Menopause Matters Forum
Menopause Discussion => Other Health Discussion => Topic started by: TizzyWizz on September 03, 2024, 11:09:44 AM
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Hi everyone, I’m new here.
I’m feeling a little overwhelmed by my symptoms and have been going round in circles for 5 years. So I’m hoping for a few pointers. 🤞🏼
Long story short, there seems to be issues getting my HRT right (I had some bleeding with it so it’s been stop/start/swap) and in the interim I have now developed extremely sore labial tissue. So bad that I’ve been up at night the last two nights with the burning sensation. The skin is dry and irritated and my vulva moisturising oil has only a very short term effect.
Is it perhaps time for me to give up on the NHS and sign up for the Newson clinic?
Any advice gratefully received, I feel awful down below and it’s really affecting my mood.
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Hi. This may well be the start of vaginal atrophy which will be relived by appropriate treatment from the GP. Usually 'vagifem' pessary is prescribed which is inserted into the vagina: gently: for 2-3 weeks every night. After which it's a bit trial and error finding out how often it is required. Some use 'estriol' as well on the outer labia/vulva.
I use 'estriol'/ovestin internally with a smear around the labia to stop the area getting dry and itchy. As oestrogen levels drop the body may become dry: inside and out ::)
Have U told the GP/Nurse practitioner about your dryness?
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Thanks CLKD!
You might be right on the trial/error…I was put on 2 weeks intensive vagifem pessary by an gynae and then told to go down to twice weekly and I think I need more. So I think I will try increasing again.
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Gosh, more rubbish advice from the people who should know about these things.
Latest guidelines and quotes from the Position statement for management of GSM (Vaginal Atrophy)
“Studies have shown that around 70% of women have symptoms of GSM, yet only 7% receive treatment.
Women should be offered an examination and their decision to accept it or not needs to be respected.
The clinical response to treatment with topical oestrogen is usually rapid and sustained.
Women should also be advised that the information packaged with vaginal hormone preparations is out of date and factually incorrect.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.
The dose of vaginal oestrogen is very low, for example, using 10mcg oestrogen pessaries regularly for one year is an equivalent dose to just one 1mg of oestradiol HRT tablet.
If symptoms do not improve with vaginal oestrogen, consider increasing the dose, changing preparation (and consider DHEA) or using an additional treatment such as systemic HRT or two local treatments.
The frequency of using these preparations can be increased in women who have persistent symptoms as the doses of these preparations are very low.
Vaginal oestrogens can often improve urinary symptoms, including urinary infections.
Some women use vaginal oestrogen preparations more frequently than the recommended dose to improve symptoms sufficiently, for example Vagifem alternate days instead of twice a week. It is safe to use the treatment in this way as the dose is very low.
Women should be reassured that it is safe for topical oestrogen to continue in the long term (medication should be on a repeat prescription). Women should continue to be reassured about the long- term safety of vaginal oestrogen preparations."
The full pdf document to print off to put you fully in the picture and in charge of your treatment.
https://bssm.org.uk/wp-content/uploads/2023/02/GSM-BSSM.pdf
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Wow Ayesha, yes this was a private experienced gynae I saw in June.
This GSM leaflet is illuminating!
I’m already benefitting hugely from sharing my experience more here than I have with the medics in the last year.
I’m going to go back to daily vagifem and then try a slow reduction to ascertain exactly the level I need.
I am also going to make an appt with Newson Health…
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Gynaes ::)
Let us know how you get on with your new regime.
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Started applying cetraban cream and upping the vagifem, noticing some relief already…got a culture and urine sample lined up to rule out any infection next….
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tnx. Stick with that for a while, don't use too many products or U won't know what is working ;-)
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I agree.
I also feel adding in vaginal moisturiser is only worth it if oestrogen is adequately replaced otherwise body cannot absorb the moisturiser - would you agree?
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No, don't think it matters one way or another as a moisturiser will do what is says it will do. I always use a moisturiser with my daily Vagifem and Estriol cream because both products have a drying consistency. They all work very well together.
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Hi Ayesha, are you using the oestrogen cream by inserting vaginally or applying it to labia, or both?
And the moisturiser- again vaginally or around labia or both?
Thanks!
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My regime for the last four years is Vagifem daily, a pea sized amount of Estriol applied with moisturiser twice daily smeared on the outside only, a tube will last me three months.
I was at a very bad stage of GSM, for instance not being able to do anything physical like gardening as it caused extreme pain and being unable to sit down but now I am symptom free.
We are all different and this is what works for me but reading the posts here its not an easy ride for a lot of women, I feel very lucky that the treatments work well for me.
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Thanks for your reply!
I’m so glad you found a solution. It was because you posted the GSM position statement that I am now course correcting. I started daily vagifem that same day. I’m using cetraben to moisturise the labia. I’m going to add in things in stages so that I can see what is working.
What moisturiser are you using please?
Thanks again Ayesha x
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I am using YES VM and again no problems with it. Sylk is another good moisturiser but it doesn't seem widely available anymore, for convenience I buy Yes on Amazon.
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Thanks. I’ve been on Replens in past but I am thinking to try Yes as an alternative, to see if any difference.
Are you also taking systemic HRT?
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I was on systemic HRT many years ago to relieve hot flushes, I stayed on it for five years and decided that was enough. It was more about the constant reviews, concerns about blood pressure, etc, that all this interference in my life was causing a lot of anxiety.
My meno journey has been very easy compared to others and its only in later life that GSM took a hold and I am very happy to use the treatment as its a necessity and not a choice.
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Hi TizzyWizz
Sure you know already but there are a few types of YES and one of them has no additives at all .. think it’s YES OB I was never able to use the standard one used to burn like mad So when I restart my Intrarosa, I’m post surgery at the moment I’m going to try this one
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I was on systemic HRT many years ago to relieve hot flushes, I stayed on it for five years and decided that was enough. It was more about the constant reviews, concerns about blood pressure, etc, that all this interference in my life was causing a lot of anxiety.
My meno journey has been very easy compared to others and its only in later life that GSM took a hold and I am very happy to use the treatment as its a necessity and not a choice.
Thanks Ayesha. And from what I read the systemic would unlikely have helped with the GSM anyway x
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Hi TizzyWizz
Sure you know already but there are a few types of YES and one of them has no additives at all .. think it’s YES OB I was never able to use the standard one used to burn like mad So when I restart my Intrarosa, I’m post surgery at the moment I’m going to try this one
Hi Kathie, I didn’t know. I’m all in for the learning, thank you!
The last gynae I saw had prescribed hydremol ointment to use as a vaginal wash during showers. It burnt like crazy. Not using again.
I intend to stay away from things like that other than to find the right moisturiser. Thanks for sharing! x
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Hi lovely ladies…so a little update, I’m
two weeks into using the vagifem daily and things seem a lot calmer than they were, so I feel quite positive at the moment and will continue.
However, I’m also planning to add in some oestrogen cream at some point really to apply directly to the labial skin…if anyone would like to share with me the different brands or options for the oestrogen cream tried and your experiences of them, I would really love to hear about it.
Thank you! x
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The common cream prescribed by GP's is Estriol, formally Ovestin.
If you are buying it yourself its extremely expensive since the name change but I believe Superdrug Online Doctor are still selling Ovestin at £25 (must be old stock) and Estriol at £55, which I think is scandalous.
An eagle eyed member here found Boots selling a product called Ovesse at £19.95 which I believe is exactly the same as Estriol.
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Thanks Ayesha!
This was indeed why I started the query - as I could see ovestin and estriol both available but they looked like identical products.
Very interesting about Ovesse.
It’s amazing what you learn…
Thank you 🙏🏼
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Hi everyone!
So a little update on this topic from my end as well as a question 😊
Following my initial consult with Newson Health last week, it appears we want to take a multi intervention approach for my GSM.
So I’ll be adding in vaginal moisturiser to the vagifem as well as oestriol cream to vulva. My GSM has been around for a while so we have to work at it to bring things back online.
I’m just wondering what’s the best order and timing of these three things plus a vulval moisturiser that I will add in.
Ayesha, I know your regime is similar - do you have a specific order?
All thoughts and suggestions welcome from all.
I ran out of time in my consult to ask about this!
Thank you so much ladies. And I hope everyone is doing ok!
Tizzy x
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What works for me is morning Vagifem, a smear of Yes moisturiser and a smear of Estriol, half a pea sized amount. Then before bed a smear of Yes moisturiser and a smear of estriol. That's the regime that works for me, you might be different but I am symptom free now.
Thanks for the update, let us know how it goes for you, all trial and error at first!
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Hi Ayesha,
Thanks so much - I think I’ll give that routine a try!
We do sound as though we may have been at similar stages. How long did this routine take to work for you?
Will continue to update, so that that others can also learn. What a wonderful forum we have here
X
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It took four months to finally get relief and one year into treatment I was symptom free. Expect flare up’s, these can happen with some medication, weather conditions like heatwaves or high humidity plus viruses can all cause discomfort but because of being well oestrogenised, the flare ups are very mild.
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Yes Ayesha, Newson health are hoping I will see an improvement by the 4 month mark.
My GSM went undiagnosed for almost 5 years - I complained and complained about symptoms - to no avail.
So now that I am here and have read up and have had my initial consult I’m
giving it my best shot, sending out my gratitude to all those who have helped and keeping everything crossed!
x