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[jasmine5]

Six months ago I started to suffer from vulval itching and irritation to which my consultant prescribed Vagifem twice weekly.  Initially this seemed to do the trick or so I thought, but later the itching returned and I was feeling really sore and sensitive down below.  Intercourse also became impossible due to pain and tearing, especially in the area of my three episiotimies.

During another appointment the consultant prescribed a steriod cream to be applied every day for two weeks then tapered off.  He also mentioned a 'biopsy' and possibly a small stitch (yikes!) to get to the bottom of this problem.  While using the steriod cream things feel quite comfortable but if I miss a day the itching returns.  This now means that during my next appointment I will have to undergo a biopsy.   Please has anyone had this procedure and what is it like?  Is it painful and how long will I have to wait for the results? 

I'm 57 and on Femseven 50 and Vagifem. 

[CLKD]

Did you have an initial every night 'load' of Vagifem  …….. localised HRT vaginally for atrophy is prescribed every night for 2/3 weeks followed by every 3 and 6/7th night.  Same with Ovestin1mg.

Steroid ?  Biopsy?

What Specilality is this Consultant ……. if you can tell us more …….. you need to ask why a biopsy is considered necessary and what the Consultant is actually looking for ……….    This is an intimate examination and you need to sign a consent form and know exactly what it is being done for.

[jasmine5]

Thanks yes i did the loading thing every night for 2 weeks then twice a week thereafter.  He is a Consultant Gynacologist in the Woman's Health Clinic at my local hospital.  I first saw him privately as I couldnt wait nine months for an appointment. 

I dont really want this biopsy but I he doesnt appear to know where to go next to be honest! 

I'm using Hydramol in the bath and not soap but I'm wondering if it could be my washing liquid?   

I'm not sure if he is looking for a skin condition such as Lichen Sclerosis.  Is a biopsy the way to diagnosis this?

[Tinkerbell]

You need to see a vulval dermatologist, yes I think he is trying to rule out Lichen sclerosis.

It was suggested I needed a vulval biopsy because I couldn't manage on 2x Vagifem a week, I refused as my discomfort improved when I upped Vagifem dose.

[jasmine5]

Yes I really feel that this might make a big difference to the itching as it did during the loading phase,  but when I asked him about increasing the Vagifem to three times a week he said that if the patches and Vagifem twice weekly didn't make any difference then he "wouldnt recommend it"!

I'm going on holiday soon and I just want some relief as this itching is driving me insane.  Would it be ok if I just went ahead increased it anyway?

[Maryjane]

He is looking for LS......I had a punch biopsy years ago and it was fine punch biopsy they don't stitch. I would go to a vulva dermo. I am also suffering around my three episiotomies with soreness, can't have sex. I so far have refused a biopsy as I am certain all it will show is inflammation ,my gynae did a vulvoscopy which is were they get a magnifying thing, they put an astringent on the vestibule area which allows them to really look at the skin for any abnormalities, they also did the same on my cervix as occasionally vulva issues are coming from the cervix, he then did a intravaginal scan followed by a womb biopsy. He suggested a vulva biopsy in February when I see him next but I will likely decline, as Dermos only do this if they really think there is a need.

I ise vagifem and steroid also, I am going to give full HRT a go along with vagifem as I am certain this is all hormone related.

[Hurdity]

Hi jasmine5 - I can't comment on your vulval problems specifically because I don't know enough about this but all I would say is- if I was offered an investigation for something I would always go for it just for peace of mind. A few minutes of discomfort or even a day or two - against perhaps getting closer to what is wrong?

I presume as you are on oestrogen only HRT you've had a hysterectomy unless you take progesterone at some point? Do you still have your ovaries?

The question about your consultant's comments re using extra vagifem. I think some other gynaes and doctors would disagree. This is not a one-size fits all solution and there are women on here who have been prescribed double the dose ie 2 x 10 mcg twice a week ie closer to the original higher dose of 25 mcg vagifem twice a week.  The research (looking into the efficacy of different doses of Vagifem) showed an increase in effect with higher doses and only a certain percentage of women showed improvement on the low dose - you may well be one of the those who don't. The NICE Guidelines do mkae provision for increasing the dose:

"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"

The amount absorbed is so small anyway so I would go ahead and increase the dose or frequency and don't worry. Several women have to do a 2 week re-load every now and again anyway - but also I would have the biopsy too. Obviously if it  you will need to speak to your consultant and/or GP at some point so that if it works that they will continue to prescribe the increased dose. It's not like increasing systemic HRT - because vagifem is such a small amount of oestrogen.

Hurdity x

[Tinkerbell]

I was recently told by menopause specialist that I could use Vagifem every day for a year and it would be equivalent to just one HRT tablet.
She informed my doctor of this and suggested he read the latest Nice guidelines

[jasmine5]

Thank you.....I shall increase the dose of Vagifem to 3 x weekly and see if it helps I think.  If it does I will then know for sure its hormonal and not something nasty going on! 

I do still have a womb and ovaries. and have been on Hrt for about four years.  I wasnt aware that Femseven conti patch is Oestrogen only!  I was doing well on Estrodot and Utrogestgan but I had some spotting and  the consultant suggested it would be easier to use a patch once a week instead.

Oh I'm a little worried now does this mean I should be taking some progesterone in another form?  I usually trust in the medics as they are supposed to be the experts aren't they so why would they put me on the wrong type of Hrt?  I have'nt got another appointment until after christmas, should I see my Gp to discuss this.....

[CLKD]

There's no need to panic.  Upping the Vagifem will give you an idea as to whether you require more of it in order to keep symptoms at bay.  Or you could ask for Ovestin1mg (which is what I use) instead. Same procedure, i.e. 2 week load then using it every 3rd and 4/5th nights to keep the vagina plumped up. 

Before submitting to intervention, I would want to know why the Consultant wouldn't recommend your suggestion of upping the Vagifem  ……… if you are seeing him Privately then he will, of course, be paid for any surgical procedure 

I think you should have some progesterone in order for the womb to shed it's lining  .  You could see a Pharmacist, your Practice Nurse or GP for reassurance.  How do you feel generally?

Steroid creams/tablets unless absolutely necessary, should be used short-term.  Make a list of queries to take with you 

[Hurdity]

Hi jasmine5

Sorry didn't mean to alarm you! In your original post you said Femseven 50 which is oestrogen only but Femseven conti contains both oestrogen and progesterone so you're OK there!

Hurdity x

[CLKD]

Phew!  we're a Mine of Knowledge 

[jasmine5]

Haha doesn't take much to make me panic these days!!

[CLKD]

Oh that goes with the terroriroty  ……. let us know how you get on!