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[TnToast]

Hi everyone

I have had VA for many years now, since perimenopause.

Over time I have been prescribed:

Estriol 0.01% Cream (made inflammation worse and resulted in having to have a vulval biopsy)

Vagifem (resulted in too much of a discharge to be coped with)

Estriol 0.1% Cream- Ovestin (initially I used every day for about 6 weeks, then dropped to 2x per week, it took 12 months before I felt any significant improvement and it burned a lot at first)

I also use YES VM and wash with Dermol or Cetraben.

Although I have had some comfortable days with Ovestin, I have felt it to be less effective recently. After a small bleed I found out I had a bacterial infection and following a trip to Gynae it was suggested that I try Vagifem again, as it is a stronger estrogen.

I've been using Vagifem for a couple of weeks now on alternate nights with no discharge this time (although the gynae told me to only use it 3 x per week). I'm thinking of it as a sort of loading dose, but not sure if this is necessary if I've just swapped from Ovestin.

I'm also still using Ovestin externally and YES VM on the night I don't use the other two. However I'm feeling even less comfortable than I did on Ovestin alone. Whenever I sit down I feel like I have sunburn down below and the other night it was so sore that I couldn't get to sleep. Is it because the Vagifem isn't a cream and so doesn't have instant moisturising properties like Ovestin? Or is it the ingredients?

I mentioned trying the Estring to my GP but she just raised her eyebrows at the cost and said that she/the practice had never prescribed it before.

I just don't know what to try next.

I really need some advice - should I give it longer or go back to Ovestin which did give some comfort, and maybe ask to use that more frequently? Another concern though is that on the YES website it says that glycerin at high concentrations is a mucosal irritant which can damage skin and at low concentrations it is a nutrient for thrush...yet this is an ingredient in Ovestin. I'm now worrying that long term, more frequent use of Ovestin will cause more damage...

Also, does anyone have any recommendations for a soothing moisturiser for the outer skin, which also feels like it is burning?

Really - is there any answer to this depressing condition?? And why after so many years of women talking on here and the subject being brought into the open by people like Jane Lewis, Dr Louise Newson and Davina McCall, do GPs and Gynaes still feel reluctant to allow more frequent use of treatments or limit the options available?

[CLKD]

Get the treatment up there every night for at least 3 weeks.  It really can be Trial and Error and many medics are totally unaware of how VA impacts on daily life or how to diagnose effectively.

Put a pessary up now and later this evening as well as the YES VM if it helps.  Some require vagifem internally with a smear of 'ovestin' on the outer regions every night.  Or a moisturiser along with one of the products - every night.

If you are using the YES product externally it shouldn't infiltrate enough to cause problems.  GPs etc. are worried that women may over dose on Oestrogen !!!! 

Your GP should be referring you sooner rather than later: due to waiting lists : to a dedicated menopause clinic - not a gynae - if the symptoms have improved by the time the appt arrives, U can cancel.  Let us know how. you get on.

[Ayesha]

If you can use all your VA treatments every day without problems then do so, for me its the only way to control the symptoms.

The problem when your VA symptoms become more complicated and the methods to control it don't work, that's when I think an appointment to a menopause clinic or even a GUM clinic is the next best option for you. A friend years ago went to the GUM clinic and they discovered she also suffered with eczema.
 
Yes moisturiser is one of the best on the market and safe to use, I find it works brilliantly alongside my other VA treatments.

[TnToast]

Thanks for your replies. 

The problem is that, although Ovestin every third night wasn't controlling my symptoms well enough (alongside the moisturiser and emollient in the shower), now I've switched to the supposedly stronger Vagifem they are worse. I am burning externally much more... this is where I am most uncomfortable.

I think I will have to go back to Ovestin and try and get a referral, as you suggest.

I have used YES VM internally as well as externally on nights that I don't use a hormone treatment - can it stop the hormone being absorbed?

[CLKD]

The vagina is self cleansing so if well plumped up, will get rid of anything it doesn't require.  It may be the fillers or packaging of the vagifem which are causing any problems.  'ovestin' internally and around the dryer outer parts every night should help.  Don't give up!

[Ayesha]

Thanks for your replies. 

I have used YES VM internally as well as externally on nights that I don't use a hormone treatment - can it stop the hormone being absorbed?

No I would say its ok to do both, I use Yes moisturiser when using Ovestin (Estriol) and it doesn't seem to have any effect on its efficiency.

[Wren]

It's trial and error finding what works for you.
Reading everyone's routines on here has been invaluable.
Although I think some of my vulval burning is from a tight pelvic floor, as mentioned on another thread, I also have dry skin and find things irritate because of that and only use emollient to wash.
I currently using Vagifem at night & Yes VM in the morning internally, to dilute the fillers.
I apply Ovestin in the morning to the vulva, wait 15 mins for it to absorb, then apply Yes oil based or Olive & Bee to protect the skin and add more through the day.
For me, the Yes VM doesn't provide lasting moisture externally.  It's PH balanced for the vagina - isn't that a different PH to the vulva/skin?...
My body and facial routine's a doddle in comparison 😁
Hope you find what works for you.

[Jane_w]

Hi TnToast, from my own experience I would advise that you should ask for a referral to a GUM clinic. This might be helpful for you. I don't know what services there are near you, but after a lot of persistence (including being seen in a vulvoscopy clinic by a very good Dr and told 'you're fine'..i was not 'fine!) I was seen at a GUM clinic by a wonderful Dr and diagnosed with vulvodynia (I don't want to hijack your thread so won't go into details). It sometimes takes a different approach to assess what is going on so I would advise asking to see someone at a meno or GUM clinic as they really are thorough and will identify if something else is affecting the area. I would just add that for some of us, the topical/local oestrogen products and moisturisers can create problems, sadly...and as Wren mentioned, tight pelvic floor muscles can play a part in vulval pain too..

[TnToast]

Thank you so much for your replies.

You have given me a few things to think about. I felt a bit more comfortable today after using YESVM internally and externally last night, so I am going to just use Vagifem tonight without Ovestin and then use the YES again in the morning as you suggest to dilute the fillers.

I remember that when I first started using Ovestin a couple of years ago it was very uncomfortable at first for a few weeks. Maybe the swap has just caused irritation to my very sensitive skin. So, on the back of a better day I'm going to persevere and try your suggestions.

If I they don't work for me I will ask for a referral to a GUM/Menopause clinic and go back to Ovestin in the mean time. I'm hoping that having made things worse by swapping meds it will settle back down quickly and that I won't have irritated everything so much that it will take a year again....

It's amazing how this affects your mood too. Yesterday I was miserable and desperate because of the soreness, today after a bit of relief, I feel more optimistic. 

[TnToast]

I also have dry skin and find things irritate because of that and only use emollient to wash.

For me, the Yes VM doesn't provide lasting moisture externally.  It's PH balanced for the vagina - isn't that a different PH to the vulva/skin?...

I have dry skin too which does make things worse. I do wash with emollient but will try something like Olive and Bee afterwards. I agree YESVM doesn't provide lasting moisture externally, just a bit of soothing for half an hour or so.

[orrla]

My advise is, insist on that Estring ring. It works!

Don't know how they calculate costs. Yes, it seems expensive but it lasts 3 months! Estriol which is ca third lasts less than one month! ..times 3 or 4 it 's actually  more expensive than Estring! Same goes for other pessaries, etc. even Vagirux which seems dead cheap but not if you need to take it everyday!

🤗

[Jules]

I use vagisil prohydrate.  I mix it with my ovestin/estriol cream and apply at night.  I've had no irritation.  It's around £10 and the tube isn't big though. I use vagifem too. The vagifem won't hydrate the outside. Both areas need treating separately.

[Dierdre]

Thanks for your replies. 

I have used YES VM internally as well as externally on nights that I don't use a hormone treatment - can it stop the hormone being absorbed?

No I would say its ok to do both, I use Yes moisturiser when using Ovestin (Estriol) and it doesn't seem to have any effect on its efficiency.

Perhaps try the WB Yes, I can't tolerate the VM one, it irritated and made me sore but I'm fine with water based. 

[TnToast]

Thanks for the advice.

As an update, in case anyone else is going through the same, the Vagifem has stopped burning. It took about a month to get used to it. I found I needed to use the YES VM more frequently once I swapped from using Ovestin internally as Vagifem isn't a cream and doesn't have immediate moisturising effect.

I use the Ovestin externally only now. I still find I burn there though - mainly after a brisk walk or sitting for more than a few minutes. Has anyone got any advice for this?

[Joaniepat]

I use the Ovestin externally only now. I still find I burn there though - mainly after a brisk walk or sitting for more than a few minutes. Has anyone got any advice for this?

A layer of emollient, such as Epaderm or Hydromol, would give protection against the friction of walking, and it's much longer lasting than a water-based moisturiser. Or try an oil-based moisturiser such as Olive & Bee?
JP x