Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: joziel on August 20, 2022, 10:06:21 PM
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I know it's always said that Vagifem is incredibly low dose blah etc, and that a year's worth of Vagifem is the same as one HRT oral tablet. ???
But someone explain this to me then...
Vagifem is 10mcg of estradiol, right? And a 25mcg patch releases 25mcgs of estradiol into you each day, right?? Am I missing something?
How is Vagifem such a low dose then? It's under half a 25mcg patch, but it's not THAT low and definitely not the equivalent of a year's worth of transdermal HRT...??
??? Someone explain... have I totally misunderstood something?!
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IGood question! Is it based on how often we use vagifem i.e. the instructions after initial loading are twice a week not every night.
Taz :-\
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Perhaps the size of the compared one pill per year is a 2mg dose?
Vagifem twice a week would be 20mcg. 52 weeks would total 1040mcg which is less than 2mg.
Can’t think of other explanation but it’s very late!
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Yes, it's compared to the oral pill dosage which is usually 1mg or 2mg tablet per day. There's1000 mcg in 1mg and Vagifem is only 10mcg. If you use 5 vagifem per week = 50mcg x 52 weeks = 2600 mcg. Thats 2.6 1mg tablets per year.
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Thanks Dierdre I see that….
But why are we choosing to compare it to an oral pill instead of transdermal?
It just seems a bit arbitrary. I mean I think it’s said that a 1mg oral pill is equivalent to a 25mcg patch (trying to remember off top of my head).
So a 10mcg pessary, especially when used every day (as I’ve been using it) doesn’t sound low in that case. 10mcg vaginally compared to 25mcg transdermally 🤷♀️🤔?
I’m questioning this because I’ve had bad side effects from taking estrogen by way of palpitations for hours and high blood pressure. I had to stop all patches or systemic estrogen about 11 days ago now. My blood pressure is now normal and for most of the days I’m fine but I’m still palping all night. And night is of course when I use my nightly Vagifem and Ovestin.
I know it’s said we don’t absorb these systemically but I’ve done a lot of googling of people’s experiences with it and it seems that some people definitely believe they absorb it systemically…..
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Joziel, the monograph for Vagifem, which was actually trialled on the old 25 mcg version, showed that it did not increase serum beta estradiol levels in the trial participants. I think that's the main thing, ie, local oestrogen stays local.
JP x
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Hi Joaniepat, do you know what was the reasoning behind the strength reduction in Vagifem please?
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Hmm, thanks JP, that reassures me a bit. And I’ve heard that before…
But definitely there are women who have experienced palps after taking Vagifem. These are women in a vaginal atrophy group who aren’t also on systemic HRT.
And there was one member here in a post that came up many years ago who could tolerate Vagifem 2x weekly but more frequently meant she got the palps that estrogen caused her.
And many other women believe it affects them systemically (many positively, not just negatively).
The vagina (and anus) are known ways that many other meds can be taken for systemic effect. 🤷♀️
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Thought this might interest you joziel:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4354766/
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Some have experienced headaches when they begin with Vagifem which go away after a couple of weeks.
My GP never hesitated to prescribe 'ovestin' even though I had breast surgery in the 1990s. I couldn't have coped with the VA symptoms with treatment.
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Here’s another one Joziel
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3234898/
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Hi Joaniepat, do you know what was the reasoning behind the strength reduction in Vagifem please?
I believe they had two versions in production, 10 & 25 mcg. The higher dose was discontinued for "commercial reasons". It is worth noting that the licensed dose for this product is still 50 mcg per week, as they did not apply for a new license for the lower dose product.
JP x
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What an interesting thread! I have been taking Vagifem pessary daily for nearly a year now with Ovestin locally. Just lately I have noticed slight hot flushes returning, and those palps I have read so much about on here too also mild anxiety like I used to get years ago.
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Women managed much better for years on the 25mcg dose twice weekly and now have to use more to achieve the same level of comfort on the 10mcg dose. Both dosages were classed as safe but I think a lot more profit would be involved in the lower dose as we have to now use twice as much! This was highlighted at the time if I remember when the 25mcg was discontinued and there were many posts on here regarding this.
Not sure why we compare to the oral tablet instead of transdermal. I didnt realise 25mcg patch was equivalent to 1mg tablet.
Vagifem definately went systemic for weeks when I first used it, sore boobs, cramps etc but after the vaginal tissue plumps up less gets through. Some always goes systemic but as its such a minuscule amount we don't need a progesterone and I hope I benefit from the extra estrogen.
You must be super sensitive to the smallest amounts joziel, not sure how long you've been on Vagifem, maybe it will settle after using a while.
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What an interesting thread! I have been taking Vagifem pessary daily for nearly a year now with Ovestin locally. Just lately I have noticed slight hot flushes returning, and those palps I have read so much about on here too also mild anxiety like I used to get years ago.
I suffered very badly with night sweats and palpatations after a dose of covid at Christmas. Had ecg and was ok after a few weeks but this is common after covid and also the vaccination . Makes you think your HRT is not working.
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Thanks Joaniepat, very handy knowing the licensing dose.
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Thanks Jenna and Marchlove - interesting links.
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That link you posted Jenna, is incredibly interesting :o Who'd have thought Vagifem can help with bone protection?? Marchlove thanks also for that one.
So it sounds like it does get absorbed systemically but not enough to take levels over menopausal range, so still considered safe and within what some women would have physiologically. (I'm not sure if that was taking it every day or if they were looking at taking it 2x weekly though, I need to read again.)
However, for me, trying to rule out estrogen as a cause of what I'm going through at the moment, maybe I need to be extra cautious especially about taking it every day. I'm going to try to go back to 2x weekly and see if my VA symptoms will stay away now. I mean, if my own ovaries have fired up again I should have my own systemic estrogen again. I don't have any of my other low estrogen symptoms back yet, no night sweats or joint pain etc.
I don't know what I'm going to do if I'm this sensitive to estrogen, when I do need it and become menopausal. I'm very worried. My working theory at the moment, is that it causes me to have high blood pressure (via some mechanism I don't understand) and it's the high blood pressure for 5 months which has caused my heart to get into these constant ectopics. Which it's having a hard time getting out of now, even though my blood pressure is now normal again. This is just my best guess whilst I wait to see the cardiology nurse specialist I've been referred to.
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I’m glad you found it interesting :)
Maybe use a vaginal moisturiser on the days you don't use Vagifem - just to see how you get on for now.
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Yes, I already use lots of other non-hormonal moisturisers. But when I get a VA flare, there's nothing quite like estrogen ;D
Talking of which, how does DHEA or Intrarosa fit into all this? Is that considered estrogen?? I think our bodies convert it into estrogen? But it might not be the same as actually taking external estrogen so I wonder if I'd be able to tolerate that if I can't have local estrogen.
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I think Marchlove knows about DHEA - she posted this link before:
https://www.agelessforever.net/bioidentical-estrogen-progesterone-hrt/dhea-why-it-is-especially-important-for-menopausal-women
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What an interesting thread! I have been taking Vagifem pessary daily for nearly a year now with Ovestin locally. Just lately I have noticed slight hot flushes returning, and those palps I have read so much about on here too also mild anxiety like I used to get years ago.
I suffered very badly with night sweats and palpatations after a dose of covid at Christmas. Had ecg and was ok after a few weeks but this is common after covid and also the vaccination . Makes you think your HRT is not working.
Yes, I've been blaming it on the heatwave but am keeping an eye on how I feel each day going forwards.
Links posted on this thread make fascinating reading and very encouraging, thanks ladies for posting!
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Thanks Jenna, will check that out.
Ayesha I don't think I get what you mean there. Are you saying that you are taking Vagifem and have noticed a return in your hot flushes and palps and you are thinking this is caused by the Vagifem? If so, I really wouldn't draw that conclusion.
I'm a very 'weird' case in that I am incredibly sensitive to estrogen and I'm just trying to recover from taking systemic estrogen for 5 months at the moment and wondering if, for me in my hyper-sensitised state at the moment, the daily Vagifem + Ovestin (which I've been liberally applying externally 2x daily!) is keeping the palps going.
I very much doubt if Vagifem is enough estrogen to cause this in 99% of other women (especially seeing it's not going to make much difference if you are already on systemic HRT as it's just a drop more). So I really wouldn't be thinking about Vagifem in your situation, I'd be thinking that you probably need more estrogen if you were fine for a while and then appeared to get some symptoms back.
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Thanks, Joziel, your comments are encouraging.
Last week I was getting symptoms that I used to get 20 years ago during the menopause. High anxiety feelings and mild hot flushes. Anxiety feelings subsiding by the afternoon and all was calm again.
I am good at overthinking things and I thought perhaps the Vagifem and the Ovestin, which I use a tiny amount of locally, but might increase it a bit more if I feel I need to to keep my VA under control!
It could have been anything causing these issues and the last few days I have been fine. This is me trying to understand my aging body and its changes :)
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Hot flushes are a sign of low estrogen, so it might be that you need a little dose adjustment. Just do the smallest adjustment possible is my advice ;D ;D ;D ;D
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Well I think I’ve disproven my own theory as tonight is my second night not on Vagifem or Ovestin and I’m still palping away. I’ve been so fine all day I really hoped tonight was the night it would all stop but no luck….
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I think you need to give it more time for your theory to work before despairing, joziel. :)
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I can’t really do that or my VA will come back.
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That does make it very difficult then - I can only think of trying to manage with moisturisers in the short term just to test your theory out and see if there was an improvement.
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Yes, I'm using moisturisers but I tend to find they are not enough usually.
I do think that 48hrs off all estrogen should really be enough to notice a difference with the palps. Hopefully Vagifem 2x weekly is okay for the VA again...
Meanwhile I'm actually going to get a call from cardiology dept tomorrow about my symptoms so they can decide whether to try to bring my appointment forwards (currently 15th Sept).
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That’s good news Joziel.
Who knows, now your own estrogen has kicked back in, you might not need so much Vagifem anyway.
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Thanks Marchlove. Yes, I was thinking that too.
Something is definitely happening as I've been bleeding lightly for about a week now. No endo pain or cramps, just bleeding. Usually very slow and dark, sometimes a bit redder and fresher.
So I don't know if taking 200mg continuously is going to work. It's good that I don't have any endo pains but I think it might result in problematic breakthrough bleeding. Which doctors are going to hate and want to investigate. And I don't want to go back on synthetic progestins.
So I am considering going sequential with the utrogestan. This would be without estrogen added in (except my very own). So it would be like Lara Briden's cyclic progesterone therapy idea, taking it from day 14 for 2 weeks. I'm a little nervous the endo will start up again, that's my hesitation. But it was 'only' mild endo, it's not like I had adhesions everywhere or had it badly and the pain was never unbearable (except for the first 2 days of my period if I didn't take naproxen!). And even 2 weeks of the progesterone should really help, along with all the supplements Lara Briden recommends for endo (zinc, magnesium, berberine, NAC - I'm on them all!).
It would also give me a chance to see if the palps get better when I stop the utrogestan. I'm pretty sure the estrogen was the cause, since my blood pressure is now normal and I'm fine for most of the day now - so there's been a huge improvement... hmmm......
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I think that makes great sense Joziel.
I’ve read both LB’s books and think she has a lot of good advice and information.
Do you know where you are in your cycle so you know when to break?
Careful with the Berberine, from memory LB said to only take it for a short period of time.
X
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Why are you taking the Berberine Joziel, are you pre diabetic?
I just looked it up re palpitations and came across this, although other articles seem to suggest that it’s beneficial to the heart.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3722425/
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Interesting. I’m taking berberine because Lara Briden recommends it for endo. But I wasn’t taking it when all this started. 🤷♀️ I guess it could be keeping this going somehow though…
I am following LB’s instructions to take 5 days a week for 8 wks then stop. I could try stopping the berberine for 10 days to see if it helps.
I don’t know where I am in my cycle and in fact im not sure I have one back yet 😂 I don’t know if I should keep taking utrogestan through this bleed until the next one starts and then stop it for 2 weeks to bleed? Or just stop whenever and then try to take it 14 days after day 1 of bleeding to try to sync up again. 🤔
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It is probably suppressing your cycle so it’s difficult to know what to do.
I’m 14 years post menopause so not very up on all that now!
You could try a new thread perhaps to see what others suggest x
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OMG Marchlove, I've just read that paper in more detail and it is VERY interesting for me!!
I did have to google a lot of cardio terms and try to translate cardio-gibberish-speak ;D but I think the gist of it (translated into normal English) is....
.... that there are some people who are "hypervagotonic" - which means that their vagus nerve relaxes quickly and deeply and they have a resting pulse of under 60bpm. (The benefit of it is that they can recover from stress very quickly.) But these people, when they take berberine (this is where my translation might be slightly dodgy) - which slows everything down and relaxes your cardio system even more - can end up with the heart freaking out that it's too slow and compensating by going into weird arrthymias. (Which I can't spell.)
WELL GUESS WHAT?? Yours truly has a resting pulse sitting at the kitchen table of about 55bpm when I'm awake. When I'm asleep (which is when the palps are happening now) it is probably even lower. (Can't say for sure because I'm asleep ;D ) MOREOVER, when I had just come around from the anaesthetic after my endo surgery, they were very concerned about my low pulse rate and monitored me very closely. (I think it was even slower after the anaesthetic, like 35-40bpm or something.) I've always known I have a slow pulse and I recover really fast after exercise too - I remember discovering that during a school PE lesson when we had to monitor ourselves ;D ;D
I don't think berberine has caused ALL of this, because I only started it 3 weeks ago (I wrote it in my diary). But perhaps it is the reason I am not okay again, having stopped the estrogen now and having normal blood pressure now. Anyway, I will definitely stop it and we shall see. It sounds like the effects wear off quite quickly so if it is the berberine I should be okay in a few days...
Then I will be forever in your debt. I will have to explain some of this to the cardiac nurse calling me tomorrow as well ;D Maybe the appointment shouldn't be TOO soon, just so we know if this is going to work!
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Gosh Joziel, I do so hope that this will prove to be causative factor, albeit perhaps not the original one.
Don’t jump the gun with it too much tomorrow with the cardiac nurse, coz remember she won’t have a clue what you’re talking about!
You can test the theory yourself by stopping it.
So, I think you should very much concentrate on issues other than tBerberine, that might be causing your palpitations.
Throw it in at the end.
Will read your last post in more detail tomorrow, looks like you’ve done a lot of work interpreting it all. Xx
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Basically, what I’m saying, is don’t let them latch onto theBerberine as being a causative factor.
As you say, it started before, but it just might, be causing the continuation of it in some way.
If they latch onto it, it may let them off the hook and potentially not proceed with further checks that you probably need.
X
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Right, I'm just going to draw their attention to my slow pulse and these other weird things in my history and I might just mention the berberine - by the time my appointment comes round, I'm sure I'll have had time to see if stopping berberine does the trick and I can then discount it. Even if all this stops miraculously in a few days, I still want to get checked out because something weird has gone on here and I especially want to talk to them about the estrogen and what happened there....
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Hi there
Coming very late to this thread but just to make a couple of points re the main subject of the thread.
The comparison between oral dose of HRT and Vagifem is for no reason other than to convince people who are concerned about using it, that Vagifem is a very low dose. There is no scientific reason nor basis for this comparison. It just serves to give perspective.
The total amount of oestrogen in Vagifem in one vaginal tablet does not bear any relation to the amount absorbed in that all it is, is the amount in that tablet. As has been posted on here there are studies which show how much of the vagifem is absorbed into the system ON AVERAGE. Different women will vary in this.
These studies showed that in cases of vaginal atrophy, the higher dose (25 mcg twice weekly) can mean that some post-menopausal women's oestrogen levels go into the post-menopausal range initially - but once the tissues are plumped up with oestrogen, levels fall to within post-meno range, and on the 10 mcg dose levels always remained within range.
The studies also showed that for a large percentage of women, efficacy was achieved (ie it worked to alleviate VA) for the 10 mcg dose but that does leave the remainder for whom a higher dose would still be needed. Nevertheless it was on that basis (ie the statistical majority) that the dose was removed. I had thought it was for safety reasons (though jusitification for this is questionable) rather than commercial but my memory is hazy there!
It is very doubtful that, especially in women or are not post-menopausal and therefore have nigher natural oestrogen levels, the tiny amount in vagifem is sufficient to cause additional sdie effects once the body has acclimatised and tissues are plumped up, though in post-menopausal women whose levels are low - this may happen in especially in sensitive women?
Re DHEA and Intrarosa somewhere in here I looked at the study in detail I think, and reported but not sure which thread. However here is a thread where the other threads are listed so you should be able to find somthing about how it works: https://www.menopausematters.co.uk/forum/index.php/topic,59814.msg840171.html#msg840171
For those who are interested and have the time I'll also bump it.
I realise the discussion has moved on joziel but hopefully the above might be of help to someone!
Hurdity x
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Thanks Hurdity. I am back down to 2x weekly on Vagifem and Ovestin now, with liberal Olive and Bee, and just hoping that is enough for VA not to come back now my own estrogen is working again ;D
Still getting the palps :'( The cardio nurse I spoke to yesterday said that if it is "just" ectopic beats then it's not a problem health-wise - even if they are pretty constant - except if they are causing discomfort, anxiety, lack of sleep - then they would be treated symptomatically with drugs (ie beta blockers). I'm not a fan of just taking drugs especially if they are not needed for health but anyways, we're not there yet... I am now waiting for this Kardia device I ordered to arrive in the post, so I can record some ECGs and email them to her.
Meanwhile having discovered that workouts stop my palps, I am getting incredibly fit ;D ;D ;D ;D ;D In the shower, I'm finding muscles I didn't know existed when I wash myself ;D ;D