Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Lamplighter on September 14, 2021, 10:21:00 PM
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Hi all, I am anticipating running into problems with my GP shortly about the number of times per week I can use Vagifem - the consultant I've been seeing has written my GP a letter saying I should reduce the amount to the 'national recommendation' of twice per week - currently this is not enough to relieve the symptoms for which I'm using it :(.
I know from reading the posts on here that some ladies use it more often than the usual twice a week, and what I'm hoping for is someone to provide links to any kind of official or authoritative sanction that I could cite to support my case for more often use.
I'd trawl through the posts some more but as I'm speaking to the consultant again very soon (tomorrow evening) and hope to convince her that more than twice a week is ok, I'd very much appreciate any info anyone can give to help me out.
By the way, I am also on systemic HRT - four pumps Oestrogel and 100mg Utro daily - don't know if that makes any difference?
Thankyou :)
xxx
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The NICE guidelines do not say twice a week is the maximum.. From memory they say the dose can be increased by the health provider as necessary. My GP said 5 per week is the maximum he will prescibe, this was on instruction from my gynae. I do manage on this amount plus Ovestin for the outer bits, and would struggle on any less.
Can you google and download the NICE guidelines to quote to your consultant.
The fact your on systemic makes no difference you can use both together, it says that in the NICE guidelines too.
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Your Consultant is completely still in the Ark! Is he a Gynaecologist?
We are able to take 'vagifem' every night for Life if necessary. Twice a week is guideline but many ladies can't cope as it isn't enough to ease symptoms.
It makes absolutely no difference as to your HRT regime. Treatment for vaginal atrophy is independent of any other. Have a read of our thread on VA and print off if your GP is sniffy! He/she may however, be more aware than the consultant, let's hope so!
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NICE GUIDELINE :)
Urogenital atrophy
1.4.9Offer vaginal oestrogen to women with urogenital atrophy (including those on systemic HRT) and continue treatment for as long as needed to relieve symptoms.
1.4.10Consider vaginal oestrogen for women with urogenital atrophy in whom systemic HRT is contraindicated, after seeking advice from a healthcare professional with expertise in menopause.
1.4.11If vaginal oestrogen does not relieve symptoms of urogenital atrophy, consider increasing the dose after seeking advice from a healthcare professional with expertise in menopause.
1.4.12Explain to women with urogenital atrophy that:
symptoms often come back when treatment is stopped
adverse effects from vaginal oestrogen are very rare
they should report unscheduled vaginal bleeding to their GP.
1.4.13Advise women with vaginal dryness that moisturisers and lubricants can be used alone or in addition to vaginal oestrogen.
1.4.14Do not offer routine monitoring of endometrial thickness during treatment for urogenital atrophy.
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Thanks so much Dierdre and CLKD for your replies, and also Dierdre :foryou: for going to all that trouble of finding and posting the NICE guidelines (I had no idea where to start looking for that, the NICE guidelines seem to be constructed in such a way as to be Lamplighter-proof ;D).
The consultant (a 'she' by the way), despite listing herself as an HRT specialist, does seem to stick to the 'as little as possible for as short a time as possible' ethos, regardless of symptoms.
I'm having a phone conversation with her this evening and my main concern is actually trying to get my points across - she's not very good at listening and tends to cut me off and talk over me.
CLKD my GP is actually very accommodating, but as she's not as clued up on HRT as she'd like to be, tends to rely on the consultant's directions for authority, which is why I'm hoping to change the consultant's attitude re the vagifem.
I left the consultant's office the other day thinking, anyone who arbitrarily says that's 'too much oestrogen' in relation to my being on pumps and prog and the vagifem as well, doesn't inspire confidence in me. :( :(
One day I will get it all sorted and life will be normal again. As we all hope eh?
Thanks again
LL xxxxx
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There may not be time now, but Dr. Currie would make recommendations and offer advice if you can contact her and are able to pay her online consultation fee? Might it be possible to postpone your appointment so that you can do that? I found her recommendations were a complete game-changer with the specialist and took all the angst out of trying to plead my case myself. Just use the CONTACT tab at the top on the black menu strip if you want to go down that route. Alternatively, maybe just saying (if you feel you have a fight on your hands) you'd like to get an opinion from her could swing it. It's so stressful and exhausting trying to assert oneself to the extent that seems necessary sometimes! Good luck!
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Too much is what exactly?
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Postmeno3 thanks for replying and for such a good suggestion - I think however you're right about there not being time, the consultant is due to phone me at 6pm and is otherwise impossible to reach - it takes days to get through to her via her secretary, who only works two and a half days a week anyway ::)
I will however mention Dr Currie (and the NICE guidelines) and plan on saying that I'll go for other opinions anyway if she stays rigid - in that case will follow your suggestion. I do hope I don't have a fight on my hands, I'm not very good at confrontation and need to keep this woman on side in case absolutely nothing helps and I need to go back for more surgery. Not that I have a lot of confidence in her at the moment, so I hope surgery won't be necessary.
CLKD, precisely! How do you determine without investigating just how much too much is? She was referring to my using Vagifem more than twice a week, which rather flummoxed me as I'd have thought the pumps would have been more likely to overdo the oestrogen than the Vagifem.
Thank goodness for this forum and you helpful ladies, I'd have been browbeaten into going along with whatever any doctor said to me as they are supposed to be the knowledgeable ones - never mind how I'm left feeling/suffering... :sigh:
Thanks everyone :)
xxx
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"I've been chatting with people at MM and the general idea is to use "vagifem" or "Ovestin" as often as necessary to keep VA symptoms at bay" might be the way to start? "Because it is localised it is advised to begin with 10-14 nights then as necessary, some can drop to twice a week, others need it nightly". ;-)
She shouldn't be strict in the 'little as possible' regime, because we are all different with individual requirements. She needs to go on a Course to get herself up2date!!
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CLKD :thankyou:
xx
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Well, just finished the phone conversation, I ended up having to negotiate - if I lower the number of pumps of oestrogel I'm using, she'll recommend my being able to use Vagifem for five days a week.
Despite my quoting the NICE guidelines (thanks again Dierdre, had them in front of me while talking) and mentioning Dr Currie and this forum she was adamant that continuing to use Vagifem so often for an indefinite time period would raise the amount of oestrogen in my system to 'above what it should be' - meaning something like someone of my age/menopausal situation (65 and 12 years post meno) shouldn't be taking such high doses of oestrogen, amongst other things because it can cause any one of a number of cancers etc.
She seemed to think that if you take Vagifem for long enough it ends up absorbing systemically and adding to the amount of oestrogen in your system - for all I know she could be right :(. And only agreed to my negotiations under suffrance, ie not happily.
Anyone have any ideas about how right/wrong she is regarding Vagifem being exponentially absorbed systemically, and about what levels of oestrogen women in my situation should/shouldn't have? It's the first I've heard of such an argument that because you wouldn't normally have such high levels of oestrogen in your system at this age, therefore you shouldn't be putting so much in. It strikes me as chop logic because of course I'm going to have b..... all oestrogen in my system at this age, that's the whole point isn't it ? ? ? ? ?
Sorry, am a bit wound up right now hence the running off at the mouth. Anyway, it didn't go as I wanted but better than I anticipated so all's well - for the moment! :) :) :)
LL xxxx
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I was told by the specialist that a year's worth of Vagifem is the equivalent of ONE systemic treatment i.e. one patch, one tablet etc. There are very knowledgeable people to approach on here like Joaniepat, Dotty etc. Might be worth a PM? Meanwhile, if you can, it would still be worth contacting Dr. Currie for validation and any future reference. Essentially, your "Consultant" is talking twaddle. I am 69 and plan to grab as much as I can for as long as I can before the "shop" shuts down permanently. I hope you can have a wee treat this evening to reward yourself. You did your best against extreme odds by the sound of it!
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I would send a query to Dr Currie ......... this GP is covering her back without knowing much about HRT at all. !! We shouldn't have to fight.
My query would be to ask her to send me details of the cancer risks as well as asking her how soon the cancer is likely to occur with the regime you want to follow? She needs to back her 'thinking' process regarding absorption etc. with research details! It's no good a GP 'thinking' which might be against current prescription procedures.
Vaginal atrophy is due to a loss of oestrogen which causes the body to become dry: inside and out. MayB direct her to "Me and My Menopausal Vagina" book ;-) ;D. Many GPs are so certain that they know more than suffers might do >:(. I could SPIT! Quality of Life!!!
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Pleased to hear you got your dose up to 5 per week that should make a lot of difference. Regarding the amount of estrogen, Vagifem is such a tiny dose, for example 1mg = 1000 mcg. An average HRT tablet dosage taken daily is 1mg but there is only 10mcg in 1 vagifem.
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Thanks Postmeno3, CLKD and Dierdre for your replies (and continuing support - which I really appreciate, as after my phone conversation with the consultant I ended up feeling like some sort of naughty child doing wrong and being punished by those in authority. I definitely got the feeling she was pissed off at me for appearing to challenge her and that always makes me paranoid :'( ).
I shall certainly pursue alternative expert validation - I'm also going to look elsewhere for a consultant/gynae who hopefully has more up to date experience - they may not be able to fix it all, but I could really do with medical support, not dissent. Shall ask my GP to refer me to the local menopause clinic and take it from there - I have lost what was left of my faith in this current consultant (there are other reasons for that, which were the point of the phone call in the first place, but her attitude about the Vagifem finally did me in.)
I can understand doctors needing to cover their backs, but not at my expense!
Thank you so much again for your lovely supportive posts, I so appreciate it :hug:
LL xxxx
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Make sure it is a dedicated menopause doctor, not a Gynaecologist nor 1 who believes that they know it all! This 1 sounds pedantic. Her time will come ;D
Tell your GP about MM, how reading the VA and 'bladder issues' threads has shown you that there are several ways of treating VA and that regular use of 'vagifem' or 'ovestin' is necessary, that some need treatment every night etc.. Add Dr Currie's name and that the Forum is medic led might help ;-).
Let us know how you get on!
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Thanks again CLKD. And will do :)
xxx
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I am late to your post but i was referred to a gynae with an interest in menopause. He was completely out of date and wanted to do an endometrial biopsy because i had been using Vagifem for 6 months. I saw a meno specialist privately after that and she wrote to my GP to say Vagifem is perfectly safe to use daily. I use three pumps of Estrogel a day as well.
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tnx Tinkerbell - some 'experts' (how I HATE that word >:(). really think that they know it all!
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Thank you Tinkerbell and sorry for the late reply. Your experience just goes to show that you don't really know the calibre of whomever you're seeing until (often!) it's too late. It seems that even if we go in armed with lots of facts and figures and 'official' support and know exactly what we want/need (and how many of us know that eh?) that's still no guarantee of getting the right treatment.
Case in point, this consultant I spoke to prescribed me something last week that is unavailable in the UK (!!!!!), but on top of that when I researched it the (very few) US sites that came up with it indicated research that said the stuff was not efficaceous for what she prescribed it for anyway. Hmmmmmmmm.
Re the Vagifem - I decided to look up the exact amount of oestrogen in Vagifem - and thinking that 1 mcg might be 100th of a gram, was gobsmacked to find it's actually one MILLIONTH of a gram. So one dose of Vagifem is equivalent to 10 millionths of a gram of oestrogen - and even then most of that doesn't get into the system. So how on earth using it daily (which is what I wanted - but of course there's only 24 doses in a pack so I'd need a prescription for double quantities hmmmmm again) is going to give me 'too much oestrogen' is totally beyond my brain to compute.
I am really really annoyed at her and doubly annoyed that she will be influencing my very helpful and very accommodating GP adversely. Now where did I put that doll with the pins in it....
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I hear you. You're being shown a quality you might need to find more of in all this? Result!
💚
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> hands over doll and pins < ;D. personally I would be giving Dr Currie the name of this 'expert' >:(.
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Hi Postmeno3, not sure I understand exactly what you mean, but it sounds positive so thank you ;D
CLKD - so that's where it went to lol. Yeah I'm not sure what, if anything, I could do about this sort of thing, not enough to warrant a complaint just a general 'I don't think this person is terribly competent, which could become dangerous if one doesn't remain vigilant' feeling. But why should any of us have to be vigilant ?? ??
Anyway I sure as hell don't want her coming anywhere near me again with a scalpel :scottie: :crutch: