The recommendation to review or break the treatment once a year was to assess the need for continued use of Vagifem - and for doctors to discuss with women any issues of concern - because long term trials have not been carried out for longer than a year, as I understand. (Please post links to refs if you know of any longer!).
In reality because for most women symptoms return on cessation of treatment, specialists advocated long term indefinite use, even though this could not be supported by trials.
Some experts recommended an annual progestogen challenge (taking a progestogen) to determine whether there is any endometrial build-up ( ie womb lining thickening). If there was any bleeding then this means there is some systemic absorption. Most docs do not do this.
However as we know it is licensed for continuous use without the need for progestogen.
As always - we are all different and all women should take note of any unusual spotting or bleeding especially post-menopause, because it is the extremely unlikely event of cancer is the only concern.
I mean most of us on HRT take/use HRT quite happily and there is likely to be more instance of endo build-up through conventional HRT than with Vagifem.
janm - I think you should insist on being prescribed double the amount on the same prescription if your symptoms return when you reduce to 10 mcg - or even now since you have tried before.
All they need to do is to make sure you are reviewed annually by your doc and discuss any symptoms of concern. I imagine you would go for a scan if you had any bleeding, spotting or unusual uterine pain.
if you wanted to you could even suggest an annual progesterone challenge - which would do the above.
When I've got time (not sure when) I will summarise all the result from that paper which will show that 10 mcg is effective in some trials on very few women - but not effective on 100% of women in the trial. I bet the GPs won't have read it....
Hurdity x
