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[PattyRh]

Hello, my first post here😁 I am an almost 65 yr old lady, last period was longer ago than I can remember . I was on a mirena coil for years before that too.
Two weeks ago my GP started me on Ovestin cream, once a day for sore, dryness etc . Then just three days ago I started spotting blood and had what could only ne described as mild period pain.
Of course I stopped the cream straight away , saw a different GP yesterday who said Ovestin isnt great for ladies of  “my age” . She has booked me in for an urgent scan next week. Should I be worried ?  No symptoms before this and stomach pain now stopped since stopping cream 

[CLKD]

No need to be worried at all.

Which info is this particular GP relying upon?  She is ageist with no knowledge of Vaginal Atrophy treatments.  I would continue with the treatment, go for the scan to give me a base line and then see another GP.  Is there a Nurse Practitioner with more knowledge than the GP?  I suggest buying "Me and My Menopausal Vagina" written by a Member of the Forum: read and pass to the Practice Manager for everyone to read!!


Which symptom did U discuss with the GP?   

As oestrogen levels drop the body may become dry: inside and out; scalp, skin, deep in the ears, nostrils, lips, vagina ....... as well as muscles may become lax = aches and pains.  If the vaginal skin is thin it may well bleed on contact with the applicator.  The idea is to insert every night for at least 2-3 weeks.  I have never had problems with this, also I smear a little 'ovestin' around the labial area twice a week to keep it from itching.

 

[PattyRh]

The GP I saw who said it wasn't  good for ladies 65 and older is a menopause specialist , we did discuss my symptoms really in depth and for ( fatter) women of my age the risk is higher . The fact that I-reacted so badly and so quickly was a deciding factor too.
She has supplied me a good moisturizing soothing wash, and we will discuss again in two weeks after my scan.
I trust her, shes a gynecologist specialising in older women & menopause. 

[Jules]

The GP I saw who said it wasn't  good for ladies 65 and older is a menopause specialist , we did discuss my symptoms really in depth and for ( fatter) women of my age the risk is higher . The fact that I-reacted so badly and so quickly was a deciding factor too.
She has supplied me a good moisturizing soothing wash, and we will discuss again in two weeks after my scan.
I trust her, shes a gynecologist specialising in older women & menopause.

I use Ovestin every night. I'm 66. Nobody has mentioned it to me. Did she explain why?

[PattyRh]

Basically the older we get the higher the risks of thickening of the lining therefore possible abnormal cells. The risk is also higher the more overweight you are-too. ( and I am) monitoring should be more frequent .

[Tinkerbell]

The meno specialist I saw said that using topical estrogen every day was the same as taking 2 systemic HRT tablets a year. As you have only used Ovestin for a short while it wouldn't have caused any womb lining build up. If VA is untreated that can cause bleeding.

It is good you are being referred for a scan though.

[sheila99]

The amount of ovestin that gets into your bloodstream is so little it's normally considered safe to use even for those who've had oestrogen receptive breast cancer. I'm 63 and on systemic hrt, there are some on here in their 70s and still on it. It's good to have the scan but I think it's more likely to be from va or irritation from ghe applicator than anything sinister. Good to put your mind at rest though. If the scan doesnt show anything I woukd try again, it's unlikely a soothing wash will be a satisfacrory long term solution. Without oesteogen it's likely to get worse.

[Jules]

I had spotting last year, I had a scan, the lining was fine. Think as some said I'd either got scratched myself or a bit of thinning inside. I've had nothing since. The atrophy before use would have been bad by now had I not used anything.  I was wasting away inside and out.

[CLKD]

is a menopause specialist   R U in the UK ?  because that is I believe contraindicative of general advice!  Is this particular GP self certified as a 'menopause specialist' or is she registered as such, i.e. has she been on various Courses? 

Sadly gynaecologists aren't always au fait with menopause.    because Obs and Gynae are totally different specialities.  I would be asking for her references to Papers etc and knowledge.

Do check with the British Menopause Association and let us know. 

[GypsyRoseLee]

That GP is absolutely wrong. Ovestin is exactly what older ladies should be using. My Mum managed several nursing homes and so, so many of the female residents suffered terribly with vaginal atrophy, UTIs, weak bladder etc because HCPs didn't bother to treat their symptoms with local estrogen.

[Jules]

That GP is absolutely wrong. Ovestin is exactly what older ladies should be using. My Mum managed several nursing homes and so, so many of the female residents suffered terribly with vaginal atrophy, UTIs, weak bladder etc because HCPs didn't bother to treat their symptoms with local estrogen.

I can imagine that after seeing how I was heading. Such a shame.  I sometimes wonder about my mum. She's odd about what she'll wear. She'd never say though

[Ayesha]

PattyRh, I have to agree with all what the other ladies on here are saying, the advice given to you is absolutely wrong and if Ovestin is not suitable for you why not try Vagifem pessaries, all very safe methods of treating vaginal atrophy because if not treated you will end up with severe symptoms from this horrid condition.

I am exhausted from a recent house move but felt I had to comment here, can't believe what this meno specialist has said to you!

[CLKD]

PattyRH:  Basically the older we get the higher the risks of thickening of the lining therefore possible abnormal cells. The risk is also higher the more overweight you are-too. ( and I am) monitoring should be more frequent .

I wonder why does this particular GP suggest that the lining will thicken as we age, when the loss of hormones stops periods  ?  If a GP is concerned then regular scans can be arranged to measure the depth of the womb lining. 

Sometimes gynaes think that they know more about menopause than they really do!!!!

[Ana21]

Hi PattyRh!

I hope your scan rules out anything concerning and you're able to resume vaginal estrogen.

Regardless of whether you choose to use Ovestin cream or Vagifem pessaries or both, you may want to ensure that you place the estrogen in the lower-third of the vagina, rather than pushing it up as far as it will go.  That's not necessary.  In fact, it's not desirable in post-menopausal women.

“First uterine pass effect” means that more estrogen will reach the uterus if estrogen is placed in the upper third of the vagina.

"The study demonstrated that the vagina to uterus preferential distribution of E2 takes place if E2 tablets [ie Vagifem] are placed in the upper third of the vagina but not in the lower third. Therefore, for improving endometrial maturation in premenopausal women, vaginal E2 tablets should be placed in the upper third of the vagina; whereas for treating postmenopausal vaginal atrophy, E2 tablets should be placed in the lower third of the vagina to minimize the risk of endometrial hyperplasia."

If you're using Ovestin internally, it's not necessary to use the applicator.  I'll post a link to instructions with diagram, as well as copy them here:

How do I apply vaginal estrogen cream with my finger?

1. Wash your hands with soap and warm water.

2. Remove the cap from the tube and apply a pea-sized amount of cream onto your finger (enough to cover atleast ½ of your index finger).

3. Find the vaginal opening. Immediately above the vaginal opening is the urethra (a small opening where urine comes out when you urinate). The urethra may not be as easy to identify as the vagina because the opening is much smaller; however, use the diagram to determine its approximate location.

4. Spread the cream into the vaginal/urethral area. As the cream is spread, make sure to cover the urethral opening and just inside the vagina as this is where most estrogen receptors are located. It is not necessary to push the cream high into the vagina.

5. Wash hands with soap and warm water.

Vaginal Estrogen:  Information and Instructions
https://www.med.umich.edu/1libr/urology/EstrogenVaginalCream.pdf


While you're applying the cream, ensure you also apply some to the labia. Low estrogen level, chronic irritation, and inflammation can cause labial adhesions/fusion.  The clitoral hood can also develop adhesions.  Spread that cream around!

Keep us posted on your scan results.