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[TnToast]

Hi
Can anyone offer any moral support/reassurance/advice, please?

After years of apparently worsening VA I got to the end of my tether and tried Vagifem but the discharge it created made my burning, sore, bleeding skin so painful and even more irritated that I had to stop it after a few days and swap to Ovestin. This as well as other management techniques (no underwear at night, Dermol 500 for shower, YES VM to moisturise etc) has given some relief and I am comfortable some of the time now.

However the skin down below is still very fragile looking and I have what could be a split or an erosion of the skin on one side of the vestibule which is sometimes very painful (particularly after a shower or if I forget to use YES and then walk).

My GP was happy for me to use the Ovestin every night for 5 weeks but then asked me to reduce it and so I dropped to alternate nights and now I am dropping to 3 times a week (I do put a bit on externally every night though). I am wondering if I am likely to continue to improve on this maintenance dose? I don't feel like I have reached a sufficiently healed/comfortable state to be 'maintained'!

Should I try something else now?

The GP mentioned referring me to Gynae if the sore patch had not completely resolved by now, but I know the wait will be long and I wondered what else might help. Or should I just persevere? Am I expecting too much too soon?

It's been 9 weeks in total...

[suzysunday]

In my experience it's a very slow healing process.  I would definitely use ovestin alternate nights for a considerable time, my gp was happy for me to do that.  I also used it externally generously.  It's horrible but it is so slow to heal.  I can't say if this will work with you, and it won't hurt to get checked by the gynae, get booked in if you can.  Keep up with the ovestin. 

[CLKD]

Use the 'ovestin' every night. Sometimes I have to put a dose in during the afternoon as well as at night and gently smear some round the whole vaginal area.  You may be using too many products, does 'yes' help at all?

Your GP needs educating  - her time will come 

You do not need to see a gynaecologist but if necessary ask for referral to a menopause clinic.  Gynaes often don't know any more than GPs seem to!!  Have you read the threads on VA on the Forum?

[TnToast]

Thanks suzysunday - it's helpful to know that it is a very slow process. I was starting to feel worried about it not having healed yet.

Thanks CLKD too for replying to my various posts!

I will take your advice and continue with the Ovestin. I was very sore today after using Ovestin last night but that was after two nights without it....I felt best when I was using it every night. What do you do if your GP doesn't agree though? She is v young. Should I ask for a second opinion from another at the same practice, or do they tend to have a practice policy on these things?

I will ask for a referral to a meno clinic although I don't think there is one locally.

I do find YES VM very soothing and it usually calms things when they get sore if I use some and lie down so it doesnt come out again. But can it dilute the effect of the Ovestin or stop it absorbing properly?

[Jasmine20]

Have you thought of using systemic HRT too?

For me that helped a lot. I'm on Estrogel and Utrogestan. The Estrogel has made my vaginal tissues less reactive and more resilient and this has helped me tolerate the vaginal HRT much more. I am also using Imvaggis as a weaker estriol product and alternate it with a half dose of Ovestin which I could only previously tolerate using externally.

The combination means I'm comfortable now 95% of the time, can wear skinny jeans and walk without burning and soreness. This is a massive improvement from the summer when VA ruled my every waking hour.

[CLKD]

Some ladies do require both as Jasmine20 suggests.  If your GP isn't keen - it's down to ignorance of VA as well as budget constraints - ask to be referred to a Menopause Clinic - not a Gynae!  or print off the snippets from here which shows that some ladies require either vagifem or ovestin nightly in order to keep the condition under control 

It's a learning curve if she's young 

[TnToast]

Hi Jasmine20

Thanks for your suggestion. I did think about systemic hrt (especially as I have recently been diagnosed with osteoporosis too) but am a bit reluctant to try for a few reasons: my Mum's mum had breast cancer and I have had abnormal cells removed, I don't want to upset any balance in mood (I am ok in that respect) or have any bleeding (awful floods in peri). It is the VA I am finding hard to cope with - I agree it just occupies your every waking moment.

I would like to give the estring a go but my GP isn't able to prescribe it. The gynae may be able to but I am expecting a long wait for a referral at the moment. I will look into Imvaggis - maybe that could be used externally with the Ovestin internally?

I definitely need more oestrogen as I used Ovestin for second consecutive night last night (after having previously dropped to every third night0 and I already feel a bit more comfortable. But I have a GP app this week and last time she told me I would have to reduce the number of times per week I was using it - so it's a question of 'how do I convince her?!'

Just seen your post CLKD - great idea about printing off posts but only got phone app this time. I will ask her to take a look at the website (!) and if I get no joy will try a different GP for another opinion. I wondered if they discussed these things between each other and had a policy on what could be prescribed...

[TnToast]

P.S. Meant Imvaggis internally and Ovestin externally of course!

Brainwave! - I could photograph the posts on my phone and upload via econsult so she can see them....

[CLKD]

Some GPs do have meetings to discuss medications and how they might be suiting patients.  Obviously some will be in agreement with medication, others won't be.

Bypass the GP and ask 4 a menopause clinic referral?

[Jasmine20]

The Imvaggis is a pessary made of hard fat but it has fewer excipients for that reason. I think some of the preservatives in Ovestin are the problem for me rather than the estriol but it's so hit and miss! I was thinking of trying the Estriol cream which is weaker than Ovestin.

Jane Lewis has suggested diluting estriol creams with an oil-based product like YES OB lubricant or Olive and Bee to help reduce any stinging or soreness when you start using them. I also reacted to Vagifem and was incredibly sore with an irritated bladder after trying it.

I've used a calendula ointment from Helios homeopathic pharmacy to help reduce soreness - it's got only three ingredients; calendula, beeswax and almond oil. No essential oils which is often added to these products. There's also a version with lanolin instead of the beeswax. Calendula is very soothing and antimicrobial and has skin healing properties. I've used that on my vulva when I was really sore and didn't react.

I quite understand you being careful about systemic HRT. My Mum has breast cancer (diagnosed in her 80s) so I umm-ed and ahh-ed myself. In the end I chose the bodyidentical estrogen and progesterone as they have the best safety profile. From what I understand (and I'm happy to be corrected),  obesity and alcohol intake etc are as likely to increase breast cancer risk as taking HRT.

[CLKD]

Yep.  HRT can really help symptoms: Quality of Life is important.  Is your Mum having treatment Jasmine? 

Calendula ? marigold? 

[suzysunday]

It seems that ovestin is the only hrt you are using  and only for  short time?   I have been using alternate nights for nearly two years now with my GPS advice  and only now experimenting with fewer doses as I am terrified of VA symptoms returning.  It's a battle with some i  know, many writing here about GPS  who think twice a week  for local hrt is enough.   If you are so early in treatment then reducing is not an option if you are sore.

[TnToast]

Thank you so much for all the suggestions.

I will ask for a referral to a menopause clinic and see if the GP will let me continue with the Ovestin nightly or alternate nights until the appointment comes through. I will also ask about Imvaggis. Can that be used nightly? The fact that it is waxy sounds like it would be moisturising. What was the name of the ointment you used Jasmine? I have had a quick look but couldn't find it on the Helios website. I tried the estriol 0.01% cream several years ago but didn't get on with it because you use more than the Ovestin and a lot seemed to come back out creating irritating dampness and it didn't seem to have much effect.

I am only using Ovestin at the moment Suzy, and only for a few weeks, so it's good to hear that your GP was happy for you to use it every other night for two years. I was most comfortable using it every night - perhaps it would have been better to continue that for a bit longer - I have found that the discomfort is creeping back the more I reduce it. Even when using it daily I felt like the comfort wore off by the evening around my sore area.

If all local treatments fail I will try systemic, so thanks for the tip about bodyidentical hrt Jasmine. I have made a note and will read up on that and discuss with dr. Are there any particular brand names to ask for? I do hope your mum is receiving good treatment and doing well.

[Jasmine20]

https://www.helios.co.uk/shop/calendula

Yes Calendula is Marigold. It's found in the 'form' menu as an ointment with the lanolin or beeswax option. You can buy a small pot for £5.95.

Have you tried Olive and Bee? No calendula but also very pure.

Mum is now 95 and doing ok, thanks for asking. As she has heart failure (another reason I wanted to try HRT), she couldn't have surgery for her breast tumour and declined chemo. I think her age has helped as the tumour is less likely to grow quickly or spread.

The bodyidentical estrogen I take is Estrogel and the progesterone is Utrogestan. There's a very long thread in the forum for women taking this combination but it's not the only option by any means. Another combination might suit you better.
Best of luck with your referral.

[TnToast]

Thank you for your advice Jasmine20