Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Shelly65 on January 16, 2019, 09:12:18 AM
-
Hi all, just been to GP for my hrt plus a script for ovestin. I use vagifem 5 to 7 days a week plus a smear of ovestin 1 to 2 times a week. Sooo annoyed because my preferred gp is happy to do this but this one today to!d me there is a VERY high risk of womb cancer. My answer was "well I'll take the risk thanks". Feel so angry right now. Do they actually have any evidence to support this. If so where is it coz I haven't seen anything. In future wil see my preferred doctor.
-
Hi, I assume you meant the risk the gp said was for the vagifem/ovestin. Sorry your gp has worried /angered you. I use ovestin and no other hrt for VA. I have been struggling with uti symptoms for a few months and saw my gp and she advised to use it every night for a while and alternate nights for life if need be and gave me a script for 4 tubes to keep me going. She said it's very safe to use. She mentioned that other gps at the practice might not agree, but she's the hrt expert there. It was a relief to hear her. I could not manage without it anyway.
-
Ye from them both. My other doctor said very safe even to use every day. Only use a tiny bit of ovestin on the outside anyway not both internally. Maybe there are women who have had womb cancer whilst using vagifem or ovestin but maybe they would have got it anyway. If I hadn't been a bit shocked at what she said and how she said it i probably would have asked for fact and figures lol. I'll be ready next time😀
-
Oh it's so scary these gps are even practising !
One vagifem tablet used daily for a whole year would be equivalent to one standard dose oral oestrogen tablet x
-
Couldn't agree more. What I should have also said but forgot because I was angry is I tried to explain to the doctor that although the vagifem is good for inside it doesn't do anything for outside. She just she just looked at me stupid. Thank goodness with forums like this we can make informed choices and hopefully feel more confident when we go to the doctors.
-
Well Tamoxifen has a huge risk of womb cancer and that is taken by mouth. But rarely do medics point this out.
Life is a risk. Quality is important. I had breast disease and my GP never hesitated in giving me appropriate treatment for VA. PHEW!
I would ask where she got her information from.
-
Oh i will be ready the next time it happens. Thank God she is not my usual doc.
-
Hello ladies,
I have one doubt regarding this subject, maybe one of you can clarify it.
This link that Jenna has posted on Tc's thread about how long an Estriol tube should last, says 'Topical oestrogens should be used in the smallest effective amount to minimise systemic effects. The endometrial safety of long-term or repeated use of topical vaginal oestrogens is uncertain; treatment should be reviewed at least annually, with special consideration given to any symptoms of endometrial hyperplasia or carcinoma.'
https://northeast.devonformularyguidance.nhs.uk/formulary/chapters/7-genito-urinary-system/7.6-vaginal-and-vulval-conditions/7-2-1-preparations-for-vaginal-and-vulval-changes (https://northeast.devonformularyguidance.nhs.uk/formulary/chapters/7-genito-urinary-system/7.6-vaginal-and-vulval-conditions/7-2-1-preparations-for-vaginal-and-vulval-changes)
The leaflet states that a progestogen should not be added. https://www.medicines.org.uk/emc/product/5869/smpc (https://www.medicines.org.uk/emc/product/5869/smpc)
This is contradictory and confusing.
Another doubt is: If there's no need for scans - Section 1.4.14. NICE guidelines: ‘Do not offer routine monitoring of endometrial thickness during treatment for urogenital atrophy.' - then why allow those warnings for products used solely for urogenital atrophy? If there is no cancer risk, the leaflets should be clear about it. If there is cancer risk, then women under vaginal atrophy treatment should be monitored for endometrial thickness.
Maybe some GP's are just following the rules, which obviously need some clarification.
Conolly X
-
Hi all, just been to GP for my hrt plus a script for ovestin. I use vagifem 5 to 7 days a week plus a smear of ovestin 1 to 2 times a week. Sooo annoyed because my preferred gp is happy to do this but this one today to!d me there is a VERY high risk of womb cancer. My answer was "well I'll take the risk thanks". Feel so angry right now. Do they actually have any evidence to support this. If so where is it coz I haven't seen anything. In future wil see my preferred doctor.
Your doc is completely wrong - as far as I know there is no evidence for this! The warnings given on vaginal oestrogen treatments are the same as for full HRT and have not been updated - there is even the same warning on my tube of 0.01% estriol cream!
It is true that there are no long term studies have been carried out on long term effects of vaginal oestrogen but nevertheless due to the very low systemic absorption (which has been studied) and extremely low doses in vaginal treatments, no progestogens are routinely needed nor is there a time limit on vaginal oestrogen treatments. The BMS 2016 recommendations on HRT recognise this.
Yes the leaflets are and have always been contradictory in this regard and worry women needlessly. These warnings were in place when I first started vaginal treatment sometime around 2005 or so before I even started HRT - and they worried me too! Shocking though that the GPs have not educated themselves.
As always though if you have any persistent abnormal pain or unscheduled bleeding - do see your GP.
The link you posted and quoted from Conolly refers to out of date info - I don't know when it was written but needs updating ( as does quite a lot of info out there!). Heaven help us if GPs are referring to this and passing scary stuff onto patients! Gynest cream is no longer available - was discontinued some time ago and is now a generic. That info you quoted about the addition of a progestogen was in the guidance/warnings I referred to above - which is for full HRT but still appears in some of the vaginal treatments. However my latest leaflet for estriol 0.01% cream obtained today has actually modified the advice re endometrial cancer - so anyone who gets this should not be alarmed. (the info on dosage is still valid as the tube size and estriol concentration of the generic is the same).
Hurdity x
-
Hello Hurdity,
From the latest Ovestin 1mg leaflet: http://www.mhra.gov.uk/home/groups/spcpil/documents/spcpil/con1536293554114.pdf
Endometrial cancer (cancer of the lining of the womb)
Taking oestrogen-only HRT tablets for a long time can increase the risk of developing cancer of the lining of the womb. It is possible there may be a similar risk with oestrogen cream used directly in the vagina for repeated treatments or over a long time.
You do not need to take a separate progestogen with Ovestin.
If you get breakthrough bleeding or spotting, it is usually nothing to worry about, but you should: Talk to your doctor. It could be a sign that
your endometrium has become thicker.
Ovarian cancer
Ovarian cancer (cancer of the ovaries) is very rare, but it is serious. It can be difficult to diagnose, because there are often no obvious signs of the problem. Some studies have shown that taking oestrogen-only HRT for more than 5 years may increase the risk of ovarian cancer. It is not yet known whether other kinds of HRT increase the risk in the same way.
It still sounds confusing to me to say: 'Taking oestrogen-only HRT tablets for a long time can increase the risk of developing cancer of the lining of the womb. It is possible there may be a similar risk with oestrogen cream used directly in the vagina for repeated treatments or over a long time.' and then adding 'You do not need to take a separate progestogen with Ovestin'
Also... If there's no risk for endometrial cancer under this treatment why the Estriol generic leaflet (from 2018) says: 'Make sure that you go for regular breast screening and cervical smear tests' if cervical screening and scans are not offered for ladies over 65 under the NHS? My question is: if there is a risk, even if it's a small one, that vaginal oestrogen can increase the chance of certain types of cancer, why the NHS isn't extending scans and screenings to ladies under oestrogen vaginal treatment?
Conolly X
-
Hello ladies,
From Vagifem leaflet:
'HRT and cancer
Excessive thickening of the lining of the womb (endometrial hyperplasia) and cancer of the lining of the womb (endometrial cancer)
Taking oestrogen-only HRT tablets for a long time can increase the risk of developing cancer of the womb lining (the endometrium).
It is uncertain whether there is a similar risk with Vagifem® when it is used for repeated or long term (more than one year) treatments. However, Vagifem® has shown to have very low absorption into the blood, and therefore the addition of a progestagen is not necessary.
If you get breakthrough bleeding or spotting, it's usually nothing to worry about, but you should make an appointment to see your doctor. It could be a sign that your endometrium has become thicker.
The following risks apply to HRT medicines which circulate in the blood. However, Vagifem® is for local treatment in the vagina, and the absorption into the blood is very low. It is less likely that the conditions mentioned below will get worse or come back during treatment with Vagifem®, but you should see your doctor if you are concerned.'
Is it necessary to have absorption into the blood to cause local (vaginal and endometrial) cancer?
Conolly X
-
Worried and confused. Using ovestin every night for VA for a few weeks. Still getting frequent weeing and fed up. Don't want to use any other hrt as had bleeding on tiboline. I'm permanently worried these days.
-
Hello susysunday,
So am I. I'm not on HRT anymore but it's likely I will need some in the near future, VA is already lurking around.
I am trying to read as much as I can on this subject to make an informed decision.
I hope your symptoms will ease soon. The worries are a different matter, I think they don't go away as long as we live.
Conolly X
-
Quality of Life Girls, Quality of Life.
This is 'can', 'may' and 'perhaps' with nothing to back it up. Companies feel the need to state everything in case they get sued at a later date.
Should my cancer return I wouldn't be blaming anyone but would prefer to become part of Research Study because without bums on seats, no-one is really going to know! Maybe I ought to suggest this to my GP at my annual visit?
-
I think I've read too much and my brain jumps from one worse cae scenario to the next.
-
I've said for years: when my Consultant called me back sooner than expected after a lump was removed from the breast, I said on the journey to the hospital that I would have both breasts removed. But he reassured me that 'lady's with this particular condition do not need mastectomy. If you change your mind in a couple of years we'll talk again'. It never crossed my mind after, too busy getting on with treatment.
Now I equate it to That Bus. Which might come along and hit me much sooner than any cancer will return. But by taking medication what ever the risks, I have a Life with DH to get on with. Something will take me off eventually ::).
So weighing up what you want to do with your Life and how to achieve good health in order to do those things, is important.
-
Susysunday,
I know what you mean, it's really hard to make an informed decision when you're struggling with health (both physical and mental) issues. I'm trying my best to read as much as I can during this 'break' after horrendous perimenopause and a much more bearable menopause.
CLKD,
I agree with 'quality of life', but for me quality of life includes peace of mind. I need to know that whatever I decide I had tried my best to weigh the pros and cons of something that can change my life for the better or for the worse in the long term. Does it look a bit like marriage? ;)
Conolly X
-
It takes too much away from getting on though. Everything has risks, even getting out of bed ;)
-
Yep, but there are risks you can control, taking drugs is one of them.
There are many drugs out there, you have to know which one is best for you. There are 2 options: you take it and wait for symptoms and side effects or you base your decision on information that's already available regarding that drug. I choose the latter option.
Conolly X
-
I don't think that enough is known about each individual person regarding those who have had treatment for breast disease and the risks of HRT. My Oncologist said at my last appt. "No HRT for you" but that was in 1997-ish. Regardless, I would need to know a lot more about certain risk if I had required treatment should symptoms have warranted it.
-
It takes too much away from getting on though. Everything has risks, even getting out of bed ;)
Even staying in bed has risks, so that's not the point, really.
The fact is: the guidelines and the leaflets are not in synch. If something bad happens and one is not entitled to sue whoever says 'it's safe to take HRT and vaginal oestrogen for as long as it's needed' or 'one year supply of topical oestrogen is equivalent to having one tablet of standard HRT', then one will be hopeless and helpless.
By the way, I keep reading these statements in guidelines, newspapers, magazines and even scientific articles, and none has properly referenced these allegations. Can someone point me to the right direction? Who has studied and found evidence that 'one year supply of topical oestrogen is equivalent to having one tablet of standard HRT'?
Conolly X
-
Often wonder the same Conolly which is probably why I remain cynical ::)
-
Oh, I'm sorry I haven't noticed you were being cynical ;D
Conolly X
-
Worried and confused. Using ovestin every night for VA for a few weeks. Still getting frequent weeing and fed up. Don't want to use any other hrt as had bleeding on tiboline. I'm permanently worried these days.
Some women do find that the night they use vaginal oestrogen (eg when used twice a week) paradoxically they get bladder irritation even though overall it has a beneficial effect on vaginal and bladder tissues. This always happens to me with Vagifem. Maybe cut down to using it say 3 x per week and see how you feel?
If you find this is not controlling your VA then maybe time to rethink systemic HRT which many of us need as well as local oestrogen.
Hurdity x
-
I have found in the past that some days after Ovestin my bladder is irritated. I take one Nurofen to settle those feelings.
-
Even staying in bed has risks, so that's not the point, really.
The fact is: the guidelines and the leaflets are not in synch. If something bad happens and one is not entitled to sue whoever says 'it's safe to take HRT and vaginal oestrogen for as long as it's needed' or 'one year supply of topical oestrogen is equivalent to having one tablet of standard HRT', then one will be hopeless and helpless.
By the way, I keep reading these statements in guidelines, newspapers, magazines and even scientific articles, and none has properly referenced these allegations. Can someone point me to the right direction? Who has studied and found evidence that 'one year supply of topical oestrogen is equivalent to having one tablet of standard HRT'?
Conolly X
Yikes your quotes in red are a bit glaring - when I see it I'm thinking someone has posted a warning!!!! Not very restful on the eyes!!!
Anyway good point there - yes this is often put out by gynaes as a simplistic way of trying to get over that the amount of oestrogen in Vagifem is minute compared with systemic HRT.
This is how it is calculated - this isn't written anywhere - but if you do the calculation it's clear where it comes from. This has been quoted for quite a few years now and even on here too. It just refers to the total amount of estradiol in the different products. I would hope that wasn't quoted in scientific articles - although a journalistic article is different from a scientific report so with the former anything can be said and doesn;t need to be referenced and can be opinion!
The standard maintenance dose of Vagifem is 10 mcg twice a week = 20 mcg per week which is approx 1000 mcg per year = 1 mg = 1 standard low dose oral estradiol tablet. In fact it is very misleading because in terms of the uterus - more of the oestrogen (from Vagifem) will theoretically go through the cervix to reach the uterus compared with oral oestrogen (even though still a tiny amount). Also the 10 mcg is the total amount in the tablet not how much is absorbed anyway. Also with 1 tablet of oral oestrogen - much is lost to digestion and 1st pass liver metabolism so a smaller proportion of this will get into the system.
Hope that explains...
Hurdity x
-
Isn't this worrying for women who need vagifem every night?
-
Isn't this worrying for women who need vagifem every night?
Surely no because it is a fraction of the systemic tablet?
-
Just in relation to what Hurdity posted, with the local hrt theoretically reaching the cervix. My gp was quite definite about ovestin being safe to use for life. I used tibolone for 18 months and that caused my lining to thicken, so systemic hrt didn't give me much confidence to use again. I need something for VA so what to do? I will have to trust my gp and the ovestin. As ckld says, quality of life. I worry whatever I take since the tibolone gave me bleeding and biopsy. But I can't live without something.
-
Yikes your quotes in red are a bit glaring - when I see it I'm thinking someone has posted a warning!!!! Not very restful on the eyes!!!
Anyway good point there - yes this is often put out by gynaes as a simplistic way of trying to get over that the amount of oestrogen in Vagifem is minute compared with systemic HRT.
This is how it is calculated - this isn't written anywhere - but if you do the calculation it's clear where it comes from. This has been quoted for quite a few years now and even on here too. It just refers to the total amount of estradiol in the different products. I would hope that wasn't quoted in scientific articles - although a journalistic article is different from a scientific report so with the former anything can be said and doesn;t need to be referenced and can be opinion!
The standard maintenance dose of Vagifem is 10 mcg twice a week = 20 mcg per week which is approx 1000 mcg per year = 1 mg = 1 standard low dose oral estradiol tablet. In fact it is very misleading because in terms of the uterus - more of the oestrogen (from Vagifem) will theoretically go through the cervix to reach the uterus compared with oral oestrogen (even though still a tiny amount). Also the 10 mcg is the total amount in the tablet not how much is absorbed anyway. Also with 1 tablet of oral oestrogen - much is lost to digestion and 1st pass liver metabolism so a smaller proportion of this will get into the system.
Hope that explains...
Hurdity x
Haha, next time I'll choose blue, sometimes this subject gives me the blues, so quite appropriate. I thought red was ok to highlight a potential danger, but I agree that it doesn't suit presbyopia ;D
Thank you for the explanation, the math is quite simplistic and doesn't mean anything in terms of how much is being absorbed by local cells. The statement is misleading, it reassures women that topical is safer than oral but doesn't address the issue in question which is: is topical oestrogen safe in the long term? It's also disconcerting that oral estrogen is used as comparison when oral tablets are still being prescribed and sold in large amounts.
Conolly X
-
Nowt in red on here :-\
Stop worrying, get on with Life. The bomb might go off tomorrow ;) ......... I've never even considered that the product will reach my womb anyway ......... it supposedly absorbed into the vaginal walls any residue drains out. Well it does in mine ..........
-
Worried and confused. Using ovestin every night for VA for a few weeks. Still getting frequent weeing and fed up. Don't want to use any other hrt as had bleeding on tiboline. I'm permanently worried these days.
Some women do find that the night they use vaginal oestrogen (eg when used twice a week) paradoxically they get bladder irritation even though overall it has a beneficial effect on vaginal and bladder tissues. This always happens to me with Vagifem. Maybe cut down to using it say 3 x per week and see how you feel?
If you find this is not controlling your VA then maybe time to rethink systemic HRT which many of us need as well as local oestrogen.
Hurdity x
I have been using Vagifem for just over 4 months, mostly daily. In the earlier weeks it started to relieve the bladder irritation and also the feeling of knicker elastic chafing me on the left (as someone else on FB expressed it) and a dull ache in my hip, also on the left. After about 2-3 months, I found that I wasn't getting up to go to the loo in the night as much. However if I reduced it to only twice a week, the symptoms crept back quickly.
Then, this week, I have found that the symptoms above have crept back even though I am using Vagifem daily. Perhaps there is some degree of irritation from it. I am wondering whether to try using 2 together but just twice a week. I did once try using 2 together as a test to see if I had an adverse reaction but I didn't.
Those of you who have already used it for over a year: Did you find fluctuations in its effectiveness to start with?
-
Many find that this particular VA treatment does cause fluctuations as it may not be enough active ingredient. I would try 3 nights of double dose.
-
I think I might have experienced this with ovestin, which I am using nightly. Trouble is, I feel so anxious since recent health scare that I don't know if I am weeing a lot from anxiety, or I am so over conscious about my vagina and weeing that I don't know what's normal any more. That probably sounds a bit daft, but I just can't settle with my body any more.
-
It doesn't sound daft at all. When I start to come down from a high anxiety hit I wee: every 10 mins. copious amounts. For about 2 hours.
Are you drinking enough SS because the kidneys will work harder if the body is dehydrated. Also, maybe take a pain relief, it eases that bladder niggle for me: 1 capsule of Nurofen
-
Not sure what SS is, but yes I make sure I am hydrated with water. Last Sunday night I had a wee every 10 minutes like you, all night . I was exhausted. But then I think some of it is the VA. I just feel like crying today I am so fed up of feeling crap and thinking how my bits feel all the time.
-
Sorry I was being lazy - i.e. SS = suzysunday ::) but now I read it back :kick:
Up your fluid intake in the afternoon. Take a pain relief tablet 30 mins. B4 bed as well as the treatment. ....... and breath.
-
Thanks. I know my breathing is very shallow most of the time.
-
Also brain fog on my part about SS. I thought it was something I should be drinking!
-
Soft Stuff? ;) sorry I was being lazy.
Have you tried proper breathing exercises or singing which means we HAVE to breath correctly.
-
No I haven't. I will look into it. I do a lot of walking and exercise at home. Walking always helps.
-
No I haven't. I will look into it. I do a lot of walking and exercise at home. Walking always helps.
Helps me too. I have done over 260 000 steps this month(part of a local challenge).
-
Haha, next time I'll choose blue, sometimes this subject gives me the blues, so quite appropriate. I thought red was ok to highlight a potential danger, but I agree that it doesn't suit presbyopia ;D
Thank you for the explanation, the math is quite simplistic and doesn't mean anything in terms of how much is being absorbed by local cells. The statement is misleading, it reassures women that topical is safer than oral but doesn't address the issue in question which is: is topical oestrogen safe in the long term? It's also disconcerting that oral estrogen is used as comparison when oral tablets are still being prescribed and sold in large amounts.
Conolly X
Haha that's why I use green - as it is calming! (CLKD go to the first page and you'll see the red unless you are colour blind?)!
Yes it is totally simplistic! I assume it was a simplistic way of getting the message across that the amount in Vagifem is tiny compared to systemic HRT - because people understand it - it's a ballpark thing rather than precise measurement!
I'm not quite sure what you are worried about? As has been said earlier in this thread - long term effects of vaginal oestrogen have not been measured and this is recognised in the HRT guidance from BMS - I'm sure I have referred to it down thread? However the stimulating effect of oestrogen on the endometrium is dose dependent and this is well documented therefore the minimal risk is by extrapolation in the absence of hard data and long term trials. As with all treatments it is a question of risk (of endometrial cancer) - which is estimated to be extremely low - even if theoretically possible.
I'm also not sure why you are disconcerted re the oral oestrogen? Provided any oestrogen is combined with the appropriate dose of progestogen for women who still have a uterus - then the risk of endometrial cancer is minimised.
There is no need for women to be alarmed at all - we have recommendations drawn up by the experts in the filed who have examined the evidence and drawn their conclusions - but as always with any hormonal treatment - be sensible and vigilant, and only deviate from the licensed regime in consultation with your medical professional.
Btw Conolly are you American/living in US?
Hurdity x
-
Hello again,
Are you saying that the BMS 2016 'guidelines' (I don't know what is the right term) contradict NICE guidelines? https://bnf.nice.org.uk/treatment-summary/vaginal-and-vulval-conditions.html (https://bnf.nice.org.uk/treatment-summary/vaginal-and-vulval-conditions.html)
I'm worried about the confusing information regarding leaflets, NICE guidelines, surgeries and now BMS 'guidance'. Shouldn't they all speak the same language? Are BMS and NICE independent from each other? I understand that the so called Menopause Societies (BMS and NAMS in the US) have many menopause 'experts' but I don't know exactly what is their 'official' role.
I might need vaginal atrophy treatment in the near future, so I'm trying to learn as much as I can.
I'm not from the US, but I go there often.
Conolly X
-
Crikey that's days away ::) in fact, I see it as orange ;)
Trust me: I could not have lived with the razor blades up there regardless of any risks ....... I would have been off a cliff.
-
Hello CLKD,
I understand you didn't have another choice and I'm absolutely fine with it. However, this thread is about Vagifem, Ovestin and cancer risk, which is exactly what's being discussed.
If alternatives (lubricants) are not enough to control symptoms, I want to know as much as possible what topical oestrogen can do for me, both the pros and cons.
I'm genuinely interested in trying this route, but I still have some time to investigate ;)
Conolly X
-
It's sensible to make an informed choice. I took tibolone without looking into it and I wish I hadn't as it caused thickening . But now I am worried about ovestin but I need something for VA as moisturisers are nother enough. I was off hrt for 3 months with biopsy and for the last 4 months have struggled with uti symptoms as a result. Still trying to get back on track with ovestin. Other hrt will also have risks, so they are difficult choices.
-
As far as I am aware there is very little cancer risk. Being locally applied it shouldn't be absorbed in any great quantity to cause a risk.
-
Do you worry about womb lining thickening?
-
Never.
-
OK thanks. As you say it's quality of life and without local hrt I won't have any.
-
I have learned a lot by reading threads here but don't apply much to me unless I have symptoms that have been discussed with a GP. Who is I have to say is very supportive. Then I come here to check, ask, share ..........
........ and breath!
-
Hello again,
Are you saying that the BMS 2016 'guidelines' (I don't know what is the right term) contradict NICE guidelines? https://bnf.nice.org.uk/treatment-summary/vaginal-and-vulval-conditions.html (https://bnf.nice.org.uk/treatment-summary/vaginal-and-vulval-conditions.html)
I'm worried about the confusing information regarding leaflets, NICE guidelines, surgeries and now BMS 'guidance'. Shouldn't they all speak the same language? Are BMS and NICE independent from each other? I understand that the so called Menopause Societies (BMS and NAMS in the US) have many menopause 'experts' but I don't know exactly what is their 'official' role.
I might need vaginal atrophy treatment in the near future, so I'm trying to learn as much as I can.
I'm not from the US, but I go there often.
Conolly X
The NICE Guidelines we refer to on here are the NICE Guidelines on menopause which may be more detailed re the use of local oestrogen for vulval and vaginal atrophy, not the ones you linked to. I don't know when they were written but although not incorrect they do sound alarmist! All HRT including local oestrogen should be reviewed annually.
The NICE Guidelines on Menopause were drawn up following extensive review of the current research literature and the evidence base is given in some detail in the full guideline. I don't know which parts you find contradictory ref the BMS 2016 recommendations on HRT (paper with Women's Health Concern)?
You can read about BMS and NICE and their roles on their respective websites. Of course BMS is independent of them - it's a specialist academic society like any other....
It was your use of "math" that puzzled me - we Brits don't use this term, which is used by Americans and in US - we say "maths" !!! If you go there often perhpas you've picked up some of their lingo!!! ::)
suzysunday - no-one need worry about womb lining thickening when using local oestrogen although everyone should be vigialnt re unexpected and unexplained pain or bleeding. Cancer risk is very very low indeed - hence the NICE Guidelines (on Menopause) stating no need for progestogen and no need for endometrial scans as precaution - although personally I think all women on HRT should get an annual U/S scan but this is never going to happen!
Hurdity x
-
Yes that is a good idea.
-
Hello Hurdity,
I'm aware of NICE guidelines, if you're referring to NG23. The link I have posted is from the British National Formulary available in NICE website https://www.nice.org.uk/about/what-we-do/evidence-services/british-national-formulary
If the information on vaginal and vulval conditions (including the use of the same medication) is different from the information on vaginal and vulval conditions in menopause, it appears to be an inconsistency.
'Math' was just a typo ;) My iPhone (bought in the US) is probably set to default American English and I can't be bothered to correct the autocomplete tool.
Regarding womb line thickening when using local oestrogen, I wonder why Besins product for vaginal atrophy, Trophigil, has progesterone, besides estriol and Lactobacillus.
Conolly X
-
That's a bit worrying.
-
Sounds like over-kill to me ;D especially as we have two well documented products available on the NHS.
-
I think I've read that there is some evidence that progesterone can be beneficial for VA independent of Oestrogen. Of course I can't find the reference I'm thinking of anywhere ::).
-
As well as many ladies having bad reactions to progesterone ::)
-
That's a bit worrying.
What's worrying you suzysunday - there is nothing to worry about? Do not fret!
Hurdity x
-
Just worried about womb linings at time. My mind jumps from one worry to another. No wonder I'm exhausted!
-
It's awful. When my brain was in over-drive I couldn't remember what was coursing through it, DH asked me once and I couldn't tell him so he was unable to help :'(
-
As well as many ladies having bad reactions to progesterone ::)
I suspect progesterone intolerance is actually ‘Utrogestan intolerance' so more about dosage. No one seems to have trouble with other natural progesterones.
-
I agree, I didn't have any problems on 50 mg compounded progesterone but felt suicidal on 100 mg Utrogestan.
I was wondering why there are no long term studies on Vagifem which has been on the market since 1995!
Conolly X
-
In what way 'long term studies'? Often users of medications simply aren't asked how they get on with a product by anyone other than their GP and apparently there is a yellow card system to report to the Manufacturers but one has never been offered to me :-\
-
You can report on the yellow card scheme about drugs through the yellow card website or by post if you have bad reactions to drugs. Most people maybe don't bother or know about it if they don't read the leaflet that comes with medication.
-
Having read the leaflets none mention the yellow card.
How R we all this morning?
-
Having read the leaflets none mention the yellow card.
Here you are CLKD:
https://yellowcard.mhra.gov.uk
-
:thankyou:
-
Yes ckld, I've looked at a leaflet I have for ovestin and it doesn't mention the Yellow card, though I have seen it on other leaflets. It should be on all medication really.
-
I agree, I didn't have any problems on 50 mg compounded progesterone but felt suicidal on 100 mg Utrogestan.
I was wondering why there are no long term studies on Vagifem which has been on the market since 1995!
Conolly X
In what way 'long term studies'? Often users of medications simply aren't asked how they get on with a product by anyone other than their GP and apparently there is a yellow card system to report to the Manufacturers but one has never been offered to me :-\
Long term studies are not usually carried out to see if there are side effects as such - these would normally be determined at the testing stage (which might be long term depending on the product!), so that is where the yellow card scheme comes in.
They would be carried out if appropriate to determine the long term efficacy or particularly safety of a treatment.
In the case of Vagifem - I imagine it just is not cost-effective due to the extremely low risk of harms, due to the very low dose. The effect of systemic oestrogen on the uterus has been much studied and the dose dependent nature quantified. I don't have any of the studies to hand - but just to repeat suzysunday - these have been extensively examined by the medical researchers and professionals to come to their informed conclusion that endometrial hyperplasia and thereafter potentially cancer would be extremely rare and therefore not justifying adding a progestogen routinely nor regular endometrial scanning either.
(As an aside, even the very low dose oestrogen patch available in US (approx 14 mcg ie 14 mcg per day delivery) - the Menostar - is prescribed without a progestogen although endometrial thickening is expected as one of the side effects).
Relax suzysunday - but of course always be vigilant.....
Hurdity x
-
Many thanks for that. I feel re assured and yes I will stop worrying.
-
Hello again,
Long term studies are not usually carried out to see if there are side effects as such - these would normally be determined at the testing stage (which might be long term depending on the product!), so that is where the yellow card scheme comes in.
Long term studies should be carried out, considering that all testing stage studies for topical oestrogen were restricted to 12 months and the drugs (estradiol and estriol) were supposed to be used for the shortest time necessary to relieve symptoms, which unfortunately has not turned out to be the case for vaginal atrophy, widely recognised as a long term (if not lifetime) condition.
They would be carried out if appropriate to determine the long term efficacy or particularly safety of a treatment.
What does 'if appropriate' means?
In the case of Vagifem - I imagine it just is not cost-effective due to the extremely low risk of harms, due to the very low dose. The effect of systemic oestrogen on the uterus has been much studied and the dose dependent nature quantified. I don't have any of the studies to hand - but just to repeat suzysunday - these have been extensively examined by the medical researchers and professionals to come to their informed conclusion that endometrial hyperplasia and thereafter potentially cancer would be extremely rare and therefore not justifying adding a progestogen routinely nor regular endometrial scanning either.
Sorry, 'not cost-effective due to the extremely low risk of harms, due to the very low dose' is for short term use and it can't be extrapolated for long term use. Besides, many users are not following the dosage indicated in the leaflet and tweaking doses at their own risk in order to relieve symptoms.
The effect of systemic oestrogen on the uterus has been much studied and the dose dependent nature quantified.
Systemic and topical are quite different routes of administration and the levels of absorption are not comparable.
... these have been extensively examined by the medical researchers and professionals to come to their informed conclusion that endometrial hyperplasia and thereafter potentially cancer would be extremely rare and therefore not justifying adding a progestogen routinely nor regular endometrial scanning either.
Again, this 'informed conclusion' is based on observational data, there are no studies to corroborate this for long term use, only for short term use (12 months)
Susysunday,
As I have already said before, my questions are not intended to scare anyone, their sole purpose is to clarify what's in stake here, risk/benefit ratio. That said, I think it is very wise to follow the manufacturer instructions regarding dosage, just to be on the safe side.
Wishing you well.
Conolly X
-
I'm now living in Spain where I saw a gynaecologist as my atrophy was really bad again after switching back to Vagifem from ovestin. I told her what I'd been told at home about only using for three months etc. She said in Spain it's for life and 2/3 times a week (but no more) so who knows??
I think for some people it might be worth finding out where your atrophy actually is. Apparently mine is mainly outside and just inside so using Vagifem - which I struggled with for a year and ended up with atrophic vaginitis even using it daily - even half way was no use to me. She advised me to use my finger rather than the applicator when applying it and it is, so far, working. At the start I needed yes on the day I didn't apply the ovestin but now I don't. I'm using it three times a week at the moment but will try to get to two once it's fully settled.
Just to let you know too, OTC ovestin costs 13 euros.
Hope this is helpful to some. It's a horrible thing to have!
-
It is horrid, for me it was like razor blades up there :o : dryness, vagina sticking together ....... so Ovestin has really eased symptoms.
How much is 13 Euros in old money :D
-
About £11. Cheaper with a prescription at home but you don't need a prescription here which makes life simpler. I have the same symptoms as you and the cream is definitely better for me so I was very encouraged when I was told in Spain there's no after-3 months fear. Mind you, what could you do anyway? If nothing else works, what choice is there? The atrophy itself causes too many other problems so, apart from the pain of the condition itself, you end up with other problems, for me vaginitis while Utis for others. Hey ho!
-
That's not bad if 1 doesn't get challenged each time one requires relief of symptoms :thankyou:. I couldn't have coped without treatment and my GP is aware of symptoms 8)
-
Hello ladies,
There are some non-hormonal new options available like this one https://vagivital.se and others on the pipeline. I'm not sure I can post this link, if not please let me know. Watch this space.
Conolly X
-
Will non hormonal cream do the trick though? My symptoms of VA have needed local hrt and without it I can't manage. So we just have to hope for the best.
-
I must say I got Vagifem quite easily, even when it was obvious it wasn't working! The problem for me was being treated with contempt when it wasn't helping, as if I was exaggerating or being a nuisance. Whether it was being talked over or the rolling of the eyes, I felt both small and desperate. My doctor gave the impression that the 'book' says this is how its treated and that's it. (And, actually, what she told me was contradictory!). It was only after being sent to hospital by another doctor (who actually examined me - something my doctor never did) that I actually got the cream. I was also asked twice why I hadn't been referred to the meno clinic - I didn't even know there was one and my doctor either didn't know about it or didn't think I was worthy of it because she never mentioned it to me.
Now in Spain I don't need to see a doctor for another year and I can buy ovestin without listening to someone nearly half my
age talking to me as if I'm an idiot. For me the whole experience was horrible. I was so nervous here when I went to see the gynaecologist waiting to be treated in the same way but not at all. Some doctors are just more understanding than others and it seems, unfortunately, to be the luck of the draw. Shouldn't be though. Connolly the non hormonal creams would put a lot of people's minds at rest if they work and we won't have to keep bothering doctors to get it presumably.
-
Hello ladies,
Otter15, it's outrageous to be treated (or not treated, actually) this way. I think you are lucky to be feeling well on estriol cream, just don't overdose it, if not needed. Maybe the notion that local oestrogen is absolutely safe and the dread feeling of a VA flare-up can lead women to OD. In many circumstances, the prescribed dose will do the job and increasing doses may lead to decreased response, a process known as tolerance.
Susysunday, if you have tried every other alternative to local oestrogen and none of them has worked for you, it's obvious that you have to keep using it, but the same applies to you, don't overdose it just because you dread a flare-up, there are non-hormonal products available and others coming up that can be used together with topical oestrogen to relieve symptoms.
Conolly X
-
Hi Connolly. I've tried not to so I will do the three times a week like the gynaecologist said then, once it's settled, I'll cut it down to two. I did use it outside every day when the Vagifem wasn't working but not for long and only a tiny amount. At least now I'm making headway so I feel quite positive but sad it took so long because someone was blinkered and not really listening to me. We know our own bodies and to be treated so dismissively (is that a word?) is really unpleasant. You can't refer yourself to someone else and you (maybe mistakenly) trust what they're saying - at least at the beginning!
-
Hello Ottes15,
Yes, dismissively is the right word to describe how you've been treated. I totally get what you're feeling and if there's a positive side to all this mess is that you are learning and taking informed decisions, but above all, you are more conscious of your own body and that is the most important thing, NEVER stop listening to the signals sent by your body, unless anxiety and depression are present, they are the most powerful diagnostic tool ever.
Conolly X
-
Hello ladies,
There are some non-hormonal new options available like this one https://vagivital.se and others on the pipeline. I'm not sure I can post this link, if not please let me know. Watch this space.
Conolly X
This is a water-based vaginal moisturiser containing:
Water
Hypromellose, a semisynthetic polymer often found in eye drops
Benzoic acid, antibacterial
Lactic acid, presumably to maintain low pH and vaginal flora
Sodium hydroxide, aka caustic soda.
It has a pH of 3.8 (good) and was trialled on 90 postmenopausal women with no I'll effects. Unfortunately they don't seem to give the osmolality. According to WHO recommendations this should be no higher than 380 mOsm/kg to avoid epithelial damage.
Other water-based lubricants, such as the well known Yes WB and Yes VM, have the correct pH and osmolality, and more 'natural' ingredients. (No, I don't have shares in Yes! ;D)
JP x
-
Hello Joanipat,
Yes, I'm also a YES user, but everyone is different, right? I posted the link just to give an example that new products are becoming available and there are many others on the pipeline, so VA sufferers can try and choose whatever floats their boat.
BTW, I'd like to have some YES shares ;)
Conolly X
-
Hello Joanipat,
Yes, I'm also a YES user, but everyone is different, right? I posted the link just to give an example that new products are becoming available and there are many others on the pipeline, so VA sufferers can try and choose whatever floats their boat.
BTW, I'd like to have some YES shares ;)
Conolly X
Oh I absolutely agree Conolly, we are indeed all different. You do manage to dig up some interesting stuff, for which many thanks!
JP x
-
We agree that atrophy is caused by a drop of oestrogen levels ......... 4 me Ovestin helped plump up the vaginal area so it's what I require. I would never consider using anything without oestrogen in it if still getting symptoms. If the area is itchy I use KY Jelly but the product you tell us about may well help me. Having more choice is always of use.
-
I was on tibolone for VA for 18 months and had pmb and biopsy and it went on for months, so I am scared to try systemic hrt. It has taken a while to treat uti symptoms with the ovestin. I have been on it for 3 months and struggling with wee problems and cystisis. A month ago my gp suggested reloading with ovestin daily for 3 or 4 weeks which I did., then alternate nights, which I am on now and using non hormonal gel in between. My gp said it was very safe. I will reduce dosage to every 3 nights when I think I can manage. I was only on the tibolone before, never other hrt and I am 60 now. I feel concerned now about local hrt, but don't trust systemic after the bleeding. I haven't had sex since the bleeding cos the cystisis really knocked me and weeks of wee problems that were grinding me down. I am getting through slowly and want to cut back on the ovestin in the future. I just want to stabilise.
-
Don't rush suzysunday as the body doesn't get where it is suddenly. Oestrogen levels usually drop slowly for most of us - it took 2-3 years 4 my GP to realise what was causing my symptoms.
Also: do take a pain relief if your symptoms niggle. Also, keep well hydrated. The kidneys work harder if the body requires liquids. Which equals to the need to pee more often.
-
suzysunday - please be guided by your doctor about your use of Ovestin as well as current medical recommendations ie NICE Guidelines, British Menopause and Women's Health Concern recommendations etc. If your specialist has said you may use it 3 x per week or alternate days - then it is fine to do so. The NICE Guidelines suggest that doses can be varied under medical supervision anyway - to quote: "If vaginal oestrogen does not relieve symptoms of urogenital atrophy, consider increasing the dose after seeking advice from a healthcare professional with expertise in menopause"
I thought I had reassured you? To repeat - do not be concerned - this is a licensed treatment - but as with all HRT local or systemic every woman should be vigilant about unexpected and unexplained symptoms - but not worry all the time!
Current guidelines are that, despite there being no long term trials into safety (ie longer than 1 year), the thinking is that any risk of endometiral hyperplasia is extremely low (and only a small proportion of hyperplasia cases actually become cancer), due to the very low doses of oestrogen being used (and risks to the endometrium are dose dependent). All the Guidelines are saying the same thing - its low dose oestrogen, low cancer risk, no need for progestogenic opposition, be guided by your doctor if you are varying the licensed dose, be vigilant about any post-menpausal bleeding.
I can understand your fears due to the bleeding you had on Tibolone but uterine thickening on this HRT is actually a known potential adverse effect - which is one reason I decided not to go on it when I was thinking about taking something for low libido. However I think your investigation showed nothing abnormal? I presume your lining is thin now or you had treatment to thin it (nothing to do with the Ovestin!)?
Also different systemic HRT types (notably the progestogens) have different effects on the endometrium so a more conventional systemic HRT may not cause the thickening you experienced on the Tibolone.
I do think if the Ovestin is not controlling your symptoms and you are suffering badly, then maybe time to reconsider systemic HRT ( sorry a bit off topic but as it's your thread I thought OK!)?
I do hope you manage to stabilise on your current treatment.
Hurdity x
-
Yes thanks clkd and hurdity. Yes I was given the all clear and my lining went back to normal when I stopped the tibolone. I have felt better this week so hope the ovestin will suffice in the long term. I would be worried whatever medication I was on. I generally don't cope very well. This forum has been so helpful.
-
Hello susysunday,
There's a relatively new product called Prasterone, sold as Intrarosa. It's going to be marketed in the UK by Theramex. It's a pessary for vaginal atrophy containing DHEA (dehydroepiandrosterone) which is a hormone precursor (prehormone). It's another option for VA sufferers.
I have taken oral DHEA for one year during perimenopause and it definitely increased vaginal lubrication (long lost since my mid 40's) and improved hair thinning. Back then there was no vaginal pessary available, so you see, things are changing very rapidly. I thought you could be interested. :-*
P.S. Launched planned for March https://www.sps.nhs.uk/medicines/prasterone/
Conolly X
-
Intrarosa has been mentioned a few times on this forum and in particular I reported its approval in the EU here a year ago: https://www.menopausematters.co.uk/forum/index.php/topic,36199.msg612972.html#msg612972
However it is of course, a hormonal treatment with the DHEA being converted to oestrogen and/or testosterone in the vaginal tissues, but as with all vaginal treatments there is some systemic absorption but from what I've read, as with the estriol and estradiol vaginal preparations levels remain within the post-menopausal range. Nevertheless as a new product there certainly won't have been the amount of studies for this as there have been with the current products available.
Good to have a choice though and especially as it is similar in from to the discontinued Orthogynest waxy pessaries which many of us found very effective - although these latter were estriol which still is now only available as a cream.
Hurdity x