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[Maryjane]

 Hi ladies, I have been here a couple of years and some of you may remember I have lots of bladder/vagina/vulva issues. I am better than I was but it is time to see if HRT will help further, I will be seeing my lovely female GP on Thursday who is happy for me to go on HRT after getting a second opinion from a gynae regards all my issues, which ended up being a Vulvoscopy/ Colpsocoy/ intra vagianl scan and to top it off a womb biopsy. All clear yay.

She was being over cautious as I have a bit of spotting between periods ( I wasn't worried ) but she got me seen in ten days NHS and the consultant wrote to me four days after seeing him just saying what he had done, and then four weeks later got the thumbs up for HRT.

So what patch would you knowledgable ladies recommended as a starting off, I don't have hot flushes just occasionally a bit warm, not exhausted, no awful anxiety just a bit, my problems are purely vagina/vulva/bladder even with two vagifem a week I am bone dry down there sore irritated , I am certain perimeno is the cause as this all happened two years ago when my vagina literally dried up over night. I use the usual things down there, vagifem, estriol, YES oil but feel I just need more. I have spoken to a private GP who had a lady who's vulvodynia only went when she went on full HRT.

I still have regular periods......i go knicker less all the time ( other than periods ) and have no discharge at all so I am shrivelled up like a prune I reckon. Sex is impossible. It's the whole progesterone and progestone and urtogestone that confuses me.

Thank you in advance.

[Hurdity]

Hi Maryjane

Sorry to hear you are still having problems down there! The thing is local oestrogen is the best treatment but many of us have systemic HRT as well as local oestrogen. What puzzles me is that you say your periods are still regular. Have you had any variation in cycle at all and in the amount of bleeding, and did the gynaes say what the cause was of the intercycle spotting? I know some women get this as the oestrogen level drops suddenly after ovulation (oestrogen withdrawal bleeding) - and then oestrogen rises again.

Have you though of increasing the amount of Vagifem? It wasn't long ago that women were prescribed the 25 mcg dose if the 10 mcg dose didn't work and it does sound like you are a good candidate for that. Is it possible to ask to double your dose ie to insert either 2 x 10 mcg tablets at once (twice a week) or use them 4 times per week ( personally I would prefer the former).

In terms of full HRT - do you have any other symptoms of low oestrogen - flushes, sweats etc - or maybe you are taking an anti-depressant which would mask these ( hope you don't mind my asking that)?

I agree it's confusing when first trying to get your head round it!

Basically HRT consists of replacing the oestrogen which becomes deficient as the ovaries pack up - and this is what leads to the symptoms. The added oestrogen causes the womb lining to thicken ( as well as getting rid of the unpleasant symptoms to a greater or lesser extent) so in order to prevent over-thickening and possibly cancer, we have to take a progestogen (this is what happens in the second half of the menstrual cycle). This changes the womb lining and then when you stop taking it the womb lining comes away as a bleed.

A progestogen is any compound which acts like progesterone on the uterus - so there are synthetic ones ( in most combi HRT types) and there is the bio-identical "natural" progesterone whose brand name is Utrogestan. This is only available as a separate pill so women who want to take the natural progesterone then take oestrogen separately as a tablet, gel or patch.

You have to decide what you want to do.

If you want a patch - there are two combi patches - Evorel sequi and Femseven sequi. Some women don't get on with the progestogen in Evorel, but Femseven is left on for a week which some women find problematic too. Quite a few of us use patch or gel oestrogen, with separate progesterone Utrogestan. Each will have its own devotees! All the different types are listed in the menu under Treatment/HRT preparations (top menu) and follow the different categories.

Hope this helps and please do ask if you have any more Qs!

Hurdity x 

[Maryjane]

Thank you for replying. Yes my periods are still regular I am 49.3. My breasts hurt for most of the month except when my period starts then they are fine for a few days. The spotting which only happened a couple of times was put down to my age the gynae I saw was an oncologist one so very thorough hence all the tests.

My pubic hair is thinning , but vagifem is helping that taken a year. I had put weight on around my middle and my breast had exploded but I have been on a diet not mixing carbs and protein in the same meal and the weight has dropped off.

I have burning mouth syndrome also sometimes which is a peri symptom, all my issues are down mostly below, which as you no is the pits.

I thought that ladies went on low dose systemic HRT with just the problems I have , as surely my oestrogen must be dropping because of my down belows and I thought this could slowly be happening from 40ish and for some local oestrogen isn't enough and systemic is required. The gynae said he prefers patches but has left it to my GP.

I know if I see someone like Dr Annie Evans I will get HRT but I am trying to work out what is best. I just have read your posts over time and all that has seemed to make you feel better down there is systemic HRT, as I believe you said you have had problems for years unless I have muddled you up with someone else. So you are saying if my periods are still regular I shouldn't really be going on HRT ? Ten minute appointments just aren't enough. So if vagifem used to be 50 a week could I have 5 a week with two days off? as so far the two hasn't given me any moisture at all, and my three large episiotomies scars are very tender, how I hate my bladder and vagina 😔.

Sorry for being a pain with the what ifs and maybes. All my GP said was blood test is pointless and with my age I will be in peri, she is herself. My mother didn't really get hot flashes either she stopped at 54 but she now has dreadful VA and nothing helps as she is allergic to all the creams so I am trying to nip it in the bud. 💐

[Hurdity]

Hi Maryjane

Sorry if my post was confusing - I am in the middle of progesterone fug at the moment - a few more days of my cycle so feeling exceptionally tired!

I didn't say or mean to imply that you shouldn't go onto a low dose HRT. (By the way it wasn't me that had ongoing vaginal problems - might have been Dancinggirl who started a thread called the Burning Club but she is well post-menopause as I am). I was just wondering really if you had had any cycle/bleeding changes at all and if your only real menopausal symptom as yet was the vaginal/bladder problems ie no flushes and sweats yet and no cycle changes.

I was really thinking that you would benefit at least from an increase in vaginal oestrogen ( this is different from someone who is post-menopausal and has much less of their own oestrogen) - because you are on a very low dose. If you had 5 a week that would be the same as the old 2 x 25 mcg. As I said in my preivous post if you have a tendency to irritation down there personally I would have thought preferable to try 1 x 20 mcg ( ie two tablets at once) which would give 40 mcg. I always find it irritates the bladder slightly the day it is inserted - which is why I said that about only doing it twice a week. I know some women use 3 or 4 a week under docs guidance. The other thing is the vaginal ring which releases estradiol continuosly and from what I've read is equivalent to the 2 x 25 mcg per week dose.

You may well find that systemic HRT does the job too but you then have to take progestogens too - which can cause problems in some women. I was only mentioning the issue re starting systemic HRT when still having very regular periods because several women on here have done so and it hasn't sorted them out (read GypsyRoseLee, Briony and I think Estelle's posts) and they have started the pill instead - not for vag problems though. More for mood changes I think.

However if your gynae has recommended it and your GP is happy then why not give it a whirl? I would still start by increasing the vag oestrogen though because it is local to where the problem is. Just my personal opinion though  The new Draft NICE Guidelines also recommend this:

Section 1.3.11
If low-dose vaginal oestrogen does not relieve symptoms of urogenital atrophy, consider increasing the dose after seeking advice from a healthcare professional with expertise in menopause
https://www.nice.org.uk/guidance/GID-CGWAVE0639/documents/menopause-draft-guideline-nice2

Your GP is right about the blood tests but peri is not diagnosed by age  - but by symptoms combined with cycle changes, as I understand. Good idea to nip it in the bud!!!

Hope this explains what I meant and sorry if I sound confusing!

Hurdity x

[Maryjane]

Thank you Hurdity 💐 I always muddle you and Dancing girl up . I am going to ask to double up my vagifem first give it six weeks but have a prescription at the ready to go of it doesn't help, as its a 4-6 wait to see my GP.

Just never realised what could happen down there.....😢