
Love Spadger x
I popped into Boots pharmacy today just to ask a question about Vagifem. Fortunately it wasn't busy so I could do so. I have noticed that every repeat prescription ,which the GP sends to Boots , assumes that I am a first timer and gives me 1 box with the instruction to apply daily for 2 weeks and then twice weekly. This is even though a consultant has told the GP that I can use them daily if needed. He was sympathetic and said that the GP's are lazy and simply hit the button on their keyboard to generate the same prescription every time. Suggested that I ask for it to be changed.
I will try that when I next have an appointment. Will have to make one soon.
Why are you stopping HRT Spadger? i have just started it and the meno consultant thinks it will help the VA further/reduce the dose needed . The Vagifem is working for me and I am sleeping through the night more often due to less frequent need to go to the loo. Occasional flare up still happens if stressed.
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5 x 10mcg a week with 0.01% Estriol cream for external bits. Not currently on systemic HRT, but needed the 5 Vagifem a week + Estriol same nights, even when on systemic (poor absorption from patches). As the other ladies have said, it varies from person to person & 2 may be perfectly adequate for many, especially on systemic HRT.
Up to 5 Vagifem rather than 2, together with the weak Estriol cream outside, recommended by menopause clinic who also suggested varying Vagifem insertion depth, saying effect is very localised, so one high, one low alternately, though I think the PIL says halfway or something similar - don't quote me though, have not read recently! Meno clinic said OK to use 2 at a time, up total of 5 a week (one high, one low on 2 nights, then a night with just one) which reduces the number of nights the area is out of action ;).
I have experimented with high and low on alternate days but not 2 at a time. I haven't persuaded the GP to let me have enough to do that yet. See my reply to Spadger.
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Katejo, I think my script repeat form allows me to have one box a month now (I am away from home so cannot check) but the problem I keep coming up against is the pharmacy have used all their monthly quota when I go to collect mine, so I try to always order well in advance & have a box in hand. The pharmacy don't seem to be aware I need 5 a week - will have to check what it says on the dispensing label. I hope you manage to get yours sorted so that you can have enough prescribed for the amount your Cons has authorised. I think GPs can be so busy that repeat scripts are issued by default, so getting one changed can take a little persistence!
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Katejo, I think my script repeat form allows me to have one box a month now (I am away from home so cannot check) but the problem I keep coming up against is the pharmacy have used all their monthly quota when I go to collect mine, so I try to always order well in advance & have a box in hand. The pharmacy don't seem to be aware I need 5 a week - will have to check what it says on the dispensing label. I hope you manage to get yours sorted so that you can have enough prescribed for the amount your Cons has authorised. I think GPs can be so busy that repeat scripts are issued by default, so getting one changed can take a little persistence!
My script currently gives me a repeat each time that I get my repeat for my other medication. I haven't come across the pharmacy having a monthly quota (yet). So it could be that a GP could send a prescription and the pharmacy would refuse it because too many other women have requested it? My dispensing label just gives the standard first prescription dose which I mentioned above.
I could try to request another prescription from the GP via their app and see if they allow it.
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The pharmacy wouldn't refuse it, but you would have to wait until their next month's quota came in to have it dispensed. This has happened to me repeatedly in the last 12 months or so & I know other women posting here have experienced the same. In fact, it's been rare for any script including Vagifem to be filled (for that item) on the day I've first gone in to collect it. My pharmacy is around 15 miles from home & I can only get there once a week so I am sometimes in the position of waiting a couple of weeks or more to get a box of Vagifem. Essential to be organised & make sure I always have enough in reserve! This was never a problem with that pharmacy until the last year or so.
They have also found it difficult to fill my thyroxine scripts with my named brand, so much so, that after a wait of around 4 months for one strength which to date they have still been unable to get, I had to change brands for all 3 strengths I need a few months ago, which I really didn't want to do as I was stable on that brand & as you know absorption differs from one brand to another. I don't want to change pharmacies as I had only moved to this one around 2 years before because my previous pharmacy consistently failed to obtain another item with long enough dates to last until the end of a box. It had become so stressful not being able to get that, that I went to several pharmacies in the area to ask which felt they could get it more easily for me with a long enough date to last the 2+ months I needed on every box. The one I'm now with is an independent who explained that the big chain pharmacy I had been with would be tied to suppliers, whereas they would have a choice of where they went for meds to fill my scripts. Worked very well for a year or so. I wonder whether perhaps more recently patients have been stockpiling meds in fear of being short post-Brexit & this may perhaps have caused the shortages.
If your scripts are not sent through to the pharmacy electronically (as mine are) the thing to do would be to shop around if you are worried you might be short of Vagifem. Just take it in by hand & see which could dispense for you? Sorry - I know that's obvious!
Seem to have taken this off topic - you got me going with the question about availability, Katejo! Sorry everyone.
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Hi I've been using Vagifem twice a week for a few years now - recently I started using it every second
night because after going for a wee I feel I need to go back to the loo again and can usually and can usually go. 🤷🏼♀️
Before I increase the Vagifem again the Doctor is making an appointment for me to have a scan of my bladder....just to see if it's emptying properly.
She also asked me if I had considered using Estring which lasts for ninety days.
Not sure which would be the best...would be interested in hearing if anyone else changed from Vagifem to Estring? 🤔
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On three a week and once a month I take four a week. Use YES VM three times a day on days without vagifem. Will be having Monal Lisa Touch as this regime does not allow me to have sex and I still get sore. Jane Lewis and all you ladies have saved me from getting worse because I am more informed and empowered. Thankyou so much. My doctors have not caught up with the modern world and so I get my HRT privately when necessary. Love to you all. :) xxx
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U may need nightly then riverrunsfree. 10 isn't a large dose after all, initially it was prescribed at 25.
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The pharmacy wouldn't refuse it, but you would have to wait until their next month's quota came in to have it dispensed. This has happened to me repeatedly in the last 12 months or so & I know other women posting here have experienced the same. In fact, it's been rare for any script including Vagifem to be filled (for that item) on the day I've first gone in to collect it. My pharmacy is around 15 miles from home & I can only get there once a week so I am sometimes in the position of waiting a couple of weeks or more to get a box of Vagifem. Essential to be organised & make sure I always have enough in reserve! This was never a problem with that pharmacy until the last year or so.
They have also found it difficult to fill my thyroxine scripts with my named brand, so much so, that after a wait of around 4 months for one strength which to date they have still been unable to get, I had to change brands for all 3 strengths I need a few months ago, which I really didn't want to do as I was stable on that brand & as you know absorption differs from one brand to another. I don't want to change pharmacies as I had only moved to this one around 2 years before because my previous pharmacy consistently failed to obtain another item with long enough dates to last until the end of a box. It had become so stressful not being able to get that, that I went to several pharmacies in the area to ask which felt they could get it more easily for me with a long enough date to last the 2+ months I needed on every box. The one I'm now with is an independent who explained that the big chain pharmacy I had been with would be tied to suppliers, whereas they would have a choice of where they went for meds to fill my scripts. Worked very well for a year or so. I wonder whether perhaps more recently patients have been stockpiling meds in fear of being short post-Brexit & this may perhaps have caused the shortages.
If your scripts are not sent through to the pharmacy electronically (as mine are) the thing to do would be to shop around if you are worried you might be short of Vagifem. Just take it in by hand & see which could dispense for you? Sorry - I know that's obvious!
Seem to have taken this off topic - you got me going with the question about availability, Katejo! Sorry everyone.
I haven't had that problem at all yet re. supply though I am expecting it with Brexit. i actually have a surplus of 100 mcg Levothyroxine due to a GP error some time ago. Mine are sent electronically to Boots.
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The following 2 links recently posted by Flaxhigh in a thread about progesterone contain information that seems to contradict what I was told about placement of Vagifem at the menopause clinic a couple of years ago (i.e. one high, one low). Deep insertion seems to be discouraged in these articles.
I vaguely remember a discussion about this on MM a long time ago that revolved around the semantics of anterior & posterior as used in the Australian link, given it is not possible to determine whether Vagifem sticks to front or back vaginal walls on insertion. But posterior here is used to mean "deep". Can't remember the consensus we all reached when discussed last time, so thought I should repost Flaxhigh's links here. I am now not sure which is the most reliable advice, but seems responsible to draw attention to the difference to what I was told.
Thank you Flaxhigh, if you are reading - though you posted the links to confirm legitimacy of vaginal route for Utrogestan, the detail on placement of Vagifem seems important here.
https://www.ncbi.nlm.nih.gov/pubmed/17981510
https://www.whria.com.au/wp-content/uploads/2016/08/HRT-Micronised-Progesterone-2016.pdf
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Katejo - ah, if sent electronically you don't have the option of shopping around. Same here, though it is possible to ask for a one-off script to collect from my surgery & take to a pharmacy of choice. I try not to do this though, as it seems to disrupt their preferred procedure!
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I feel unsure of the safety of local hrt, wrensong, though I have to use something. I use Ovestin worried all the time about it.
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Hi I've been using Vagifem twice a week for a few years now - recently I started using it every second
night because after going for a wee I feel I need to go back to the loo again and can usually and can usually go. 🤷🏼♀️
Before I increase the Vagifem again the Doctor is making an appointment for me to have a scan of my bladder....just to see if it's emptying properly.
She also asked me if I had considered using Estring which lasts for ninety days.
Not sure which would be the best...would be interested in hearing if anyone else changed from Vagifem to Estring? 🤔
Hi Bluebell. I too have this problem. Have had cystoscopy and full and empty bladder scans which were all okay. The consultant suggested that when I think I have finished then I should cough and this does work for me so I sit for a bit longer and just cough a few times. Worth a try
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susysunday - try not to worry. My GP wouldn't have prescribed it for me had it not been safe. I had breast treatment in the 1990s. I couldn't have lived with the VA feelings anyway ..... what's the worst that could happen?
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Suzysunday - so sorry if the links were scary, but after having posted the advice I was given at a very highly regarded menopause clinic then finding those 2 links posted elsewhere in current circulation, I felt it would be remiss not to flag them up. Topical HRT is generally considered very safe indeed, so I really don't think there is cause to worry - it was just that the issue of placement concerned me, given the advice in the links differs from what I was told by a Meno specialist.
We all need to take some difficult decisions at this stage in our lives & the information we have to base these on is often imperfect, but if it's all there is, we have to make something of a leap of faith. Life without topical HRT would be unthinkable for many of us & it's important to keep the urogenital tract in as good condition as we can, so my feeling is that with medical approval & vigilance we have to use whatever is available and at the dose we each need individually. Then relax as best we can(!) in the knowledge we can flag up anything that concerns us so it can be checked out.
I sometimes wonder whether the weight of responsibility we feel when taking HRT is greater because it is sometimes regarded as "optional", but other hormonal treatments are not seen this way - for instance thyroid medication. The latter carries risks if used incorrectly, but must be used to enable us to carry on with life, so those of us who take it have no choice. If perhaps you think of your need for topical HRT in this way, maybe this will make you feel more at peace with it? :)
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I think it's because I must take hrt I worry. My gp prescribed Ovestin alternate nights for as long as needed and to insert high up. Should I use lower down? After pmb on tibolone I am so anxious.
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Is it working already suzysunday? You are over-thinking, a habit during The Change ........ 'must' take HRT? what's the option? It is replacement after all.
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I meant I need some hrt for VA and bladder pressure. I know. I over think. After 7 months of bladder pressure after coming of hrt for bleeding, I think I am getting on top of symptoms, so my brain is going into what if mode. I am just so frightened of my own body these days I can't get on with life.
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Suzysunday - please don't worry about the Ovestin cream - I've used that too in the past, but just don't get on well with internally applied creams of any sort, so the Vagifem suits me better. Just insert the Ovestin with the applicator as the info leaflet advises & at the frequency agreed with your doctor. The cream is meant to coat the internal area & will disperse as it should to work its magic & keep you healthy & comfortable down there. The form of oestrogen it contains is weaker than that in Vagifem. With Vagifem it is a tiny pessary without a cream base, so more concentrated than the Ovestin & it seems there is a more localised effect with it, which is why some of us find varying insertion depth can improve our symptoms.
I had intermittent pmb for the whole time I was on conti HRT (postmenopause) & had the various necessary investigations, so I do understand that can be a worry, but topical HRT is far weaker & therefore very unlikely to cause you problems of that nature.
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What could happen suzysue :-\. That bus might knock you over far earlier than any symptoms relating to HRT ;)
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Many thanks for your kind replies wrensong and clkd I need such assurances sometimes when my brain goes into over anxiety mode.
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Bless you Suzysunday, we all need reassurance at this time of our lives - there's so much happening, it can be overwhelming & takes time to workout what's the new normal. You will get there - I'm still working on it more than 7 years postmenopause! Don't be too hard on yourself. We are all here to help each other out.
Wx
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Thanks Herdwick, I'll definitely give the coughing a try. I don't think the scan will show up anything because I've had scans before and they were fine.
I'll let you know if the coughing gives me any relief. Cheers. 😉 x
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suzysunday - remember the 'replacement' word [H*R*T]. Forget the word 'hormone'! I couldn't have lived with the razor blades up there :o and my GP prescribed 'ovestin' which works for me.
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I'm on my first ever box, and after the 2 week loading I was doing well with frequency but now down to 2 per week on the same day I change my patch, which is only 25mcg due to spotting, the frequency is returning. M planning on trying to get to the Dr to increase it.
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https://www.facebook.com/groups/1505719029448248/?ref=share
FB if it shows ? I will be able to see it as it's my group.
It's called Vaginal atrophy, there are 1300 of us, it's a green background with the silhouette of a women, not everyone can find it, but those who do are very relived. 😊
Bumped for Avalon
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Thanks Joaniepat, you're a dear!
How do I receive notifications on MM? I don't see any symbols for that at all.
My pleasure!
If you look at the blue tab under a post it says " notify", but I have never tried it out. Maybe other MM folk can help better with that one?
JP x
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Hi, if you select notify from the blue tab either at the top or bottom of a topic, then you will receive a notification via email which will link you back to the topic. It's useful, especially if you haven't contributed to a topic but want to follow it. If you have contributed and don't want to do this then you can go to "show new replies to your post s at the top of the pages.