Hi KaTo
![welcomemm :welcomemm:](https://www.menopausematters.co.uk/forum/Smileys/extended/welcomemm.gif)
from me too!
Sorry to hear about all your problems.
The first thing is - I presume you were given Tibolone because it also breaks down into a weakly progestogenic substance, and so will prevent the endometrial deposits from growing under the influence of oestrogen? Did you have deposits outside the womb? If so you will continue to need some form of progrestogen.
The other thing is that Tibolone is a very low dose type of HRT and not the same as the others - and the fact that you have developed VA and also your libido has declined suggests that your oestrogen dose is too low and insufficient to prevent VA (as well as the weak testosterone component of Tibolone is probably too low as well). You started this at quite a young age when your oestrogen levels should have been very high.
In your position I would want to talk to a knowledgeable GP or menopause specialist (can you ask to be referred to a meno clinic - if there is one near to you or a specialist GP in your practice?) to review your whole situation and treatment. I would want to know whether my bones were OK - is there osteoporosis in the family for example? You had an early surgical menopause and it might be an idea to ask for a check?
I would definitely get a different vaginal oestrogen if the cream doesn't stay in! Many of us use Vagifem which is a tiny vaginal tablet that sticks to the vaginal wall so doesn't fall out! Keep the cream (maybe get some more before you change the prescription) so that you can use it on external areas - labia, vaginal entrance etc - which is what several of us do.
Depending on your endometriosis - I would think about getting a higher dose oestrogen - if no deposits outside the womb then you could have a transdermal patch or gel, and for your libido, the NICE Guidelines do make provision for testosterone to be prescribed off licence but not many GPs/specialists will do so.
There is a lot of information on this website so explore the top tabs with pale green banner and have a good read about what is available - but definitely make that appointment as soon as you can and try to get a referral if possible
![Smiley :)](https://www.menopausematters.co.uk/forum/Smileys/extended/smiley.gif)
Let us know how you get on
Hurdity x