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[Bella247]

I feel like I should start this with a disclaimer - I have really really bad health anxiety.
I’ve been struggling with vaginal atrophy since 2020. First I had estriol which seemed to be really working until January 2023 so the GP switched me to Vagirux which wasn’t that great. I read on here you can also use estriol with it so I was using Vagirux up to 5 times a week then estriol on the vulva twice a week with olive and bee morning and night. That seemed to be working ok but I’m having a flare up of symptoms and it’s making my life totally miserable.

I was worried about lichen sclerosis (and various other things thanks to Dr Google) so I insisted on an examination. The GP said it’s not LS but took a swab and is blind treating me for thrush (which I don’t think it is). She said if the swabs come back not thrush then make another apt for an exam.

I asked her if systemic HRT could help and she said we don’t prescribe it if vaginal dryness is the only symptom. She seemed a bit irate that I’d asked. This really pissed me off because I don’t consider this to be trivial it’s having a massive impact on my well-being, vaginal dryness isn’t actually my only symptom and I’m sure I’ve read some people find symptoms are relieved by systemic HRT. I don’t want to google any more because it makes my health anxiety so much worse. I don’t want anyone to suggest what might be wrong with me. I say this politely because I don’t want to fall into the pit of wondering if I have this that or the other. I just wonder if there is anyone who has found that systematic HRT helped with VA where topical oestrogen didn’t entirely work .

[Dierdre]

I tried systemic a few years ago as local estrogen alone wasn't completely sorting out my atrophy. It didn't make much difference to be honest and I started having bleeds again which didn't help. As I didn't have any other meno symptoms I stopped taking it and instead increased the local estrogen to every night Vagifem and every night Ovestin externally. I still get flare ups mainly brought on by anxiety.
Some on systemic HRT still have to use local estrogen aswell. If you have other meno symptoms then ask for both, perhaps a diiferent doctor might help if there's more than one in your practice.

[Tinkerbell]

I ended up on systemic HRT for my VA, I use Estrogel. When we have a spell of hot weather I always get a flare up of VA and I believe this me not absorbing it so well, it always flares up if I forget my day application of Estrogel ( I split dose 2 pumps day , 2 night) as well. So for me it does help, I also use Vagifem every night and Ovestin cream. I need to throw the whole lot at it to live a normal life!

[Bella247]

Thank you so much for replying. It’s so depressing how little GPs know about menopause and HRT. She is supposedly the one with an interest in women’s health. Another GP practically shouted at me when I suggested the vile metallic taste in my mouth was related to peri menopause. I really try not to google because when I had therapy for health anxiety I agreed with my therapist not to and not googling does help but GPs make it impossible when it comes to menopause because they seem so ignorant.
Can I ask you specifically which systemic HRT you’re on and how long it took to work on the vaginal dryness?
I know just what you mean. Vaginal dryness is debilitating and to have it described as “only” is infuriating. They honestly act like if you’re not having hot flushes you’re wasting their time or trying to pull some sort of scam on them.

[Bella247]

Oh sorry I mis read that and thought you meant it helped. The VA is really affecting my sleep because it’s making me anxious

[Cara999]

I tried systemic HRT to see if it helped my VA. I di have other symptoms of menopause but nothing too bad that I would have tried HRT except for VA  it made no difference to me, I didn't feel it was helping and brought on other side affects, like headaches, monthly bleeds etc so after about 6 month's I stopped. It may help for you, it does for some women. VA is awful, constant battle. Best of luck 🥰 xx

[Julia Dizzy]

Hi Bella247,
I've found the combination of systemic HRT and Vagifem have really helped my VA which I had terrible problems with at the start of the menopause. So much pain and UTI's before.
 
I have been on Vagifem for about 5 years now ( I use one every other night) - and am on Estrogel (just increased to 3 pumps a day to try and help anxiety...) and Utrogestan 100mg orally every night, which I have used since 2019.

It's taken a while and while not perfect, is so much better. Hope you find the right path for yourself. x

[Elizabethlovejoy]

Yes it really helped with mine which was debilitating. I am now on 4 pumps Oestrogel utrogestan vaginally every other day plus androfemme. I also use vagifem every other day.the androfemme proved to be the final key for me in getting my bladder symptoms back to normal, which surprised me as it was added to help with fatigue! But apparently there are testosterone receptors all around the bladder and vagina- who knew?!
Best of luck resolving your symptoms.

[Ana21]

Hi Bella247!

"Traditional menopausal hormone therapy or MHT is only effective about 50 percent of the time for GUSM as the resulting levels of estrogen are often not high enough in the vaginal and vulvar tissues."

If you want to read more, these are excerpts from The Menopause Manifesto by Dr. Jen Gunter:

"Vaginal estrogen is considered the gold standard for GUSM, meaning that of all the pharmaceutical and over-the-counter options, it’s by far the most well-studied and effective. Another hormone called dehydroepiandrosterone or DHEA is a recent addition to prescription vaginal therapies for GUSM. DHEA is one of the hormones in the process that converts cholesterol to estradiol (see chapter 3). DHEA doesn’t have any direct effect on tissues itself; it’s useful because it’s converted inside the cells into testosterone and estrogen. Vaginal estrogens and DHEA increase blood flow, reverse tissue fragility, restore lubrication, and repopulate the vaginal microbiome with beneficial bacteria. They’re effective at treating vaginal dryness, vaginal itching, pain with sex, and may help with changes in odor.
         
Traditional menopausal hormone therapy or MHT is only effective about 50 percent of the time for GUSM as the resulting levels of estrogen are often not high enough in the vaginal and vulvar tissues.  As there are greater risks with MHT (albeit those risks are small) compared with vaginal therapy and MHT is only helpful approximately half the time, MHT is not recommended for the sole purpose of treating GUSM. However, a woman starting MHT for other reasons, for example hot flushes, may wish to wait two to three months to see how that therapy helps her vagina and vulva before deciding on adding other approaches."

"Vaginal estrogen comes in a wide range of doses as well as methods of application, including creams, a vaginal ring, vaginal tablets, and vaginal suppositories, so customization to an individual woman’s needs is possible. Vaginal DHEA is a vaginal suppository and is available in one dose."

"Vaginal hormones haven’t been studied head to head (or perhaps vagina to vagina?), so it isn’t possible to say product A is superior to product B. Pharmaceutical companies rarely put their product on the line with a direct comparison to a competitor—what if their product comes out the same or inferior? Consequently, we typically only see studies from drug companies that compare their results with placebo, and almost always these results show benefit. When independent researchers with funding from non-Pharma sources look at pharmaceuticals, their results are not always as impressive. For example, when the 10 mcg estradiol tablet was studied by independent researchers, it didn’t perform any better than the placebo moisturizer. It’s unknown if this is formulation-specific (some women report the tablets don’t always dissolve well) or if there is another reason."

Hope you find something that works for you soon.