OK, so had time to reread the BSSM Position Statement for Management of Genitourinary Syndrome of the Menopause (GSM) I posted earlier & here are some more extracts (with the link again) that are particularly relevant to our discussion & may give further reassurance to anyone who is worried:-
https://balance-menopause.com/uploads/2021/10/GSM-for-BSSM-FINAL-version-with-links.pdf"The frequency of using these preparations can be increased in women who have persistent symptoms as the doses of these preparations are very low."
"Women using vaginal oestrogen – even in the long term – do not need to take progestogens or progesterone or have their endometrial thickness measured."
"after regeneration and cornification of the vaginal skin, increased systemic levels of oestrogen are not seen and they remain below postmenopausal levels."
And this next link is from the BMS (highlight of final point mine). Though it makes no mention of increasing dose beyond the manufacturer's recommended minimum if necessary to control symptoms, it's worth bearing in mind, that with Vagifem the original dose was 25mcg twice weekly, before the reduction to the 10mcg size they come in now, which is why many of us have been given the go ahead to use 5 x 10mcg a week.
https://thebms.org.uk/wp-content/uploads/2022/08/04-BMS-TfC-HRT-Guide-01-AUGUST2022-A.pdf• When vaginal and/or bladder symptoms of urogenital atrophy predominate, vaginal oestrogen alone can be used.
• Vaginal oestrogen may also be required in addition for some women taking systemic HRT.
• Estradiol – Vaginal tablet: Vagifem 10, Ring: Estring (changed 3 monthly)
• Estriol - Ovestin (0.1%) and Gynest (0.01%) creams, Imvaggis pessary 0.03mg, Blissel 50 micrograms vaginal gel
• Tablets and creams should be used nightly for 2 weeks (3 weeks for pessary and gel) and then twice weekly.
Twice weekly maintenance doses can be continued long-term; symptoms frequently recur on cessation of therapy.
Systemic
absorption is minimal and progestogen is not required.Lynne888
My consultant prescribed provera every 6 months for 10 days when I was on vagifem. It gave me a bleed twice a year and shed the lining.
that's interesting your having been prescribed occasional courses of MPA to reduce any lining build up. Can I ask were there unusual reasons for this in your case?
Wx