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[Hurdity]

These products seem to be coming thick and fast - well at least they are appearing on our medicines database. I discovered this product by Besins while searching for the other new one....

Goes by the great name of.....

IMVAGGIS  !!! Yes it really is called that!

"IMVAGGIS 0.03 mg Pessary"

Made by our favourite company Besins (who make Oestrogel/dose and Utrogestan)

https://www.medicines.org.uk/emc/product/10435/smpc

What's good about this one is that it is an estriol pessary. Some of you will remember the wonderful Orthogynest pessaries (which I used to use) which were discontinued. These were 0.05 mg - a bit stronger but had all the advantages of estriol but neatly packaged into a pessary.  Judging by the description and the fillers - it looks like Besins have filled this gap in the market!  Also no applicator so less plastic! I am interested to know how effective is the lower dose. Interesting that a 3 week loading is recommended.....

So now we have in addition to Vagifem and the estriol creams:

IMVAGGIS (Estriol pessary)
Blissel  (Estriol gel with reusableapplicator)
Intrarosa (DHEA pessary)

Senshio (oral ospemifene)

Let's all ask for some of these eh and report back?
I wonder how expensive they are

Hurdity x

[Perinowpost]

Good news and also a move in the right direction.  I'll definitely ask for some x

[Wrensong]

Great Hurdity - thanks for posting this  .  Bit disappointed to see this in the product info though:-

"IMVAGGIS 0.03 mg pessary must not be combined with estrogen preparations for systemic treatment, as there are no studies of safety and risks with estrogen concentrations attained in combination treatment."

and . . .

"Blissel 50 micrograms/g vaginal gel must not be combined with estrogen preparations for systemic treatment, as there are no studies of safety and risks with estrogen concentrations attained in combination treatment."

Wx

[Joaniepat]

Great Hurdity - thanks for posting this  .  Bit disappointed to see this in the product info though:-

"IMVAGGIS 0.03 mg pessary must not be combined with estrogen preparations for systemic treatment, as there are no studies of safety and risks with estrogen concentrations attained in combination treatment."

and . . .

"Blissel 50 micrograms/g vaginal gel must not be combined with estrogen preparations for systemic treatment, as there are no studies of safety and risks with estrogen concentrations attained in combination treatment."

Wx

Thanks Hurdity and Wrensong. Yes, I noticed the bit about not being combined with systemic, which seems odd as the two existing creams containing estriol are prescribed to systemic users. Wierd.

I wonder how long it will take for the new products to get onto local formularies.

JP x

[Hurdity]

Ah thanks Wrensong - I didn't read the info in detail - it was quite late last night when I found them!

I agree it is very strange as NONE of the current vaginal products give this warning. Also odd because the Imvaggis is similar but weaker than the Orthgynest pessaries which carried no such warning.

Also the Patient leaflet for Imvaggis says nothing about not being used if you are taking HRT - just the specific warning re other "medicines" and all the usual risks info about systemic HRT

"IMVAGGIS is used for a local treatment in the vagina and is not likely to affect other medicines.

IMVAGGIS may affect other vaginally applied treatments but is not likely to affect other medicines"

It says something similar for Blissel (I can't see how this one will work or stay in place as I would have thought gel is more likely to become runny and slip out even than the estriol creams, but obviously will have been tested...?).

I wonder if this is some sort of new regulation on labelling ie that instructions and warnings have to be very specific - even though logically, if there is minimal systemic absoprtion there will only be a very small additive effect to existing HRT concentrations (systemic oestrogen levels?).

However I can imagine some GPs following these instructions to the letter and deny these products (if they ever get prescribed!) to women on HRT.

I have an appt with GP tomorrow to review HRT and I might mention it and ask for some!

Perinowpost - let us know!

Hurdity x

[Alicess]

Hi Hurdity, I found this information on Wikipedia about estriol. In the presence of estradiol it could be acting as a antagonist of the estrogen receptors? I don't think Wiki is always a reliable source but there are some references.

Although estriol is an efficacious agonist of the ERs, it is reported to have mixed agonist–antagonist (partial agonist) activity at the ER; on its own, it is weakly estrogenic, but in the presence estradiol, it is antiestrogenic.[8][9] Given by subcutaneous injection in mice, estradiol is about 10-fold more potent than estrone and about 100-fold more potent than estriol.[11][12] It is notable that unlike estriol, estrone can be metabolized into estradiol, and most of its potency in vivo is in fact actually due to conversion into estradiol.[1]

[Tracey E]

Fab news...

[Tinkerbell]

While it is good to have another option, i shall struggle to place it high enough without an applicator. In my early days of VA i was prescribed the Ortho Gynest pessaries and had little success because they would slip out, so i will have to continue with the Vagifem.

[Hurdity]

Well I didn't have time to ask my GP today about one of the new products as by the time we'd talked about our holidays, the oestrogen patches, a blood tests, Estriol cream and the testosterone, I'd already been in there almost 25 mins so decided I would save that until another time!

Would be inetersted to hear if someone manages to get one of these products prescribed.  I wanted to go for the Imvaggis as it's estriol.....

Alicess estriol binds to oestrogen receptors in the vaginal tissues and has the same effect as estradiol hence the products have been developed.

Hurdity x

[KiltedCupid]

If anyone has experience with intrarosa, I'd be really interested to hear. Had to re-schedule my GP appointment so won't be able to request it for a few weeks yet.

[Tracey E]

Asked my doctor about Imvaggis today and I was told it had been discontinued. 

[Hurdity]

Umm - well it's only just been released and licensed and is listed here: https://bnf.nice.org.uk/drug/estriol.html so I would doubt it had been discontinued before it has even been used much? 

I'm thinking perhaps your doc might not have heard of it because it is so new and was referring to the discontinued Orthgynest pessaries which were a similar type of thing - but containing 50 mcg estriol ( Imvaggis contain 30 mcg).

What a shame eh Tracey E? However If you really  want to try it or one of the other products then maybe ask again? Perhaps print off the info from the drug list or emc database of medicinces https://www.medicines.org.uk/emc/product/10435/pil. Better luck next time!

Hurdity x

[Tracey E]

Hi, my doctor found it on her data base list of medication but it was listed as discontinued. Maybe someone else will have better luck.. x

[Hurdity]

Update on information about IMVAGGIS estriol pessary for VA.

I wrote to Besins and they have provided the following information in two separate communications:

Message from supply chain manager at Besins:

"This refers to your recent enquiry with regards to Imvaggis, unsure if you have already received information regarding the launch of Imvaggis. In case you haven't heard yet please note that Imvaggis is now launched in the UK/|Ireland and available for purchase across the pharmacies.
 
At this time we have only launched it in the UK and Ireland, may consider launching in other European countries in due course.
 
Here is link to the website which may provide further details  https://imvaggis.co.uk/
 
Please let us know in case you require any further help. Also, in case you pharmacies face any difficulties in obtaining the stock they may inform us with their supplier / wholesaler details via [email protected] and we will try to assist via their wholesaler."

Information from medical information dept at Besins about EU availability and name of the product:

"Imvaggis® (estriol) – EU Availability

I can confirm that the product is also licensed in other EU countries under the following brand
names:

Austria – Estrokad
Belgium – Oekolp
Denmark – Estrokad
Finland – Estrokad
Hungary – Estrokad
Ireland – Imvaggis
Italy – Atrocom
Luxembourg – Oekolp
Netherlands – Estriol Dr Kade
Norway – Estrokad
Sweden – Estrokad "

ie not Germany, France or Spain.

For those who want to take an estriol based vaginal oestrogen product but find the creams too messy as well as the washing of applicators - this may prove an attractive alternative and like I said before replaces the previous discontinued Orthgynest pessaries - albeit at a slightly lower concentration.


Hurdity x

[Turkish delight]

Thanks H, your the best!

Wonder if anyone here is taking IMVAGGIS, I mean REALYY...who signed off on that name, how can we have a serious conversation about IMVAGGIS, heads must roll as well as these eyes

Will the NHS take the IMVAG and run with it?

Does MJ have anything to add, she's got her ear to the vag ground I'm sure of it.

Sorry guys, I've got the cheeky Friday feeling early this week, just ignore me. 

TD