Dancinggirl - I wouldn't say that the trials were flawed - just inadequate. The findings are correctly stated, but the conclusions that are drawn from them are not. Trials are designed to answer specific questions (or test a hypothesis) and the question in that case was: "Is 10 mcg Vagifem effective in treaing vaginal atrophy?" The answer of course was yes, based on the study and the criteria used for "effective".
In terms of lay people - I am not such when it comes to looking at scientific data as I have a research degree in a scientific subject - and the time to look at the information presented. Most doctors would not have the time to go back to the original data nor questions the trials and so would read the recommendations and statements that follow. We can't blame them for that.
There is no information on the safety of long-term use of Vagifem at all as I understand. This is what the British Menopause Society says about it in their latest recommendations:
Low-dose vaginal estrogen preparations can be used long-term in symptomatic women as required, and all topical estrogen preparations have been shown to be effective in this context.
There is no requirement to combine this with systemic progestogen treatment for endometrial protection, as low-dose vaginal estrogen preparations do not result in significant systemic absorption.
However, there is little evidence to prove the safety of vaginal preparations beyond one year of use; clinicians should therefore aim to use the lowest effective dose for symptom control and counsel women regarding this. http://min.sagepub.com/content/19/2/59However in practice most gynaecologists will prescribe it long term because there us equally no evidence from the short term studies to show that it is likely to be unsafe long term.
Sorry to hear about your mother in law too and her poor treatment for dementia and especially that your experience of the memory clinic was also poor. I lead a twice monthly music group for people with dementia and their carers (through Alzheimer's Society), which alternates with a memory cafe (I'm not involved with that) but is immensely rewarding and I can't imagine any similar service being provided that would fall short in their care. I agree long term health costs are not taken into account - eg due to osteoporosis as we all live longer and our bones thin due to oestrogen deficiency.
Suzi - the cost of a prescription isn't based on the amount of hormone contained eg Elleste solo 2 mg tablets are £1.78 and those for 1 mg are £1.68 - almost the same. The hormones themselves are only a fraction of the total cost of the product. I am sure the company isn't expecting women to double up otherwise the dosage would be given as such. Also I would expect that the drive for the reduction came from the medical or legal side - in America, and because of the repeated mantra to use the lowest effective dose for the shortest possible time. In fact the company said as much in their FAQ:
The development of Vagifem® 10μg was part of our goal to provide our customers with products that are effective at the lowest possible dose. More recent recommendations have made it ‘best practice' to use low dose HRT products where possible. Therefore the trial was designed as I said above with this in mind. I am not defending it (the decision to reduce the dosage) whatsoever. What is absurd as dancinggirl says is that the trial results are accepted just like that and that no more are being conucted ( maybe they are???)
In the meantime those of us who have read up on it continue to express our views and share our findings with everyone on here so that we can continue to press our doctors to prescribe the dose we need to alleviate our symptoms and to hell with the cost!!!
Hurdity x
