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[Stillsearching]

I went back to my GP this morning after being advised on this forum to use vagifem. I read up about options before going and decided I'd rather try the Estring. I always start my appointments with a precis of what we've done so far and then we talked about the options. GP didn't know whether Estring was available on the system, it wasn't his recommendation, but I did leave with a prescription for Estring. He said that with all the topical treatments you have to have a break every 2 or 3 months to have a bleed, they can't be taken continuously. I can't find any info on this.

[Dancinggirl]

Oh dear StillSearching - another GP who hasn't a clue. 
If you are talking about local oestrogen for the vaginal area, then the Estring can be a good option as you insert this and leave it for 3 months.  Vagifem is used every night for 2 weeks and then 2-3 times a week ongoing - possibly for the rest of your life.  Quite where your GP got the idea that you take a break every 2-3 months I'm not sure - perhaps he thought it was a type of systemic HRT???

I think you need to print out the info on vaginal oestrogen on this site for him/her to see and it explains about this type of treatment.  The dose is very low so there shouldn't be any build up of womb lining, so a withdrawal bleed isn't necessary.
DG x

[Tinkerbell]

Another clueless GP

All topical oestrogens are safe to take long term and no break is needed. I have been using topical treatments for 4 years now and have taken the time to educate a few GP when I have heard the type of nonsense you have been told.

[Stillsearching]

Thank you both.

The Estring lasts for 90 days so that will fit in nicely with my plan to re-evaluate after having a 3 month break from HRT. I've read conflicting reports about whether progesterone should also be taken, particularly if Oestrogen is used long term even topically. I can understand why a GP would be unsure. On the Estring and Vagifem websites it states that "Using estrogen alone may increase your chance of getting cancer of the uterus" It's a very confusing time.

[Tinkerbell]

Personally I think GPs should keep themselves up to date/improve their knowledge as half of their patients will be female and obviously a good proportion will need/want hrt of some description at some point.
Keep us up to date on the Estring, wondering if to give that a try as I need to use Vagifem every day.

[Maryjane]

Very worrying just how little GPs no re HRT.

You can be on local oestrogen for life with no need for progesterone.

[Dancinggirl]

Menomale - the Estring is a very low dose vaginal ring that delivers a very small amount of oestrogen directly to where it is needed - it is not full systemic HRT. There shouldn't be any build up of the womb lining with any local oestrogen treatment, therefore progesterone is not necessary. The information given with all local oestrogen treatments tends to be the same as for systemic HRT which can be very misleading and often confuses GPs and patients.  I think the new NICE guideline actually state that long term use of local oestrogen is fine - hopefully someone can confirm this? DG x

[Maryjane]

Yes dancing girl local oestrogen long term/ permanent without the need of progesterone.

[Stillsearching]

I think that advice is just for oral oestrogens. The Estring only contains 2mg of the drug to last 90 days. NICE does say that such low dose topical oestrogens can be used unopposed by progesterone.

[Dancinggirl]

Menomale - drug companies cover their arses  - so give the same ‘warnings/precautions' for local oestrogen as for full systemic HRT.  Something does need to be done about this!!!   DG x

[Tinkerbell]

According to my meno specialist usage of Vagifem every night for a year is equal to just one oral HRT tablet....I guess that applies to the Estring too!
She kindly worded a strong letter to my GP practice informing that local oestrogen is safe to use long term with no need for additional progesterone.

[Stillsearching]

There is only 1 Estring dose. It works out at 7.5 micrograms per day. The leaflet inside says that the known risks are for HRT taken orally and that the risks are not known for local treatments. All things considered I'm happy to use this without progesterone. If it works and the other symptoms calm down I'll replace it and use continuously.

[Dancinggirl]

It's true that Estring delivers a slightly higher dose than other forms of local oestrogen treatment, BUT, Vagifem used to be 25mg, not the 10mg it is now, and subsequently many women have to use more than the recommended 2 times a week to keep everything healthy around their ‘lady bit's and bladder.  The effects of VA can be very distressing so local oestrogen should be far more widely available.  As to the risks, well if there does happen to be any build up then spotting or bleeding would probably be the outcome which would then be investigated - I think there would have to be a thickened lining for quite some time for anything sinister to develop.  The risk of womb cancer are very, very small.
My mother developed Vulva Cancer in her 70s - she had had a premature meno and didn't receive any HRT treatment - her VA must have been terrible and she was so used to discomfort that she didn't go to the doctor about this sore area because she thought it was normal!!!! When the GP examined her she was rushed to the specialist - resulting in major surgery and a subsequent bladder prolapse. If she had used local oestrogen then she wouldn't have been used to this awful discomfort and might have sort treatment sooner. I even wonder whether the vulva cancer could have been prevented if she had used local oestrogen, her ‘lady bits' might have been healthier? I have asked this question to a couple of gynaes but they are unsure about this - clearly there haven't been any studies looking into this YET
Basically - don't worry about any risks - there are risks with everything in life and a doctor can only prescribe in good faith and inform a patient of the slight risks so she can make up her own mind. GPs regularly hand out ADs/SRRIs and many other drugs without telling patients about the side effects. DG x