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[Hurdity]

I have never used Ovestin but I have Vagifem and estriol cream (used to be Gynest but now generic). Vagifem contains estradiol (the main oestrogen in our bodies), whereas the other two are estriol - with the Ovestin being 10x the strength of the estriol meaning you use less.

In my opinion (which is immaterial now) the best vaginal oestrogen treatment was (?were) the discontinued Orthogynest pessaries which CLKD referred to. This was because the estriol was contained within a hard waxy pessary - easy to insert and gently oozed out providing less messy lubrication as well as plumping. As you can see from here some of us use Vagifem for plumping up the tissues internally and the cream for the outer areas and vaginal entrance. Unless you have very bad VA if you go down this route (ie two products) I would say the estriol cream is better  (than Ovestin for the external bits) as can be used much more liberally - being weaker.

As I've written elsewhere the two types of oestrogen target different receptors in the bladder/vagina. Estradiol binds to both oestrogen receptors but estriol only weakly to the alpha receptor and mainly to the beta receptor.

Unfortunately the paper I used to refer to about all of this no longer works at my link so is no longer freely available so this is all from memory.

Some people say that Vagifem is stronger than the estriol creams but from what I've read, although estriol only binds weakly to the alpha receptors, the doses have been calculated so that they are each equally effective (approximately) in treating vaginal atrophy.

If you are going to use just one product, I would say therefore it's a matter of preference -  the messier creams with the applicator that has to be washed each time, or the easy to insert tiny tablet (Vagifem). I would actually ask for both - the generic estriol (for outer areas) and the Vagifem - and then you have the option of trying the cream internally as well.

When I was in late peri-menopause like yourself I was prescribed the estriol pessaries for a few months until I eventually went on to HRT and stopped the pessaries, and then later re-started these too until discontinued when I swapped to Vagifem ( personally couldn't be doing with washing and loading an applicator!).

The amount of systemic absorption is minimal and if you still have high oestrogen you really should not notice any side effects, unless you are very sensitive to the fillers.

Hurdity x

[Dorothy]

I use Ovestin, mainly because by the time I was diagnosed, it was too painful to insert an applicator and with the cream, I could start off applying it outside and gradually apply it further in as the pain eased.  Something to bear in mind if you do find an applicator too uncomfortable when you try it.  I don't find the applicator difficult to wash but never having tried Vagifem, I've nothing to compare it with.

[CLKD]

That's the preparation Hurdity and really sorted my 'razor blade' feelings.  Ovestin1mg works well too.

[Elizabethrose]

Hi ladies, so sorry for my late response, nightmare mig today!.

Thank you all so much for your responses and for taking the time to post. Ironically today all feels calmer: interestingly I had used Yes for the past 3 days and I don't know whether I reacted to it. Used a blob of Sylk this morning instead. Whatever the case I'm going to educate myself, taking on board all of your help and advice and go see a GP. The stories of VA on here should not be ignored and with my ridiculous reactivity to hormone change who knows what I have in store next! I am not producing any vaginal mucus at the moment so that in itself needs to be considered.

Sweetscarlett Thank you for your comment, I shall consider the use of both, I hadn't realised that was a possibility. I've never heard of Hydromol so will look in to that too x

CLKD Thanks CLKD, all these little tips are invaluable! x

Maryjane Oh Maryjane, your experience sounds just like mine, what a bloody nightmare. I didn't have big babies but my first was stuck in my pelvis and they didn't realise even after a 3.5 day labour. They had to rip him out as he was in trouble but thankfully managed to revive him after about 12 mins. All nightmarish but we were very very lucky that he survived. It rather took my mind off of my savaged body! What you must be going through, I'm so very sorry for you. Thank you for the comprehensive detail and advice, I hope your body continues to mend x

Annie Thank you for the further detail, the more info I can acquire the better informed I shall be. Good luck to you, it's seems like you've had a real battle. x

Hurdity Thank you for your very detailed advice: you've rather blinded me with science and the brain is addled today so I'm trying to take it onboard. As I understand it, the estriol cream is weaker than the Ovestin, which I suspect may better suit me as I don't yet appear to have a problem externally aside from sudden dryness. I will consider combining this with the Vagifem. I am very sensitive but of course won't know whether I will react until these things are tried.

Your comment about the oestrogen receptors is very interesting: I am going to look into this further. You say your link no longer works but if you have posted this info previously I may find it with a MM forum search, I'll give it a try.

For the past few years some of my oestrogen surges have been through the roof, these cause immense problems for me. However, it appears that they are becoming less frequent and less intense, and I've been on a low for the past 2 months. Unfortunately even minute doses of added hormones have affected me in the past but hopefully this will be less likely with my own hormones removed from the equation. I can but try. x

Dorothy Thank you Dorothy, I'm sorry things weren't sorted out early enough to prevent you from experiencing the pain. I shall consider your advice re the applicator with Vagifem. x

[ancient runner]

Can I suggest the Estring if you think you might react badly to the fillers in Ovestin or Vagifem?
It's a silicon ring impregnated with enough oestrogen for three months, when you replace it. It sits happily in place and you cannot feel it.

[Elizabethrose]

Hi ancient runner

Thank you for your suggestion. I know nothing about this so will google and check out the MM links. How high does it sit, can you feel it? After my first labour, tampons were never comfortable again. I tried and tried but in the end had to just use pads. Before I flood you with questions I'll research it and return to you if I may? x

Have any of you other ladies used the Estring?

[CLKD]

Have a 'search' - it rings a bell.

[ancient runner]

Hello again ER
I can't feel it but looking back I might have been conscious of it to start with, when I was probably sore anyway. That phase didn't last long. I think there are quite a few on here who use it - there have certainly been discussions about it.
Good luck with the doc.

[Hurdity]

I don't think this was the reference I was thinking of (it was a few years ago now) but it does explain about estriol and beta receptors and I see i referred to it in 2013:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3003469/

I really doubt whether you would be affected by the very small amount of oestrogen (estradiol) from Vagifem - mostly any initial effects from systemic absoprtion would be more likely in women who had very low oestrogen, and in any case after the first two weeks systemic sborption is minimal. I think you mentioned Premarin in your original post - well that is totally different and as you know a mix of very strong horse oestrogens taken orally. There is no comparison between what any woman would feel taking this (orally) in early peri, and vagifem (vaginally) in late peri! That's not to say you won't, but less likely and the effects would settle unless you are extremely sensitive to any exogenous hormones (introduced from outside the body).

Hurdity x

[Elizabethrose]

Thanks for searching that out Hurdity, I will read later.

The Premarin I was prescribed many years ago, was a cream used vaginally. I almost immediately developed abdominal cramps, spotting, constant headache, nausea, bloating, painful breasts and excessive, desperately excessive underarm sweating. It was stopped after 3 weeks and all symptoms disappeared. Nick Panay and Anne MacGregor did not seem at all surprised by this. I had the same reaction and more, to the contraceptive pills tried in my twenties and indeed the HRT tried to treat the migraine.

I can't know until I try what reaction, if any, I would have now to exogenous hormones.

Thanks for your response x

[Elizabethrose]

Thank you all for your advice: I went to my GP today and I'm going to start with the Vagifem. I'm very lucky in that she is one of Nick Panay's team so is terribly switched on. Given my disastrous previous experience with HRT, it was felt one product should be started and then adjusted or other things added as is necessary. I'm going to either call in a repeat script in 3 months or see her at any stage if nec.

Thanks again for your help ladies x

[CLKD]

Well done.  Let us know?

[Elizabethrose]

Thanks CLKD, will do! x

[Hurdity]

Heavens re the Premarin cream - I didn't even know that this was ever available in this country - I think it still is used in US. Have just looked it up and it was only discontinued in UK in 2010 - I'm glad I was never offered it - wouldn't want to be putting horse oestrogens on my bits   

Hope the vagifem does the job.

Hurdity x

[Elizabethrose]

Thanks Hurdity. It was prescribed by a dinosaur GP about 20 years ago when all else was failing at treating thrush caused by ABs. My reaction was a violent one. Another GP had a hissy fit when she found out!