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[babyjane]

Yesterday I had my annual repeat prescription review with my GP and she was asking about how I was getting on with the Vagifem.

I was interested to hear her say that the 10mcg pessaries are now licenced in the UK for daily use so women can adjust the dosage according to their individual needs.

I was also sad because I have read posts on this forum from ladies whose doctors insist on no more than twice a week and then want them off it after a short time even though hardly any is absorbed into the blood stream.

Why are doctors not all singing from the same hymn sheet?  surely they all have access to the same information 

[babyjane]

After reading another thread about not posting medical advice I just want to say that this was not my intention when I made my post.

I would not presume to try and advise anybody of anything, I just wanted ladies to be aware that the GPs that say 'twice a week and no more' are not giving correct information.

[scriv]

That is very interesting and very welcome news, babyjane. Thanks for the update.

[Joyce]

You're just giving info as you were told it bj. I've done similar in the past.

As you say why can't all doctors sing from same hymn sheet, it's no wonder we all get confused & it doesn't take much for me these days. 

[Hurdity]

I'm interested to hear this babyjane    - it does make sense especially since the Estring gives a higher daily dose than 20 mcg per week.

However I can't find any information about this on the web ie the information leaflets, and product details etc have not yet been updated, so maybe it is something that only doctors get information about - re latest prescribing guidelines or something?

Hurdity x

[babyjane]

I didn't think to ask but my lady GP knows her stuff so I believe her.  She has always been happy for me to use it every other night and an extra one for luck occasionally 

[Hattie]

Is roughly 50mcg a week still the maximum safe limit though ?- this was the old 25mcg vagifem regime @ twice a week which introducing the 10mcg vagifem was meant to change.

So what were the true reasons for 10mcg being introduced ?

Hattie X

[Hurdity]

It was based on the widely proposed tenet that HRT of any sort should be taken at the minimum dose for the shortest period of time. I'm not sure what the driver for this particular piece of research was - but the reduction was based on the results of a study which purported to show that 10 mcg was as effective as 25 mcg. The result did not in fact show this as a blanket statement applicable to all, and as with all studies the conclusions were limted. It was all to do with statistical significance - which of course does not mean - every woman!

If you are interested I can look it all up for you.... I have the reference somewhere. 

Hurdity x

[dahliagirl]

The instructions on my prescription have always been 'one or two twice weekly', which confused the  pharmacist no end the first time.  The GP I saw last also recommended regular recharges as some women find it is not enough.  They do not seem to mind how often I ask for a prescription.

Most things there seem to be run 'by the book', so there must be room for different opinions.

[Hattie]

Thanks Hurdity - i won't trouble you for a reference - understand what you have written.

The GP I saw last also recommended regular recharges as some women find it is not enough.

Then this means regular 70mcg per week for two weeks when doing this - where is the upper safe limit ? especially if you are postmeno with a uterus still.

Hattie X

[babyjane]

I believe that Vagifem is not absorbed into the bloodstream, at least only a microscopic amount.

Did I read somewhere on this forum that the amount absorbed is something like the same as one HRT pill in a whole year?

[dahliagirl]

Then this means regular 70mcg per week for two weeks when doing this - where is the upper safe limit ? especially if you are postmeno with a uterus still.

I hear that less is absorbed once your vaginal tissues are plumped up with oestrogen.  It will depend on how much gets through into your blood.  Everything I have seen says it is very little.

However, progesterone can be absorbed and I have read (probably a less reliable source) about vaginal oestrogen being used for endometrial atrophy.  It is confusing.

I always wonder what happens to the endometrium if you are still producing your own oestrogen and not ovulating and producing progesterone. From what I have read, it would seem you lose it if there is too much or if the oestrogen level drops.  Not sure what happens if you have a continuous low level of oestrogen and whether it is a good thing or not.

[Taz2]

There are various threads on the reduction in dosage. Like Hurdity I have the research somewhere but I think it's already posted on the forum under our previous posts. I did find this just now http://www.dslrf.org/mwh/content.asp?L2=2&L3=5&SID=130&CID=2061&PID=42&CATID=0

It seems to be an about-turn if they have now given this advice to doctors so hopefully it will be reflected in up to date advice on the leaflet issued with the packs. I know that the new dosage is not enough to keep me comfortable and fully functioning!

Taz x

[babyjane]

me neither Taz2 which is why my lady GP suggested I use it every other night which makes 70mcg over 2 weeks.  Seems to be right for my comfort as I have had no thrush, cystitis or BV since I have been on this regime, although not sufficient to make intimacy possible unfortunately 

[Hattie]

  Not sure what happens if you have a continuous low level of oestrogen and whether it is a good thing or not.

Me too Dahliagirl   

Hattie X