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[Joaniepat]

The gynae did say one twice a week wasn't enough, that was even without examining me. What's estring?

It's a vaginal ring that you can leave in place for 2-3 months. It delivers 7.5 mcg estradiol over 24 hours.
JP x

[Dierdre]

Vagifem is such a tiny dose. There are 1000 mcg to 1 mg and each vagifem is only 10mcg. Oral HRT tablet form usually has 1 or 2mg per tablet, just do the maths to see the huge difference.. This is why progesterone is not needed as very little of this tiny dosage goes systemic. Vagifem has been used now for 30 years since 1988 and was 25mcg per tablet then so why some doctors are still not up to date on this drug is a shame when their ignorance is affecting women's quality of life and causing unnecessary stress. I take one everyday and get on with my life, this option should be for everyone who needs this dosage and not based on a doctors out of date opinion.

[suzysunday]

I assume this is the same for ovestin. I'm just worrying after pmb and biopsy and can't settle with my body.

[Katejo]

Vagifem is such a tiny dose. There are 1000 mcg to 1 mg and each vagifem is only 10mcg. Oral HRT tablet form usually has 1 or 2mg per tablet, just do the maths to see the huge difference.. This is why progesterone is not needed as very little of this tiny dosage goes systemic. Vagifem has been used now for 30 years since 1988 and was 25mcg per tablet then so why some doctors are still not up to date on this drug is a shame when their ignorance is affecting women's quality of life and causing unnecessary stress. I take one everyday and get on with my life, this option should be for everyone who needs this dosage and not based on a doctors out of date opinion.

I strongly suspect that the restriction on allowing some of us to use it daily is a budget issue (false economy/rationing?). If a daily dose works, we are less likely to need repeated urine tests/AB's or other treatments.  That suspicion was reinforced for me when the hospital pharmacy refused to supply it. If I try to reduce to alternate days, the symptoms creep back quickly and then take a while to clear again.
When did the dosage change to 10mcg from the 25mcg? I know it did happen but have no idea as to how long ago.

I get free prescriptions because of other medication which qualifies for that. I recently told a pharmacist that I would be willing to pay for medication not on the permitted list. She appeared to agree with my point but said that they weren't allowed to charge in that way.

[Dierdre]

I use Ovestin everynight too on the outside and entrance. Vagifem changed to 10mcg in 2010.

[suzysunday]

Nickyp, I know sometimes everything you do worries you. The vagifem dose reduced maybe 6 or 7 years ago I think. Interesting about the financial side.  The gynaecologist I saw only a couple of months ago was still suggesting having a break from ovestin. I have va and know it will worsen with a break and uti symptoms, tests etc.  But then as Nicky says, you worry of you use more then you get spotting or other problems that scare me to death.  I've been told just twice a week with ovestin but worry it's not enough and worry if I use more.

[Dierdre]

The NICE guidelines state local oestrogen can be used continually with or without full HRT with no adverse effects and the dosage increased if necessary. Look in the search menu, the guidelines are in the burning club thread by dancing girl. Perhaps show this to your doctors and asked them why they aren't following this, their replies could be interesting!

[suzysunday]

Thanks, I'll have a look. When things have gone wrong, as Nicki days, I worry if I do something and worry if I don't.

[suzysunday]

Could there be a problem with local hrt use of there had been womb lining thickening in the past. Tibolone caused this with me but it all went back to normal when I stopped it?

[Dierdre]

In the trials they did after the 2 week everyday load on both 25mcg and 10mcg the systemic amount was very low with both. It was just recommended that the lowest dose possible was used, but one hat doesnt fit all. Some women are fine on 2 doses a week, some of us are not and this should be an important factor when prescribing. Certainly start at the lowest but allow increase to those who need more. The NICE guidelines state there is no need to scan the lining so this can't have been a concern.

[Shelly65]

I use vagifem every day as I cannot cope with the burning and tiny cuts that I used to get as well as the uti infections. At first I used ovestin every day but the meno specialist I saw said use only twice a week. I explained that it was not enough but she was adamant only to use twice per week. I then tried estring and it was fine for first week or so then constant low period type pain for three weeks. Took it out and pain went. Back to ovestin every day as all symptoms came back on twice a week regime. Back to see meno specialist for follow up appointment and she was not happy and said I risked getting cancer. She suggested vagifem but still wasn't happy with everyday use. I said I would still use everyday. She then said she didn't need to see me again. My own doctor says use everyday and there is no evidence that it will cause cancer. Shocking that we get told different things. Quality of life is important and i know I cannot live with the symptoms of VA. Thank God for the doctors at my practice.

[suzysunday]

Thanks that really interesting and good for you shelled for sticking to your guns. I assume it's ovestin your gp approved  of for every day use. As you say the conflicting advice causes great stress when VA symptoms are so hard to live with if not properly managed. 

[suzysunday]

Also it's confusing that the ovestin and vagifem leaflets seem to be the same as those for systemic hrt.

[CLKD]

One does not need progesterone with localised treatment for vaginal atrophy.  One does not need to take a break from any HRT however delivered unless 1 requires a break.  The GPs tend to still quote the 5 year issue but it really isn't necessary.  HRT can be essential for many and certainly VA treatment should be considered for Life.  GPs wouldn't be likely to discontinue other essential treatments, ie. for diabetics, but they can be iffy about getting thyroid treatments correct for patients.

[Shelly65]

Suzysunday yes she approved both but decided on vagifem and ovestin in the outside. It's much better with the odd few days every now and again where it feels a bit burny. I would not go back and see the specialist that I saw again. Very disappointed 😞