Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Ayesha on May 10, 2024, 10:08:25 AM
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My first request for Estroil cream and my usual Vagifem pessaries from my new surgery resulted in a phone call from them stating the GP said its very rare to use the two medications together. My first reaction was to say, the trouble is doctors don't know enough about the condition and one tube lasts me 3 to 4 months, it can sometimes be a fault being assertive but life has made me this way.
I rambled on to the hapless lady on the phone giving over my point of view and she said she would explain all to the doctor but needless to say I will not be getting the Estroil cream.
But then on reflection I have decided to stop the Estroil and see how I get on, perhaps I only needed it at first but not now and the only way to find out is to experiment. If I find I need to use it again, alongside Vagifem, I will buy it as I tube will last me a long time.
At my next review if I have to, I will bring the subject up and in the meantime gather as much evidence as I can on the treatment regarding Vaginal Atrophy for each individual woman and what her needs will be.
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Morning. Buy a copy of "Me and My Menopausal Vagina (https://www.menopausematters.co.uk/books.php#meandmy)", read then pass on with notes in the margins ;-). It's about time that GPs began listening to women!
With 'ovestin' I can smear a little around the outer labia area when necessary or I use KY Jelly without problems.
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Did they say why it is rare? I'm using them together
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My immediate thought was that not enough women are coming forward when suffering this condition. I didn't think it was anything to worry about re overdosing on too much oestrogen, just a lack of knowledge on a condition that affects women in different ways and needs treating accordingly.
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I don't think that we can 'overdose' on hormone replacement, it's what it is: replacement : ::) but many medics have no idea .........
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My first request for Estroil cream and my usual Vagifem pessaries from my new surgery resulted in a phone call from them stating the GP said its very rare to use the two medications together. My first reaction was to say, the trouble is doctors don't know enough about the condition and one tube lasts me 3 to 4 months, it can sometimes be a fault being assertive but life has made me this way.
I rambled on to the hapless lady on the phone giving over my point of view and she said she would explain all to the doctor but needless to say I will not be getting the Estroil cream.
But then on reflection I have decided to stop the Estroil and see how I get on, perhaps I only needed it at first but not now and the only way to find out is to experiment. If I find I need to use it again, alongside Vagifem, I will buy it as I tube will last me a long time.
At my next review if I have to, I will bring the subject up and in the meantime gather as much evidence as I can on the treatment regarding Vaginal Atrophy for each individual woman and what her needs will be.
I for one if you don’t mind would be interested in how your experiment without using Estriol on the vulva goes. I had a fit of pique at one time & stopped using it. The itching & burning was worse than when I started out ! So back on it.
Pity the GP just won’t accept what another GP has already given you and you’ve been ok with.
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I darent stop using the estriol. I was using vagifem and it didn't stop the external atrophy
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I think they make it so hard for us to try and put us off bothering them by asking for what we need imo anyhow - sounds like my GP. I have not had to order another cream yet but when I do I suspect it will be rejected as was the last one, although they did give me a prescription for 1 cream rather than 2 (so I will have to re-order more often) - when this does happen, I will be making a face to face appointment with my GP and discussing, sorry I meant to say educating her on this - there is no way I am having a wasting away fanny and I will say that to her, because of her ignorance/incompetence. Honestly, I will be strong and assertive regarding this. Too many women have had to put up with this for far too long and it's about time it changed...
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I have no problem with two boxes of 'ovestin' each time :-\
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I think they make it so hard for us to try and put us off bothering them by asking for what we need imo anyhow - sounds like my GP. I have not had to order another cream yet but when I do I suspect it will be rejected as was the last one, although they did give me a prescription for 1 cream rather than 2 (so I will have to re-order more often) - when this does happen, I will be making a face to face appointment with my GP and discussing, sorry I meant to say educating her on this - there is no way I am having a wasting away fanny and I will say that to her, because of her ignorance/incompetence. Honestly, I will be strong and assertive regarding this. Too many women have had to put up with this for far too long and it's about time it changed...
I got 3 boxes last time. They've just realised it. I'd got so annoyed that they wouldn't repeat my prescription until id had a hysteroscopy that when I got the all clear, two of the did the same prescription .
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Pity the GP just won’t accept what another GP has already given you and you’ve been ok with.
This is what made me even more angry even when I had explained that my gynaecologist had prescribed Vagifem & Estriol to be used daily. What gives the right of another GP to over-ride another professionals treatment regime just because of a change of surgery, it shouldn't have made one bit of difference.
I will update the thread on how I get on without the Estriol as its nearly three years on from starting treatment.
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Hi Ayesha, I'm sorry you're having to fight this battle. I understand your intention to experiment to see if you can manage without the cream but personally I can't & I don't think you should have to. I was prescribed both the weaker Estriol cream (0.01%) & Vagifem to use together 8 or so years ago by a very good specialist nurse at an NHS menopause clinic & still use both now. However, I later had a similar problem with a Cons Gynae who didn't understand that the Estriol cream was for use on the vulva & the Vagifem internally, as the effects of Vagifem can be very localised.
If you don't have a copy of the clinic letter detailing this:- my gynaecologist had prescribed Vagifem & Estriol to be used daily
I suggest you ask admin at your surgery to look it up in your records & let you have one. You could also ask them to show it to the GP who's not confident prescribing both together. Once you have a copy of your own you can also produce it should the same situation arise at any time in the future. If they can't trace the letter in your recs (this sometimes happens with stuff at my surgery), you could ring the Gynae's sec & ask for copies to be sent to you & your surgery.
I'm sorry it's a faff to have to do any of this & it's tiresome we should have to be our own advocates in this way, but you will also be educating the GP for future dealings with any other patients in your situation.
I hope you manage to get the cream reinstated.
Wx
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Ayesha when I saw the meno consultant I asked if I could have 2 tubes of Ovestin and month (as well as estradiol daily) and she was fine with that. I told her I used it twice a day and she said use more if I need to. If I don't, I itch like mad. If you have a look at PWHCF online (you do have to register as a health professional but it's worth it) there is a comparison table of vaginal oestrogen treatments that detail usage etc. If you find you can't do without it, you could show the GP the table.
I think we're all livid for you.
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?? ignorance on behalf of GPs or cost cutting ??
Let us know how you get on.
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I saw my GP yesterday about something else and she mentioned the estrogen treatment as part of the discussion and seemed to have no issues with what I was using. It does vary greatly across GP services
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I had the same,
ask the GP to write to the local menopause clinic specialist for confirmation that it is safe to use the medications . I would email and ask them why they are refusing you treatment and that you know the risks and benefits and it i your choice etc. I would read up on the literature - Louise newson has a load and quote the relevant evidence based information. Then thank them for reading your email and ask them to reconsider -- If it is in writing they can't gas light you so easily. You can use vagifem and estriol which is the weaker one daily inside and outside if required - as long as it is helping.
Ps - VA is cured it is managed - so stopping treatment that is working may have consequences.
PMXX
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Sorry to hear this Ayesha. I have both (Vagirux and the weaker 0.01% estriol cream) - not even had to be prescribed by private gynae - just regular NHS GP, as well as systemic HRT. And I wouldn't think of stopping any of it at the moment and I'm in 70's. I use the estriol cream as and when to relieve dryness and itching because Vagifem/Vagirux alone doesn't work for me on these external areas. I hope you are successful.
Hurdity x
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Thanks for all the very helpful comments ladies (ammunition) which I have taken on board.
Its difficult to comprehend it all on how this condition is treated and with a statement of "its very rare to need both treatments" the fight continues.
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A word with the Practice Manager ?
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Its difficult to comprehend it all on how this condition is treated and with a statement of "its very rare to need both treatments" the fight continues.
Well obviously it isn't! Just a read through this thread makes it clear we often need both if not usually.
I did email my GP Ayesha and although I included my email from Dr Currie with her recommendatios, my GP was far more attentive. I told her I absolutely cannot go on if I don't gave estradiol daily. It worked.
I think maybe them having to sit and read it changes things. It's worth a go.
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It's so ridiculous. I feel like what menopause forums and facebook groups seem to spend more of the time is helping women navigate the shite healthcare services we have so that they can get what they need.....
I had the same thing, my NHS GP wouldn't give both Vagifem and Ovestin. I just got Ovestin from my Newson Health doctor who was happy for me to have as much as I wanted. Had to pay for it of course. It's great for your face as well ;)
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. It's great for your face as well ;)
You can use it on your face??? What for wrinkles? I'm intrigued.
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Thanks for all the very helpful comments ladies (ammunition) which I have taken on board.
Its difficult to comprehend it all on how this condition is treated and with a statement of "its very rare to need both treatments" the fight continues.
As a newly registered patient with this practice i would ask for a face to face appointment with the doctor who you are now registered with.
We moved home four and a half years ago. I thought it normal practice to be asked to see the new doctor that i was newly registered with. Maybe old fashioned thinking on my part. When nothing was forthcoming i asked to see her. It meant that she read my previous notes, she checked me out and i had a conversation with her. She is a senior partner at the practice and i've since seen other more junior GPs there but have in some instances been able to refer back to seeing her initally.
Realise face to face appointments are now difficult to get at some practices but might be worth a try and not such an unreasonable ask as a new patient.
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One of the reasons I stay with (expensive) Newson Clinic is that I just don't trust the NHS to prescribe me what I need for HRT. Not to suddenly decide I can't have X and Y or 10 pumps of gel or 300mg of utrogestan, and just to be at the mercy of whatever crap a particular doctor decides to implement...
Anyway, yes - for wrinkles. Estriol is what's in Ovestin, so it stays local to where it's applied and doesn't go systemic and it's great for the skin. (That's why we put it on our vags to make them plump and moisturised! It will do the same elsewhere!) I also use the tiny amount of gel which gets left in each pump bottle when I finish. It's not enough for full measured doses but rather than throw it out, I put it on my face.
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Well putting Ovestin on your face is as safe as putting it on your vagina. Your skin is your skin is your skin..... wherever it is. And there are creams available in the US with estriol in them for the face.
As for putting the gel (estradiol) on your face, it probably depends how much you absorb from it, what dosage of progesterone you're on and that kind of thing. As I am on 10 pumps of gel a day and absorb it not very well, and am well protected with 300mg of utrogestan a night, putting a small amount on my face really doesn't do much for me systemically.
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Well putting Ovestin on your face is as safe as putting it on your vagina. Your skin is your skin is your skin..... wherever it is. And there are creams available in the US with estriol in them for the face.
As for putting the gel (estradiol) on your face, it probably depends how much you absorb from it, what dosage of progesterone you're on and that kind of thing. As I am on 10 pumps of gel a day and absorb it not very well, and am well protected with 300mg of utrogestan a night, putting a small amount on my face really doesn't do much for me systemically.
Hi, has it made a difference to your skin on the face?
PMxx
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Skin = skin - it isn't the same ::). Hopefully your vaginal skin isn't the same as that on your heels. ;)
I go to the reception desk at our Surgery and ask to see our GP face2face. I may need to wait 3 weeks but have not been denied, despite Covid restrictions. Some GPs simply don't have the Staff to cover as many sessions hence seeing Nurse Practitioners when necessary. Plus with all the new builds across the UK, there aren't enough GP Surgeries to cover the influx. Sad state of affairs :-\ :'(
Reading an article yesterday it seems that due to government pressures which take GPs away from face2face appts because they have to fill in so many forms etc., means that GPs are leaving in droves or ending their lives :'(. As with education, governments of the day should keep out of telling GPs etc. what to do!
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I don't mean skin everywhere is exactly the same, I mean that in the same way that estrogen benefits vaginal skin (moistens it, plumps it), so it does the same to facial skin. (And all skin.) That's why one of the symptoms of menopause is dry skin - not just in your vagina, but everywhere - and often itchy as a result.
If you google 'estriol cream for the face', you'll get up multiple products. Estriol isn't absorbed systemically, there is research which shows that. It's why women with histories of breast cancer can have local estrogen in the vagina.
The only thing I'd say about estradiol (Oestrogel) on the face, is the alcohol in it can be quite drying so needs to be well moisturised afterwards. As I am basically bathing in gel every day, putting a bit extra on my face doesn't really make any difference. But if someone was on a very low dose or very sensitive, Oestrogel on the face might well not be a good idea. Estriol, on the other hand (Ovestin) should be totally fine because it's not systemic.
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Update: After my explanation of how I use the Estriol cream and the fact a tube will last me 3 to 4 months the GP approved my prescription. The confusion came when he assumed I was using it the same as you would without another form of treatment, for instance Vagifem.
Its been 4 days without applying Estriol and I haven't noticed any difference, usually the first sign would be the constant need to pee but the Vagifem alone is doing a great job so far. I feel now after nearly 3 years of treatment I can be more flexible on usage, but its a wait and see situation.
Needless to say I am very happy to have both treatments and not have to worry when flare ups arrive as they sometimes do.
Thanks all for the great advice and support ladies but don't think I will be using any on my face, far too late for that ;D
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Tnx for the update.
My face thus far hasn't required anything, both Grandmas had beautifully soft skin 8)
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I don't mean skin everywhere is exactly the same, I mean that in the same way that estrogen benefits vaginal skin (moistens it, plumps it)
Yeah like I need plumping anywhere else 😆😆
But very interesting Joziel, thank you.
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But then on reflection I have decided to stop the Estroil and see how I get on, perhaps I only needed it at first but not now and the only way to find out is to experiment. If I find I need to use it again, alongside Vagifem, I will buy it as I tube will last me a long time.
"I for one if you don’t mind would be interested in how your experiment without using Estriol on the vulva goes. I had a fit of pique at one time & stopped using it. The itching & burning was worse than when I started out ! So back on it."
Just to confirm four days of experimenting finishes today as the VA symptoms are coming back.
There is now no doubt that I need the Vagifem with the Estriol cream and a moisturiser to be used daily and very happy that the GP understands this now.
Looking forward to being 100% better again but I had to prove to myself that I need the constant VA treatment.
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Ayesha, that's great that you managed to get both authorised.
Wx
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Do let us know how you get on.
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But then on reflection I have decided to stop the Estroil and see how I get on, perhaps I only needed it at first but not now and the only way to find out is to experiment. If I find I need to use it again, alongside Vagifem, I will buy it as I tube will last me a long time.
"I for one if you don’t mind would be interested in how your experiment without using Estriol on the vulva goes. I had a fit of pique at one time & stopped using it. The itching & burning was worse than when I started out ! So back on it."
Just to confirm four days of experimenting finishes today as the VA symptoms are coming back.
There is now no doubt that I need the Vagifem with the Estriol cream and a moisturiser to be used daily and very happy that the GP understands this now.
Looking forward to being 100% better again but I had to prove to myself that I need the constant VA treatment.
Missed your post yesterday. Thanks Ayesha I found out too that I can’t manage without using estriol ( ovestin) on the vulva. I found it almost as if once using it you can’t get off it as all the burning & itching was worse than when I started out.
So glad that you have now been listened to and your prescription has now been sorted at your new surgery.
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Glad you're sorted Ayesha, I can't manage without both. I had Vagifem only for about 3 years and it never really sorted outside and I suffered alot of shrinkage because of this. It was a real life changer when I was given Ovestin for external use by a vulva specialist who was also investigating lichens sclerosus.
I always feel very anxious when I have my yearly review as it's always someone different and they usually query why I'm using both (I was told one year by the surgery pharmacist doing the review to reduce all of it as causes blood clots)! Someone with health anxiety really doesn't need this unnecessary scare mongering about a drug I have no choice in taking for the rest of my life. I tell them now to read the consultants letters and they haven't gone against them yet. The reviewers have not even been doctors just the surgeries resident pharmacist or a locum that has no idea who I am or my history.
I always feel I have to defend what the experts have prescibed to these people who aren't experts!
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It shouldn't be this hard :bang: and pharmacists should be up2date with treatments available across the different specialists and requirements?
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Glad you're sorted Ayesha, I can't manage without both. I had Vagifem only for about 3 years and it never really sorted outside and I suffered alot of shrinkage because of this. It was a real life changer when I was given Ovestin for external use by a vulva specialist who was also investigating lichens sclerosus.
I always feel very anxious when I have my yearly review as it's always someone different and they usually query why I'm using both (I was told one year by the surgery pharmacist doing the review to reduce all of it as causes blood clots)! Someone with health anxiety really doesn't need this unnecessary scare mongering about a drug I have no choice in taking for the rest of my life. I tell them now to read the consultants letters and they haven't gone against them yet. The reviewers have not even been doctors just the surgeries resident pharmacist or a locum that has no idea who I am or my history.
I always feel I have to defend what the experts have prescibed to these people who aren't experts!
I was the same, the vagifem didn't stop vulval atrophy. Ovestin has certainly helped to restore, not completely but better than I was and I would have only deteriorated further. It's taken quite a while, you have to persist and be patient
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I agree Jules. Although the extra estriol externally hasn't replaced the lost shrinkage of labia it has not got any worse since using it and keeps everything plumped up and healthy so not so noticeable now.
Why don't doctors know these things, HRT is a massive industry now.
CLKD, I suppose as long as menopause and estrogen deficiency are still not classed as an illness doctors priority will always be people who are ill and at risk of dying and rightly so.
Separate menopause clinics are definately the way to go.
The chemists in my area didn't even know Ovestin is now Estriol 1mg/g. It took me going to 5 chemists before i found one that had Estriol.
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I agree Jules. Although the extra estriol externally hasn't replaced the lost shrinkage of labia it has not got any worse since using it and keeps everything plumped up and healthy so not so noticeable now.
Why don't doctors know these things, HRT is a massive industry now.
CLKD, I suppose as long as menopause and estrogen deficiency are still not classed as an illness doctors priority will always be people who are ill and at risk of dying and rightly so.
Separate menopause clinics are definately the way to go.
The chemists in my area didn't even know Ovestin is now Estriol 1mg/g. It took me going to 5 chemists before i found one that had Estriol.
Yes that's right though ive read differentexperiencesabout that. I wish someone had told me sooner, then I would have recognised what was happening and also not been led to believe it was normal aging, as it was preventable. It was probably happening so slowly at first I didn't notice but then it worsened at pace. By then, physical changes have taken place.
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Are we in the minority here, the women who reach out to forums looking for answers. I am still mindful of my new GP who said it is rare to need both treatments, Estriol & Vagifem, if that's in his experience I have to respect that, with my previous GP being a gynae, it made life so easy with no issues to prescribing both to be used daily. Will say though, once I explained fully in a calm manner exactly how I use the Estriol there was no problem with me getting the prescription, perhaps a different story if I was on any other form of HRT, it might have been more difficult to obtain.
This is a condition that we ourselves have to be in control of because there is so little known about it, and it doesn't help that the leaflet attached is out of date which doesn't help our cause at all!
My advice from now on once you get your VA regime under way, don't mess around with it. Yesterday I had to apply three doses of Estriol to get my symptoms back under control which is much better today thankfully.
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I wouldn't have known without your explanation Ayesha. I'd have wasted away. I have to be cautious with the frequency of vagifem but I've used ovestin/estriol nightly for 9 months and it's helped. I don't have irritation or discomfort. I wish I'd known sooner though.
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His experience ........ he's a bloke, he won't have 'experience' ::) and should listen to his patients. Then read up to become more informed. I don't mind working with medics who listen and take on board that we are all different.
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Are we in the minority here, the women who reach out to forums looking for answers. I am still mindful of my new GP who said it is rare to need both treatments, Estriol & Vagifem, if that's in his experience I have to respect that, with my previous GP being a gynae, it made life so easy with no issues to prescribing both to be used daily. Will say though, once I explained fully in a calm manner exactly how I use the Estriol there was no problem with me getting the prescription, perhaps a different story if I was on any other form of HRT, it might have been more difficult to obtain.
This is a condition that we ourselves have to be in control of because there is so little known about it, and it doesn't help that the leaflet attached is out of date which doesn't help our cause at all!
My advice from now on once you get your VA regime under way, don't mess around with it. Yesterday I had to apply three doses of Estriol to get my symptoms back under control which is much better today thankfully.
Maybe we are rare, I don't know anyone at all personally, other than this forum, that suffers with atrophy.
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His experience ........ he's a bloke, he won't have 'experience' ::) and should listen to his patients. Then read up to become more informed. I don't mind working with medics who listen and take on board that we are all different.
When I wrote 'in his experience' I was referring to his experience with caring for his female patients. He may be a 'bloke' but he is a General Practitioner with emphasis on the word 'General' he is not a specialist in gynaecology.
I respect him very much for listening and believing that I needed the Estriol to be used alongside Vagifem, in his experience I am rare to need it.
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Glad you are sorted Ayesha :)
I am following with interest as I will be having an assertive and knowledgeable conversation with my GP at some point as she is another GP who doesn't understand that I need both ...
BIG Thanks to Jules, deirdrie & clkd and anyone else I have missed for sharing your experiences as hopefully I shall avoid the shrinkage and wasting away part as I have started early enough and I will advise my GP of this after learning from you lovely ladies - and she should be a bit more educated by the time I leave, in fact she will be ... just a pity we have to really help ourselves when it is actually them we go to hoping for help with whatever issues we have x
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Are we in the minority here, the women who reach out to forums looking for answers. I am still mindful of my new GP who said it is rare to need both treatments, Estriol & Vagifem, if that's in his experience I have to respect that, with my previous GP being a gynae, it made life so easy with no issues to prescribing both to be used daily. Will say though, once I explained fully in a calm manner exactly how I use the Estriol there was no problem with me getting the prescription, perhaps a different story if I was on any other form of HRT, it might have been more difficult to obtain.
This is a condition that we ourselves have to be in control of because there is so little known about it, and it doesn't help that the leaflet attached is out of date which doesn't help our cause at all!
My advice from now on once you get your VA regime under way, don't mess around with it. Yesterday I had to apply three doses of Estriol to get my symptoms back under control which is much better today thankfully.
Maybe we are rare, I don't know anyone at all personally, other than this forum, that suffers with atrophy.
I do, they don't use forums though. And there are surely others who suffer in silence not wanting to say
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Maybe there's a lot of women on systemic HRT from an early age now so atrophy never becomes a problem.
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Yes, maybe deirdrie - all my younger friends who are peri are on hrt now. Whereas in my day (haha) my gp wouldn't even discuss until meno (1 year without a period) and then still fobbed me off with nothing ...
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It will probably protect them now but if they come off it post menopause when their symptoms may reduce that could be a problem and some still need local estrogen even with systemic. I never needed HRT during peri, one of the lucky ones, not so lucky post meno with atrophy.
I wish they would do more research why some women get this and others don't, why some sail through menopause and others suffer so badly. I know we're all different but what is the difference in this case?
I know the adrenal glands have something to do with it as they take over after the ovaries stop producing estrogen. Maybe we should be targeting and stimulating these glands. I'll perhaps start a thread on this or check there's one already.
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My younger friend is on systemic hrt and that didn't stop the VA, she's having to treat all that separately. I would imagine more women than you think have it, they just won't talk about it.
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This is a condition that we ourselves have to be in control of because there is so little known about it, and it doesn't help that the leaflet attached is out of date which doesn't help our cause at all!
Below is a quote from GSM BSSM which is guidance for all the issues & treatment for what they are now calling Genitourinary Syndrome during Menopause (formerly VA) it's co written by Dr Louise Newson. GPs need to read it and as I hope to move in the future which will mean a GP, I will have no qualms about giving a new GP the link to the PDF paper so they are well informed about the condition. It is now recognised that the info in with the medication is outdated. My meno specialist even told me to ignore the leaflet info. It really seems we have to educate ourselves and then educate the medical professionals we see.
"Women should also be advised that the information packaged with vaginal hormone preparations is out of date and
factually incorrect. This needs to be changed by the MHRA."
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How did VA treatment ever get to the stage that it became available to buy over the counter, albeit for the over 50's, or if you lie, online. Someone knew but forgot to tell us!
I remember reading research papers with conclusions of 'surgeries should be prepared as more women come forward. But then also reading papers with surveys saying too many women will not come forward and giving the reason why, too embarrassed, my business, its private.
The whole subject is bewildering as to why some women have to fight for the treatment and some don't but its a condition that can't be lived with once at the chronic stage.
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This is a condition that we ourselves have to be in control of because there is so little known about it, and it doesn't help that the leaflet attached is out of date which doesn't help our cause at all!
Below is a quote from GSM BSSM which is guidance for all the issues & treatment for what they are now calling Genitourinary Syndrome during Menopause (formerly VA) it's co written by Dr Louise Newson. GPs need to read it and as I hope to move in the future which will mean a GP, I will have no qualms about giving a new GP the link to the PDF paper so they are well informed about the condition. It is now recognised that the info in with the medication is outdated. My meno specialist even told me to ignore the leaflet info. It really seems we have to educate ourselves and then educate the medical professionals we see.
"Women should also be advised that the information packaged with vaginal hormone preparations is out of date and
factually incorrect. This needs to be changed by the MHRA."
Thanks for this updated view on VA, I will be making a note of the correct terminology for future reference.
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It will probably protect them now but if they come off it post menopause when their symptoms may reduce that could be a problem and some still need local estrogen even with systemic. I never needed HRT during peri, one of the lucky ones, not so lucky post meno with atrophy.
I wish they would do more research why some women get this and others don't, why some sail through menopause and others suffer so badly. I know we're all different but what is the difference in this case?
I know the adrenal glands have something to do with it as they take over after the ovaries stop producing estrogen. Maybe we should be targeting and stimulating these glands. I'll perhaps start a thread on this or check there's one already.
I’d love to know this too.
I learned something like cholesterol makes pregnolenone, which makes dhea, which then makes estrogen, progesterone and testosterone.
But cortisol caused by stress uses up pregnolenone (called cortisol steal) which causes sex hormones to dip. No wonder we go worse when stressed.
So I read some women are on pregnolenone as an hrt alternative but under supervision of a functional medicine practitioner. Their approach is to provide the body with the “grand mother” hormone to help the body make the sex hormones it needs, instead of simply adding estrogen because there are certain metabolites that estrogen alone can cause.
Something like that anyway. I may be wrong with the details.
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It all sounds very complex, no wonder so much can go wrong and definately when stress is involved. I was told to reduce my cholesterol which then had a knock on effect on my hormones and worsened my atrophy. It doesn't take much to upset the balance but takes an awful lot of time to put right.
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I was told to reduce my cholesterol which then had a knock on effect on my hormones
It means to reduce bad cholesterol, but you can eat plenty of good cholesterol. Anyway your liver makes all the cholesterol your body needs, so no way reducing bad cholesterol in your diet will have an effect on your hormones.
Menopause is still not properly studied subject, that contains more questions than answers.
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It was the treatment that messed up my atrophy. I was taking plant sterols which did reduce my cholesterol but also reduced my estrogen by attaching to receptors and mimicking estrogen.so blocking the real thing.
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It was the treatment that messed up my atrophy. I was taking plant sterols which did reduce my cholesterol but also reduced my estrogen by attaching to receptors and mimicking estrogen.so blocking the real thing.
OK, sorry, I misunderstood.
When we are young, we have normal level of total cholesterol, because estrogen keeps it under control. In menopause, when estrogen falls down, cholesterol rises. But I can’t see how good cholesterol can be related to estrogen receptors. In fact my good cholesterol level is higher, than normal, mainly because I like nuts and seeds and other foods, which is rich in good cholesterol. The same time I have very high level of sensitivity to sex hormones. High level of good cholesterol doesn’t block my receptors at all, I also used to be estrogen dominant, and suffered from severe symptoms of too much estrogen.
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It was the plant sterols blocking the receptors not the cholesterol. I couldn't understand why my atrophy had come back with a vengence after taking the plant sterols for months. A few others on the forum had the same problem after trying to reduce cholesterol with Benecol, i researched it, the doctor told me to stop taking it and it eventially improved. We had a thread about it. Maybe lowering my cholesterol didn't help then either, it's probably gone back up now lol.
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Last month it was a GP questioning whether I needed Estriol as it was rare to need both, got that all sorted but this month its 'as you requested in May a three months supply of Vagifem, your next prescription is not due until August'. Some lucky lady has gone on a long holiday I presume with three boxes of Vagifem and I am left in good old blighty fighting for my one box.
I popped into the surgery and tried to explain only to be told by the receptionist, oh its HRT you will need a review. I explained on deaf ears no, its not needed for topical oestrogen and that someone had got three boxes of Vagifem and its not me. No you need a review, no I don't I said again. Ok we both said in unison, put in another request and see what happens.
I absolutely hate being in this exclusive club called Vaginal Atrophy (GSM) because its still the big mystery to medics and admin staff and to think I could have walked next door to the pharmacy and bought Gina but because I use the pessary every day, its extremely expensive but my goodness the freedom it would give from all the crap that goes trying to get a prescription.
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I've requested extra as I've been told to use extra. I dread being told I can't have it. I'm still waiting for the reply. As if this isn't bad enough without having to beg for the treatment
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Last month it was a GP questioning whether I needed Estriol as it was rare to need both, got that all sorted but this month its 'as you requested in May a three months supply of Vagifem, your next prescription is not due until August'. Some lucky lady has gone on a long holiday I presume with three boxes of Vagifem and I am left in good old blighty fighting for my one box.
I popped into the surgery and tried to explain only to be told by the receptionist, oh its HRT you will need a review. I explained on deaf ears no, its not needed for topical oestrogen and that someone had got three boxes of Vagifem and its not me. No you need a review, no I don't I said again. Ok we both said in unison, put in another request and see what happens.
I absolutely hate being in this exclusive club called Vaginal Atrophy (GSM) because its still the big mystery to medics and admin staff and to think I could have walked next door to the pharmacy and bought Gina but because I use the pessary every day, its extremely expensive but my goodness the freedom it would give from all the crap that goes trying to get a prescription.
So frustrating! I have had to do 2 HRT reviews already this year despite asking for Vagifem. Then they supplied Evorel Conti instead of Vagifem. I tried to buy 1 box of GINA as back up but Boots blocks this if someone is on systemic!
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I can't afford to buy my own so not sure what I'd do. Is it a funding issue?
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Received another message from the surgery saying they have approved my Vagifem prescription but I need to make an appointment for a review of this medication.
What I can't get my head around is, if I can buy it over the counter and I have been on it for two and a half years and no matter what this review comes up with, I will still need to be on it for life. I am not on any other HRT just topical.
Am I being unreasonable here because I think this review is totally unnecessary and a waste of all our time and I will be saying so when I go to the surgery tomorrow to make the appointment.
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I believe that GPs have to do a medication review, at our Surgery the Pharmacist rings me at an arranged time to see what is/not working. Then he approves my repeat prescriptions.
So any1 on a new product may B asked to attend a review, after which I can't see a problem with slapping all the reviews if necessary together once a year.
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All I will say is this has taken me back to when you could only get Canesten on prescription after seeing a GP and I always said then, one day we will be able to buy it over the counter. We are half way there with Vagifem, you can buy it over the counter but you still have to have a review, which doesn't make any sense to me.
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I'm guessing it's partly to do with funding of prescription drugs, so that they aren't paying for drugs eternally without checking they're still appropriate however I think that depends on the gp surgery too as my son is on sertraline and hasn't had a review for years. I know someone who gets omeprazole on prescription and doles them out to anybody with indigestion. You're right though, there's such contradiction.
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It's to make sure that the product is still suiting the user. As well as being a control of how much medication is being prescribed annually.
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I'm an adult, if it doesn't suit that's up to me to say so. Its to justify the cost, the slippery slope to buying it yourself as its available over the counter.
This is living in the real world not what any latest report or new findings on the condition states.
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I think the treatment we have for VA is slightly different as we will always need it, though there may be new and better products that are developed down the line that may be offered at a review. There are adults though who are taking medication long term when it's either no l9nger the mist appropriate or they don't need it at all or its harmful long term so that's partly why reviews are put in place. Ours are on our prescription print off from the pharmacy I think, a reminder. However for treatment like ours, I don't see any justification for not prescribing whilst a review is taking place. I'm sure my current problems have stemmed from being told to stop until I'd had my gyny appointment
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I am on other medication that's due for review in October, its the Vagifem that has been singled out for a review now, that's why I am questioning what's really going on!
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Did you change your gp? I suspect I'd have the same problem if I changed. At present they give me what I ask for though they stipulated twice a week and I'm using more so how long that will go on for I'm not sure. Thos condition is bad enough without the treatment being withheld
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Yes, moved to a different county.
Its interesting there are two of us in the household with repeat prescriptions and only my Vagifem is coming up for review, pardon me for being ever so cynical!
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Yeh that sounds like a lack of upto date knowledge about topical estrogen