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[Jules]

Right, that's concerned me with the frequency I use and placement. What the heck do you do?

[Wrensong]

CLKD, that's why we were trying to thrash it out in Ann B's thread.  But what we found ultimately seemed reassuring & I think the take home is in the extracts towards the end of my last post above:-

"Certainly, after longer-term vaginal estrogen treatment (12 weeks, 83 or 84 days, 52 weeks), levels of circulating estradiol were similar to those at baseline or with placebo"

"CONCLUSIONS
Our review of systemic absorption of estradiol with use of low-dose and ultralow-dose vaginal estrogen therapies found low to negligible amounts of circulating estradiol that may be influenced by product formulation and vaginal placement."

Wx

[Jules]

Out of interest, and considering the change of advice, how many women on here are using more than twice a week and how many using externally too? Am I in the minority?

[Wrensong]

Jules, I use Vagifem 5 nights a week with the weak 0.01% Estriol cream externally (& systemic HRT).  I can't get by with less.  I think the general medical consensus is that vaginal oestrogens are very safe for long term use, but I'm not sure what the answer is to minimising initial systemic absorption in terms of the loading phase.  We wondered on Ann B's thread whether avoiding consecutive nightly use for 2 weeks as is usually prescribed might simply prolong the duration of systemic exposure as that would likely mean it would take longer for the condition of the vaginal mucosa to improve to the "barrier" stage.
Wx

[Jules]

Jules, I use Vagifem 5 nights a week with the weak 0.01% Estriol externally (& systemic HRT).  I can't get by with less.
Wx

Similar then but I'm not on systemic HRT. It's hard to get the balance isn't it.

[Wrensong]

Agreed Jules & as others have said it seems to be quite individual how much we need on a long term basis.  I actually feel better using both vaginal preparations every night, not just 5 nights, but my systemic oestradiol levels have been quite low (poor absorption) so that won't have been helping GSM symptoms.  Actually my last post to you was misleading & should have said Vagifem 5 nights a week, Estriol cream externally every night.  I used to have 2 nights free of both but have fairly recently begun using the cream every night.

I'm really sorry if the links & extracts worried you Jules, it absolutely wasn't my intention to alarm anyone.  I'd just hoped the articles would help explain why we get some initial systemic absorption & give pointers re placement to minimise any possible effects on the uterus given jorainbow's situation.
Wx

[Ayesha]

Wrensong thanks for this information, I was looking yesterday for latest research on the use of topical oestrogen.
I use Vagifem every day with Ovestin. I remember reading an Australian research paper where it was recommended not to place the Vagifem pessary too high up to prevent it going systemic but from reading the research you have posted, once the body has healed enough the systemic effect becomes less and less.

Anyway, its reassuring reading as far as I am concerned and the benefits of Vagifem/Ovestin far outweigh the horrible symptoms of VA which I found impossible to live with.

Ann B's thread 
https://www.menopausematters.co.uk/forum/index.php/topic,66941.0.html

[Wrensong]

Ayesha I'm glad you found it helpful/reassuring.  I think the majority of women have no need to worry at all, it's just in special circumstances where we are rightly asking sensible questions I personally like to look for research to help me become more informed.
Wx

[CLKD]

 

[Wrensong]

Ayesha, thank you for linking Ann B's thread.  I'm not sure how coherent it is as I believe some posts from around mid-Aug are missing, lost during that period when there were server problems.  I didn't reread the whole thread this morning, but remember being dismayed that some stuff I'd posted with links that had taken some time to compile was lost!
Wx

[Jules]

Its quite ok. It's useful to know and I might stop pushing the pessary so high. I've been using vagifem ir equivalent for over a year now.

[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.

[Bindi]

Hi guys i found this thread interesting as ive been useing ovestin for over a year now thankfully with my gynos blessing for every 2nd day.which is working for me. I do agree with the application queries as i find if i use the applicater i get lower back pain i think from the higher insertin but systemically  it last longer i can go 3-4days without ovestin.
If i use with finger insertiin just inside and outside ive found to be alittle more comfortable if that makes sense no lower back pain..ovestin for me i can honestly say has been a god send for my aches and pains ,headaches,and bladder issues.My gyno has done tests and said we are all different and there is no real proof of damage being done from this low dose  so im happy with that for now.im 60 and on nothing but ovestin but for now that suits me 🙂

[Ayesha]

Ayesha, thank you for linking Ann B's thread.  I'm not sure how coherent it is as I believe some posts from around mid-Aug are missing, lost during that period when there were server problems.  I didn't reread the whole thread this morning, but remember being dismayed that some stuff I'd posted with links that had taken some time to compile was lost!
Wx

Yes I remember now when the site went down and a number of posts disappeared which was very frustrating as a lot of good information went with it.
It's good to keep looking out for the latest research as knowledge is power and hopefully posts in Ann B's thread will still be helpful.

[Wrensong]

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