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[flutterby]

After almost 16 years of HRT (I'm 64), I am going to take my last patch off on Tuesday. I have never had a real break from it apart from swapping back and forward from Evorel Sequi to Conti and back again plus a couple of months on Tibolone. Since the end of February I cut down to Evorel 25 plus cont Utrogestan 100 from Evorel Sequi 50 because of erratic bleeding which now I believe may have been entirely due to a polyp as there was no more bleeding when it was removed 2 months ago.
I've been having 'warm episodes', a bit of memory problem which comes and goes and a feeling as if I may have problems with VA when I come off it all together. I have very little idea what can be used locally /topically to help with VA and bladder irritation. I was hoping for some advice please Flutterbyx

[Dancinggirl]

I'm 60 and stopped HRt about 3 months ago - getting quite a lot of flushes but coping generally OK .  You need Vagifem for the vaginal problems - get back to the GP and ask for this.  Look under TREATMENTS above for info on Vagifem.  I also use Sylk every day to moisturise vaginal area.
Dg x

[flutterby]

Thanks Dancing girl, I have Astroglide, but I will read up on Vagifem. Feeling fairly optimistic Flutterbyx

[flutterby]

I may have a problem getting the Vagifem as several years ago my GP said that she wouldn't prescribe unopposed oestrogen when we were talking about topical preparation. She even said to me recently not to use phytoestrogens as they would be unopposed. Flutterby

[Annemaria]

Flutterby, I'm 58 and stopped HRT almost 2 months now and coping better than I had expected. Although VA and bladder discomfort showed up at about my 3rd week off hrt. Gyn put me on Vagifem and things are settling down although slowly. Both my gp and my gyn assured me topical estrogens are perfectly safe. Astroglide is not going to fix va unfortunately.

Annemarie

[CLKD]

You're GP is talking rubbish.  I use Ovestin1mg, other ladies find Vagifem good, nothing else will ease symptoms. It is replacing oestrogen in the vaginal area in order to keep skin from drying out, for me it felt like razor blades up there  ! even though I use KY Jelly it didn't work to stop the dryness causing problems.

In the worst case scenario the skin can become so thin that it splits = infection.  VA presents like repeated urine 'infections' or irritated bladder and as there is treatment, your GP should be able to prescribe it without comment!

[flutterby]

CLKD I entirely agree that my GP doesn't understand, but I have a feeling she won't be persuaded by me. However when I had an email consultation with Dr Currie she was happy to follow her advice.
Annemarie I did originally buy the Astroglide for those ' moments.  I am concerned about any bladder issues as I suffer from shy bladder syndrome and it will only make me more anxious if I am worried about using the loo. Flutterbyx

[Dancinggirl]

flutterby - I would print out the new NICE guidelines to show your GP (I think they are on this site but also on the NHS Choices website - I believe it states that local oestrogen should be offered for vaginal and bladder problems and it also says that long term use is often necessary.

THERE IS NO NEED FOR OPPOSING PROGESTERONE with local oestrogen treatment and if your GP is not clued up about this then they are being negligent in not keeping up to speed and denying their patients this treatment. 

Here is the section from the NICE guidelines about the treatment and use of local oestrogen:
Urogenital atrophy

1.4.9 Offer vaginal oestrogen to women with urogenital atrophy (including those on systemic HRT) and continue treatment for as long as needed to relieve symptoms.

1.4.10 Consider vaginal oestrogen for women with urogenital atrophy in whom systemic HRT is contraindicated, after seeking advice from a healthcare professional with expertise in menopause.

1.4.11 If vaginal oestrogen does not relieve symptoms of urogenital atrophy, consider increasing the dose after seeking advice from a healthcare professional with expertise in menopause.

1.4.12 Explain to women with urogenital atrophy that:

symptoms often come back when treatment is stopped

adverse effects from vaginal oestrogen are very rare

they should report unscheduled vaginal bleeding to their GP.

1.4.13 Advise women with vaginal dryness that moisturisers and lubricants can be used alone or in addition to vaginal oestrogen.

1.4.14 Do not offer routine monitoring of endometrial thickness during treatment for urogenital atrophy.


Do not it says that monitoring o fate endometrial thickening is NOT necessary!!!! It  also states that treatment should be continued as long as is necessary.

HEre is the link for the NICE Guidelines:https://www.nice.org.uk/guidance/ng23/chapter/Recommendations

Local oestrogen is about preventing problems with the vagina and bladder and I hope as GPs get more clued up it will be made more available to all women as a preventative.
DG x

[Stillsearching]

Flutterby I am another lady going through this at the moment and have had similar conversation with my GP, the last one this Monday. Since then I have been doing a lot of reading and also found that topical oestrogens can be used without opposing progersterone as the dose is so low. I asked for, and was prescribed,an Estring which I picked up yesterday. Bit of an awkward little devil to put in and keep in place but this morning it seems ok. It's been 22 days since my last pill. I'm taking quite a lot of vitamin supplements so can't say for sure what is responsible for the changes. So far I have more energy, bleeding has stopped after almost 12 months of pretty constant bleeding or spotting, Night sweats started after a couple of weeks and continue, joints are ok, I felt like I was going to the loo more frequently and not quite making it so I'm hoping the Estring will help with that. I'm planning to have 3 months off then make a decision what to do. I'm not particularly happy with my GP so am planning to move to another surgery with a lady GP who is interested in women's health. Looking at other surgery websites you can see who practices there and find reviews and interests on t'internet.

[flutterby]

Many thanks DG  :thankyou:I will definitely go armed with the guidelines. At the moment there is no pain, discomfort or stinging. Just an odd awareness of the vaginal walls, maybe a dry feeling but there are still vaginal secretions I hope that doesn't sound too strange. I am preempting by asking for info, also an appt at GPs usually takes 2 weeks so I think I'll request one sooner than later.
Stillsearching thanks for relating your experiences. I am taking a multivitamin and will look at other supplements depending on how the symptoms progress. I've started going to Pilates ballet and I'm also doing a mindfulness course in October
Flutterbyx