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[KaraShannon]

Hi everyone

I've had an email from my GP to say they are going to refer me to a women's health physiotherapist, which is great.  Meanwhile they said to call back if I need to discuss anything further. 

I wanted to ask them if there were an alternative to the Vagifem, as I can only use that twice a week otherwise I start getting migraine, sensitivity to noise, irritability, etc.  I don't know if anyone else gets that, but was wondering if there were an alternative that might work differently?  Also the vagifem is only partly solving the problem, it's early days and I can't use much of it, but it's another issue.

I don't want to call her and wait in the queue, and disturb their very busy schedule unless it's likely they could offer an alternative to try. 

Thanks for any info that you might have.

[Uptick]

Hi KaraShannon, the alternative treatments are listed here https://www.menopausematters.co.uk/local.php DHEA pessaries (Intrarosa) are also available now.
A friend has systemic effects (migraines) during the loading dose of Vagifem (one tablet daily for 2 weeks), but they get less frequent after that. Have you done the loading dose? It's supposed to transform the vaginal epithelium into a more dense tissue which will prevent further systemic absorption. I think it could still have some systemic effects depending on individual sensitivity and anatomical variations.

[shrosphirelass]

You could try estriol or ovestin. They are both creams. Different things suit different people.

[CLKD]

Why do you associate your symptoms with 'vagifem'  which can be used every night : how soon did these symptoms happen after starting the treatment?  Is it that it's classed as HRT that has raised worries.  How is your overall health?  Dehydration can cause headaches as can fluctuating hormones.  It is a very small amount of active ingredient which is absorbed locally ...... 

I have used ' ovestin' successfully for several years. Have a lookC at the 'yes' and 'sylc' websites though they won't cure vaginal atrophy.  They can ease itchiness in the outer labial areas. 

Tnx Uptick - interesting though why such a small amount of active ingredient should cause headaches? 

[Catcc]

Hi
I have been on vagifem for 18 months now.  Initially it gave me headaches too.  (I was fine during loading dose but got headaches during the first few weeks of the 2 per week dose).  They did stop once my body adjusted and I am glad I persevered for those few weeks as the benefits of vagifem have been amazing.

There are other options eg ovestin, estriol etc but do bear in mind that it might take some time for your body to get used to whatever you use.

Hope you find the right thing x

[CLKD]

That's interesting about the headaches.  I wonder why ?    as it's local application.

Fortunately there is choice - mayB try 'ovestin'?  Same idea, delivered differently by applicator.  I use at night and it's never messy ;-)

[Js]

Hi ladies

I have been prescribed 10 micro grams of the Vagifam pessaries and suppose to start them but worried now reading about headaches and migraines as I get migraines and don’t really want to add to them by using this .i am on hrt patches also and get migraines so again concerned but as it’s a local application and doesn’t enter the blood stream hopefully will be ok but I’m dubious about using it I have checked with doctor that’s it’s ok to,use with hrt patches they have said ok . I’m due a smear test and that’s why I’m trying the vagifam to ease the discomfort of the test so I won’t be on vagifam long term

Any advice will be appreciated 

Js

[CLKD]

I'm confused now  even more than for a usual Friday 

If VA treatment is localised how can it infiltrate the body to cause headaches and breast pain?  Surely the point is that the products are safe to use even for those with history of breast disease. 

[Uptick]

Hi Js, considering you're on HRT, Vagifem won't make much difference if you're already having migraines. The dose is low compared to any systemic HRT. The important thing is to follow the leaflet instructions regarding the 2 weeks loading dose. During these first two weeks, very sensitive women can have migraines exacerbated because the vaginal tissue is atrophic and will allow some systemic absorption. After that, things usually calm down. Are you on medication for migraines? You can use a preventative during the first two weeks if they are really bad.

[Uptick]

I'm confused now  even more than for a usual Friday 

If VA treatment is localised how can it infiltrate the body to cause headaches and breast pain?  Surely the point is that the products are safe to use even for those with history of breast disease.

Hi CLKD, you obviously never had migraines. All people who have migraines are hypersensitive to a lot of triggers, including medication. Any amount of hormonal fluctuations are enough to trigger migraines in sensitive women.

[Uptick]

Js, you can ask for Estriol Cream, it's more migraine friendly than Vagifem (Estradiol).

[CLKD]

Fortunately Uptick never.  I would have been off a cliff !  but my query is how does a vaginal treatment infiltrate the whole body?  ? via the blood stream ? which rather defeats the object .......... still confused 

I am aware that pessaries in the anus distribute medication quicker than by mouth ...........

[Uptick]

Yes, once a drug enters the blood stream it can cause systemic effects. It doesn't defeat the object, the local effects are going to happen independently of the blood stream.

That's exactly the purpose of the two weeks loading dose, it will thicken the vaginal tissue in order to minimise systemic absorption via the blood capillaries.

[CLKD]

I wasn't aware that the product would migrate though 

[Catcc]

Excellent explanation Uptick.  I have always been a headachy person.  Had hormonal migraines before my periods. So it didn't suprise me that initially I had headaches with vagifem, for exactly the reason you describe.  As you say, once the tissue has thickened a bit the very tiny systemic absorption stops. I was post Meno when I started it and my body needed a while to adjust. 

I absolutely would encourage anyone who needs vagifem to try it.  It's worked wonders for me.  Just don't be put off if your body needs a few weeks to get used to it.  Don't give up too soon.

Js, don't be frightened to take it.  The dose is tiny and if you're already on HRT you won't notice a thing.  I was 3 years postmeno when I first tried it, so my body needed a few weeks to settle on it.  It's worked wonders for me.  I'd highly recommend it. 

Like you I started to use it so that I could have a smear, but I wasn't on HRT.  If you're already on patches you shouldn't't notice anything.