Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Cab6 on July 31, 2025, 08:52:15 PM
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Hi, the nurse practioner at my GP surgery has told me I can't have Estriol & vagifem pessaries. They've also changed me to Ovestin & told me to use it daily for a month but have only prescribed 45g, where as I previously had Estriol 80g tube, when I said it wouldn't be enough they replied via email that Ovestin is stronger so I don't need to use as much. I'm confused as it doesn't make sense.
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Ovestin is the stronger of the Estriol creams, give it a try and if it doesn't work you can ask for more treatment.
In the meantime read this document which explains all what you may need as far as dosages are concerned for treatment of GSM. By reading the document you will more than likely end up knowing more than your nurse practitioner given what she has prescribed for you.
https://bssm.org.uk/wp-content/uploads/2023/02/GSM-BSSM.pdf
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Brilliant, thank you, will do
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Hello Cab6 it does seem that we have to fight to get not only the appropriate treatment but also the dose our body needs as we are different, obviously. I use Estriol 1mg cream & estradiol 10 micro gms pessaries every day together. I had been using the cream externally but now use it internally as well because my pain is not under control. From time to time when I've had a flare up I've bought Gina online from Boots & used 2 x pessaries every night for 2 weeks - I've seen comments on here saying you can 'overdose ' on it.
To get my daily dose of both, I had to contact Dr Currie via an email consultation & took sent her recommendations for the dose I need to my GP. They refused to prescribe more than 2 x weekly without. I then had to wait 18 months to see a menopause specialist at the hospital (she trained under Dr Currie) to get enough cream & pessaries on repeat.
My GP is finally (I hope) on board as she has accepted my symptoms are not currently controlled. For me, & others here too, it doesn't seem to matter how much vaginally oestrogen we use, we can't get rid of symptoms to the point where we feel normal.
Maybe, if you haven't already, ask for a referral to your local menopause specialist. Also you can buy what you need online so maybe, if funds allow, do that for 2 months & then report back to the GP if it improves your symptoms. Perhaps print out the document Ayesha posted the link to & give it to the nurse practitioner as well as some of Dr Currie's articles about doseage. I've found they don't like that but tbh I'm past caring.
I hope you can get what you need & quickly.
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Dr Currie posted this recently in another thread which I found very helpful, particularly to those of us who have to always fight for the correct dosage to ease symptoms. Although I can't get down to five pessaries a week but still need seven, I am reassured by her post and just to add my surgery has no problem prescribing Vagifem and Estriol daily.
"Vaginal estrogen is minimally absorbed, but we do not know the effects of using more than one preparation at a time, or using higher than licensed doses. As with HRT doses, if a licensed dose is not fully effective, then a different type could be considered but also the underlying problem may not be purely hormone related and review would be indicated.
The BMS consensus statement does not recommend adding preparations together--see https://thebms.org.uk/wp-content/uploads/2024/04/09-BMS-ConsensusStatement-Urogenital-atrophy-MARCH2024-A.pdf
The dose increase for vaginal estrogen tablet as mentioned is reasonable because of the following--
Many years ago, we had a preparation Vagifem 25mcg--every night for 2 weeks then twice weekly. When it was taken off the market, we then used the lower dose Vagifem 10mcg (Vagirux is the same)--nightly for 2 weeks then twice weekly. So the maintenance dose of Vagifem 25 provided 50mcg of estradiol over a week, for which there was no concern about significant circulating absorption affecting the womb lining. Therefore, if needed, this can be achieved by using Vagifem 10 of Vagirux up to 5 times weekly. For many, twice weekly is enough and can be continued long term, for others using it 3 to 4 times weekly or maximum 5 times weekly works better.
If vulval and vaginal treatment needed, some find using the large volume estriol cream 0.01% applying half with a finger to the vulva and remainder into the vagina can be useful. However, other vulval conditions and sensitivity may need to be considered.
I hope that this is helpful."
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Thank you, this is all very helpful, I've downloaded the documents too
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Ayesha, where do we stand then when the only thing that keeps pain from GSM at bay is 2x pessaries each night 3 - 4 times a week and 1 the rest of the nights, is the only thing that works, I wonder? Clearly it can't be anything else but atrophy but I also understand it's a high dose but no one seems to listen (ie health care professionals). I'd personally rather risk it than endure the misery without. What do we do when a lower dose just doesn't work?
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We stand alone, I honestly think we alone are doing the research by experimenting on ourselves when it comes to topical oestrogen and dosage. In my view topical, being completely different to systemic HRT, I wouldn't mess with that and would always follow medical advice, in the past it caused me too much damage to ever tinker with it.
With a recent severe flare up I bought a box of Gina as a back up, I like to keep under the radar because I no longer have the patience to explain myself to all and sundry.
I used two Vagifem daily and a smear of Estriol three times a day, including moisturiser and after three days I became symptom free again. We always say we are all different and this worked for me. For you its obvious you are in a more complex situation and you are still a work in progress but at 76 years old I am not going to suffer needlessly and will do what it takes to relieve symptoms.
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Oh Ayesha, isn't it ridiculous to have to keep quiet about what helps with the pain we suffer. I was (stupidly with hindsight) thinking about mentioning to the GP I'm seeing about extra doses with Gina because she's been so sympathetic & understanding. But I mentioned Intrarosa & the fact I'd heard it delivers testosterone to the area it's most needed & she raised an eyebrow. Apparently (according to her) it's not licenced for uk use so she wanted to know how I knew about it. As soon as I mentioned Louise Newsome she changed completely. Still very caring but she told me to be very careful what I read etc etc & not listen to Louise's advice at all. I had to do a lot of assuring that I didn't follow her or watch/read her stuff, just that I'd heard.
Anyway dear lady, thank you for just being there with empathy. I know it's just words on a forum but it really helps enormously to know all of you are here with advice & comfort. I appreciate everyone here - but I do wish we weren't here with our struggles but rather all aging gracefully without our bodies going haywire!!
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I mentioned Intrarosa & the fact I'd heard it delivers testosterone to the area it's most needed & she raised an eyebrow. Apparently (according to her) it's not licenced for uk use so she wanted to know how I knew about it. As soon as I mentioned Louise Newsome she changed completely. Still very caring but she told me to be very careful what I read etc etc & not listen to Louise's advice at all.
Its disappointing to read this, Louise Newson's name gets thrashed and the rest of us suffer the fall out.
Intrarosa is mentioned in the British Society For Sexual Medicine Position Statement as one of the treatments for GSM. Her name is referenced in the document along with many other names. Its unfortunate but I would not have mentioned her name, obviously now too tarnished going by the response you got from your GP, but the fact that this medication is included in the document and whether its licenced or not, its still a treatment that can/should be considered when everything else has failed.
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According to Google intrarosa is licensed for use in the UK. Apparently it's expensive so perhaps it isn't on the nhs list (or perhaps it just has a big red flag against it because the T word is used). The nhs seem to be doing everything they can to discredit Newson though perhaps it's back firing as now everyone knows they can go her if when they can't get adequate treatment on the nhs.
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I googled Intrarosa after I posted & it is listed as a treatment by the NHS provided the benefits outweigh the risks, apparently. I do regret mentioning Ms Newsom but although I knew she'd had some very bad press etc, I had only read that she'd had good results with it so was kind of caught on the hop, as it were.
It's again frustrating that there is appropriate treatment but we're told 'no, you can't have that'. The only thing that concerns me about this GP is that she said there is no evidence testosterone helps bladder/urethra issues & it's dangerous which is why she told me to make 1 sachet of testogel last 20 days because my blood results were free androgen index :5 . Everything else was well below all the limits.
Apologies Cab6, didn't want to highjack your important thread 🤗
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That's ok Mrs Mitch, I'm just grateful to read all your comments and know that I'm not alone with this. You've all been very helpful.