Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[Jules]

I've been using vagifem alternate nights and ovestin nightly externally.  I've had right sided breast pain for over a week and had some brown blood staining last night. I'm sure its the topical estrogen.  I understood very little gets into the system but it must be doing. I'm 66 and havent had periods for donkeys years. I've had panic all night. I last had a scan in autumn and uterus lining was "nice and thin". This has scared me though.  I want to stop using it but I was wasting away so darent stop

[Hurdity]

Hi Jules - sorry to hear about the blood staining. How long have you been using it? When you first start using it then because the tissues are thin more does get into the system, but once your tissues have plumped up - which can take a few weeks, then less is absorbed and (on average) stays within the post-menopausal range according to research. I don't think there is research into estradiol and estriol being used at the same time (unless recent) but both work on the receptors in the vagina. So you may well be exeriencing a slight effect from initial absorption of estradiol, and this should settle soon. There is no evidence to suggest that there is a risk of endometrial thickening from using vaginal oestrogen at licensed doses.

Also when first used, if tissues are thin, some bleeding or spotting can occur from physical trauma to the tissues ie from inserting the applicator, and this should also settle.

However if you are concerned about any bleeding, you should consult your doctor, but please do not panic! There is no need to stop using it!

Hurdity x

[Jules]

I've been using it for about 18 months but increased the dose in Sept. I've got an appointment in the morning but have been told to stop the vaginal estrogen as its likely the cause. So what now? I'm so upset

[Hurdity]

There should really be no need to stop vaginal oestrogen!!! OK then it is not due to trauma of the tissues if you've been using it for 18 months. The point is, the docs should investigate what the cause is, not just say its due to X, so stop.

That exact argument was used in my case with systemic oestrogen - 10 years ago. I had some spotting so the docs said: stop HRT and if the spotting stops or doesn't occur again, then that's the cause! So what?!!! I had an e-mail consultation with Dr Currie who said I didn't need to stop HRT pending investigation, took this back (to a different doc in the practice) and said I wasn't going to stop, but that they could investigate the cause - and thats what happens. They didn't find the cause anyway....and I'm still on HRT....

If you can I would be firm, and say you need the vaginal oestrogen, and as you have had abnormal spotting, you would like this investigated, but you are not prepared to stop due to your own vaginal health, comfort etc. There are all sorts of resons for the spotting and they need to determine if possible what is causing this. If by some remote chance you do have endometrial thickening - due to the dose you are using - then if the worst came to the worst you could take a course of progestogen to thin it down.

Please don't give up, but I realise how difficult it can be sometimes working with the medical profession, if they are not completely up to date with current thinking.

You couls always have an e-mail consultation with Dr Currie and see what she advises in this situation? https://www.menopausematters.co.uk/contact.php (£30) - but this won't be in time for tomorrow.

Hope this helps and all the best with your appointment. Do update us on this thread and let us know what happens.

Hurdity x

[Jules]

The thing is, I was led to believe localised estrogen was safe and hardly any got in the system. So that's a worry. I've never been able to contact Dr Currie, she closed her appointments down due to workload. I'm going to suggest a lower dose and go back to twice weekly which seemed to be ok and reduce the nightly ovestin to less frequently.  I really am fed up of health problems.  It's been one thing after another this last year and I feel so weighed down with it that I've no motivation to do anything

[Hurdity]

Hi Jules

There is no evidence to suggest that vaginal oestrogen is not safe, and research has been carried out into systemic absorption, but to reiterate that as far as I know there hasn't been research carried out into both estriol and estradiol being used long term - and that the rationale is based on the fact that all the research carried out shows very little systemic absorption. Nevertheless, surely it is worth finding out what might be causing the spotting, so that you may be able to continue as you have done, with ovestin and vagifem, without worry?

According to this MM website the e-mail consultation is available - there is usually a notice when it is closed temporarily - but I might be wrong about that....

So sorry to hear that this is affecting you mental health. In terms of the vagifem - the old max licensed dose was  2 x 25 mcg per week which is 5 x 10 mcg tablets, - it was only reduced because research looking into the minimum effective dose, demonstrated that the 10 mcg dose was effective in something like 2/3 of women (that figure might be wrong - but you get the idea). Therefore it is not going to be effective for the remainder - hence some women are offered daily Vagifem or alternate day etc.

I do hope you are able to resolve this so that you are able to continue your life without this worry.

Hurdity x

[Jules]

I've just checked, she isn't taking anymore questions. It's been like that for quite a while. I don't understand the difference between the two types of estrogen you mentioned. In increasing the dose I may have caused this. Funnily the breast pain has improved greatly but I'm going to ask for a check. Originally when I started vagifem I had 2 episodes of blood spotting and was told to stop. I had an examination and scan and everything was fine but it scared me and I didn't restart using it until things got worse, sex became painful so I started again.  Then I got breast pain and was told to stop to see if that was the cause. The breast pain stopped but could have been coincidence.  It's always right sided pain. So I started again. Last year I had some pelvic pain and saw a bit of blood on the applicator so I had another exam and scan and was told the uterus lining was fine. But at the examination the GP told me the vaginal lining was thin and also noted vulval atrophy. She remarked as though its just what happens with age and didn't offer any solutions. I was basically wasting away. She did say i could use vagifem every night if i needed to and that its for life as i would keep getting UTIs. I started using ovestin though after reading accounts on here and increased the vagifem to alternate nights last September.  Both have made a difference but perhaps I've been using too much. I definitely can't manage without so I will ask about trying reduced dose. I have no pain or discomfort down there. But in the last year I've had flu, endless colds, a painful knee problem,  bereavement and diagnosis of oesophageal disease. This is in addition to family health things. I'm desperate to get away for a break but I expect I'll now be waiting for a scan again.

[Jules]

I've had a doctor appointment.  Examinations fine. She said the guidelines are to stop vaginal estrogen for 6 weeks, if no bleed in that time it can be resumed. I've agreed 4 weeks and after that she will check again and I will revert to twice weekly as she thinks the frequency was too high. Vagina well estrogenised apparently, a lot better than the last exam. Won't be after 4 weeks though but I'm going with her recommendation otherwise if I have more bleeding it will skew things. I dont need a scan as i had one in autumn. If I have more bleeding I will need a referral. I'm pretty fed up but she thinks I'll be ok for that time. I'm going to use some internal until then. Any suggestions? I can continue with ovestin externally.

[Dazedandconfused]

Sorry to hear you're suffering Jules, it's such a worry.  Good that the examinations are all fine though.  Are you on any other HRT?  I'm asking as I had bleeding and very sore boobs a year after starting HRT. (I was late to the party as I'd had my last period over seven years beforehand but never been offered any sort of HRT until I was 60).  I was fast tracked through the system for bleeding and thoroughly checked out, my thickened lining was because I wasn't absorbing the Utrogestan well.  I ended up having a Mirena fitted.

Re the Vagifem, I upped my dose to every other day after reading several posts on here to see if it could help with some stress incontinence, which I had despite pelvic floor exercises.  It does seem to have helped a lot but I was only prescribed enough for two doses a week so was buying Gina over the counter.  I spoke to the menopause nurse who was happy to change my prescription so they didn't have a problem with that frequency. 

However, when I when to collect it, the pharmacist said the dosage on the prescription - three times a week - was unusual and he thought it should be two times.  I explained this had been agreed by the surgery and he let me have it.  I understand they have to check but it did panic me a bit, thought he might stop me having it.

I hope you get sorted soon and can get back into the routine and feel better, it's such a juggling act this menopause business, isn't it?

[Jules]

No I'm not on any systemic HRT.  So she thinks it's due to me increasing the vagifem and if there's bleeding the guidance is to stop for 6 weeks to see if that resolves it. I'm not stopping for so long as my VA will regress but I'll have to try for a bit because otherwise if I get another bleed we won't know. I think id have had a scan if I hadn't had one in autumn. I've been really down today as I felt I was getting somewhere and also the examination was really painful until she used the right speculum so I've felt shake. I'm grateful that she squashed me in though and did spend time listening to me, and keen to help especially about health anxiety. Clearly though estrogen gets in the system even from vaginal estrogen.

[Dazedandconfused]

Glad you were listened to but sorry the exam was painful and stressful.  I can totally understand why you're feeling down  Sending big hugs and hope you're feeling better soon. 

[Hurdity]

Sorry to hear you had an uncomfortable time. I understand you want to go with the doc's recommendations and pleased to hear your vagina is well oestrogenised but if you stop for 4 weeks, when you restart then I would definitely do the pre-loading dose which is daily for the first two weeks and then reducing to the maintenance dose.

Incidentally there is another product which isn't talked about much on here - the Estring -  a ring you insert and usually leave in ( except maybe removed for sex?) which releases a higher dose of estradiol directly to the vagina, and you wouldn't have the trauma of inserting an applicator all the time? It's listed here: https://www.menopausematters.co.uk/dryness.php

I hope the bleeding stops - it seems odd that she wasn't going to investigate the cause!

Good that you can continue with the Ovestin

All the best

Hurdity x

[Jules]

Thanks everyone. She seems to think the cause is due to increased dose of vaginal estrogen. As everything was normal on examination and its just been one small bleed and my pelvic scan was normal in October she decided further investigation wasn't necessary unless I have another bleed and that if I don't over the few weeks, she will have another look and I can restart on the twice weekly which wasn't really enough but better than none.

[Jules]

I'm kind of worried now that she's not at least arranged a scan. Something else to worry about

[Jules]

Ive posted an update in another thread on the post meno forum

Had my scan, everything in uterus is ok so I was given the option of a vaginal one, she found a tiny thickening on the inside of the cervix wall, so small she couldnt even label it a polyp, she didnt think it was anything more serious, I already have a doctor appointment tomorrow so she is forwarding the report to discuss. She did initially think the bleed was hormonal with the estrogen. She said the thickening could just be a lumpy cervical canal as vaginal estrogen can cause that. I am going to ask for a smear at least and I will see what else is advised.