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[Babylon Burning]

I had a ridiculous doctor's appointment this morning and just had to share.  I was plunged into surgical menopause 5 weeks' ago due to surgery for ovarian cancer.  My two main problems are night (and evening!) sweats and the dreaded VA.  I'm not too bothered about the night sweats but I know I need to get some vaginal oestrogen as a long term solution for the VA.  The doctor I saw is the only female at the practice and is an 'expert' in women's health according to their website.

After I had described the situation to her and asked for Ovestin or similar, she said 'oh no, we can go down the non hormonal route first' and offered me a prescription for Replens and we all know the problems associated with that - anyone for gunky white discharge and burning sensations?!  I tried to persevere with the oestrogen discussion but she was having none of it and then she came out with the classic line 'maybe everything will sort itself out once you are more mobile after the surgery'.  In light of this staggering show of her ignorance, I mentally threw in the towel, and literally threw the prescription in the bin when I got home.

How can a GP not know you need oestrogen to deal with VA? (Or is there a hidden financial agenda here?) There are 3 other doctors at the surgery but as she is meant to be the expert, I don't hold out much hope and anyway one of them is her husband!   I'm not sure what to do now, can I go private with my ovarian cancer background?  Thoughts please.  Right, I'm off now to see my dealer! (Joke!)

[pixie]

You could speak to your oncology consultants secretary at the hospital?  I do feel sorry for you, that you have had all that to deal with on top of everything else, then I'd go and see one of the other GP or even the practice nurse if she is a prescriber (some of them are).  You shouldn't have to put with all that. !

[CLKD]

    which bit of we know our own bodies best do GPs still not get?

How about a personal e-mail to Dr Curry here?

Also, have a word with a pharmacist?  Get the low-down on the various treatments and take it back to your GP.  Do you have a Surgery you could register at as a 'temp patient' to see if they are any better?

[Trey]

BB this is from a Medscape.com with two noted gyns and a nurse practitioner from a year or so ago.  Your doctor is a disgrace if she pretends to be gyn wise.  I'm sure Dr. Currie would be the one to get behind your sensible request.  Replens is awful!!  Also contain Parabens, thought to be a possible carcinogen.  I could not live without the cream.. More effective for me than Vagifem although Vagifem  was, in this study, found to have even less systemic absorption than the cream.

About Vagifem and estrogen cream........

Dr. Nachtigall: Well, we do have scientific studies that show almost no systemic absorption both by endometrial biopsies, which show no increase in the endometrium, and by blood levels. There is always going to be an outlier or a woman who uses it incorrectly, uses it for 5 days and then gets atrophic again, and then uses it, probably gets no superficial cells, no cornification, and does absorb it. I think that is a difference between when you first use it in a very atrophic vagina, you are going to get some absorption; we have studies that show it. But it only lasts a few days or maybe a week.

Dr. Kagan: But then when you get that skin thick again, that is how I describe it to somebody --

Dr. Nachtigall: That is what I say. You see a thicker skin, and then you reach a steady state. You don't absorb it any more.

Ms. Moore: Well, that is one of the reasons that that sort of preload concept comes up from a perspective of getting folks started with nightly dosing, and then you can go on to typically twice a week dosing, which makes perfect sense.

[Babylon Burning]

CLKD, I love that emoticon, that's just how I feel at the moment!  I live in a rural area so there's no other surgery nearby.  I've dropped an email to one of the specialists named on this site so fingers crossed she can help me.

Trey, thanks for that, it's very interesting.  Yes, Replens really isn't a very pleasant substance, I did try to point this out to her but she really didn't want to listen - big sigh.

Pixie thanks for the hug, much appreciated.

Cheers for your replies.  Have a good evening.

[English Rose]

Dear BB
I wonder if the doctors decision was linked with your recent diagnosis? Sorry that's probably not what you wanted to hear, but I think that some oestrogens are not recommended if you've had some types of cancer. Might be worth asking your gynae next time you see him/her? (see from your recent post you've emailed someone for advice now).

I hope you'll be feeling better very soon and good luck with everything.  Best wishes ER x

[CLKD]

If so, then the GP should have explained this - not dismissed the request as if she hadn't heard/isn't bothered!  There are ways and means of explaining issues 

[Suz]

Hi BB,

Two things I d like to say:

Frustrating (that's a polite way of naming the feeling) and the other thing: where do u live, we could have a party together  ,

Suz x

PS I am absolutely shocked by this GP of yours and don't let her fob you off: stand your ground, arm herself with information and remember that u can also make an official complaint to 1. Practice manager 2. To ur PCT.

[Trey]

BB, my point is that there is almost no systemic absorption and thus you might inform the doctor and perhaps she old ask some colleagues if it would be fine for you.  Show your oncologist, he/she should know.  It's so easy to deny a patient, rather than do dutiful research in their behalf.

[Babylon Burning]

I have read about some tumours being oestrogen receptive and systemic oestrogen may not be a good thing but as Trey has pointed out, it's different for localised oestrogen. (I looked at my pathology report and the tumours weren't tested so we'll never know if they were oestrogen receptive or not)  The funny thing is she never even uttered the word cancer, it was almost as if she had forgotten I had it!

I won't be seeing my gynae/oncologist again as he has now referred me on to the oncology department where I've got an appointment at the end of the month.  It all comes across as a disjointed process.

Thanks again everyone.

[Suzi Q]

I now got 8 pkts of 25 Vagifem they are stil seeling it here in Ozz
I checked the date and it was june 2015
Getting another pkt tomorrow and still have 3 rpts
Im so sorry if shes a recog person in her fiels my advise go to someone who kows sod all xxxxx

[CLKD]

I would ask the oncologist how long-term treatment can be given if the tumours weren't tested - the samples will be in the Lab. so you could ask if this can be done retrespectively so that you can work out a treatment regime.  Remind him that surgical menopause needs careful handling 

[Trey]

They'll check during surgery if surgery is BB's choice and I assume they will do a frozen section to check the margins.  Does seems very odd that the lump was not tested for estrogen positive or negative.

BB, my experience is that oncologists are far more effective and receptive for this female problem than gynaes.  Dr. Currie excepted, of course. Your next appointment should wrap up the unknowns.

[Babylon Burning]

Thanks guys, I'll let you know how I get on with the oncologist.

[CLKD]

Make that list to take with you! (as much from us on here as for yourself  ).

I was passed to the oncology team for the duration of my treatment sessions, after which I was seen by my Consultant and the Oncology Consultant on alternate months/3 months/6 months ........... however, that was on a private basis.