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[Sunnyangel]

I have in front of me the document Position Statement for Management of Genitourinary Syndrome of the Menopause in which it states ,'It is not necessary to use progestogens or progesterone for endometrial protection when using vaginal oestrogen long term.'

Can anyone more knowledgeable than me clarify that this statement holds true for women (not taking systemic HRT of any kind) who require more than the licensed 2x week dose (quite a large number I suspect!) including those who might even need it every day. Forever. Assuming that since the treatment, vaginal pessary, stays pretty much where it is placed, I cannot see why endometrial protection would be necessary but there seems to be some confusion about this (and so much else  ) in my GP practice. I'm confused too-it's been a steep learning curve.

On the more positive side, a different doctor (male this time) virtually asked me what I wanted prescribed when I went in( yet again!) to discuss my prescription and was very sympathetic and prepared to listen. However, I've been here before and I need to see words translated into prescriptions and not be 'nobbled' somewhere along the line. Oh, how I wish they could just issue a repeat prescription and give me a good few months to gradually test out how much I need and then prescribe the magic number. Why is it all so stressful?!!!

[Ayesha]

You don't need progesterone when using topical oestrogens, simple as that and if your surgery doesn't know this then that's just sad that they can be so ignorant of a horrible chronic condition affecting so many women and the treatments that will help.

[Dierdre]

I would ask to see the male doctor next time and ask him to put your medication on repeat as you will be taking it for life. It states on the Position Statement and NICE guidance that the treatment for GSM is for life.

[dangermouse]

Just to clarify, it does not stay where it is, all transdermal/buccal travels through the blood stream. There will just be more absorption where you apply it.

I am guessing it’s very low dose, even if using double, to need progesterone to stop it over-stimulating tissue.

[Sunnyangel]

Ayesha- thank you. That is what I thought originally. I also assume that any excess oestrogen from the pessary (if there is any) just makes its way out once the vagina is sufficiently lubricated. It's just that when qualified medical staff tell you something different, it makes you doubt your own grasp of the facts. It is quite alarming the depth of ignorance around menopause issues from the very people who should be most informed.

Deidre- I hope to do exactly what you suggest but sometimes it can be difficult to get to see the doctor you want at my GP practice.

Dangemouse-I think we are talking about two different things. I believe you are describing the effect of systemic HRT treatments but my question concerns topical vaginal oestrogen in pessary form which is neither transdermal or buccal and therefore does not travel round the body in the bloodstream.