Im using both, Vagifem 5 times a week and Ovestin is prescibed by gynae every night. I find the Vagifem works better inside and for bladder issues and Ovestin is better for the soreness. Vagifem alone does nothing for me outside and the fillers sometimes irritate the labia, but when I stopped using it and tried just Ovestin my bladder felt uncomfortable and heavy when filling up and needed to pee more. Ovestin sorts the dryness outside and keeps my Lichens at bay. I think ive read on here that the different oestrogens attach to different receptors so maybe we all need both estriol and estradiol to work.
WE don't actually need estriol and estradiol to treat VA - but estriol is the only cream based local oestrogen we have and therefore if women need something for the external areas and Vagifem alone is not working, then estriol is what it is. Either estriol or estradiol (Vagifem tablets) can be used internally.
In fact they do both bind to both receptors. A paper I read and reported about this a while back was over-simplified i think. I just read recently that for both receptors estradiol is stronger than estriol ie has greater affinity than estriol for the receptors (alpha and beta) but when you look at just estriol - it binds with slightly higher affinity to the beta than the alpha receptors from what I gather (even though less than estradiol). It all sounds a bit complicated!
However from this I would deduce that it's not worth using them both at the same time in exactly the same area ( ie both internally) instead - as most commonly used - ie the Vagifem inside and the estriol on the outside and as they don't mix then the estriol should work! if they were both used internally then it sounds like only the estradiol ( in the Vagifem) would bind to receptors and the estriol wouldn't do anything other than provide a lubricant or something like that? Thinking aloud there!
However the dose worked out for estriol to treat VA is whatever is needed to achieve approx the same level of tretament as the estradiol. Ovestin is estriol but more concentrated so a smaller amount is needed to do the same job.
From reading some comments on these forums I don't understand why my Dr won't issue me with both Vagifem and estirol....
The thing is that docs are prescribing extra topical oestrogen ( ie both Vagifem and estriol/Ovestin) off-licence as the licnesed dosage is for either product ( even though the higher dose Vagifem was discontinued) so there is no standard to go by when prescribing both,. The NICE Guidelines made provision for specialists to vary the dosage of topical oestrogens anyway, if the licensed amount didn't work - but it may be that some docs need persuading! If you feel you would benefit and your doc won't prescribe then do ask to be referred to a specialist (not sure what sort of specialist - can meno clinics just deal with VA issues?).
I have both + systemic HRT although the estriol cream was takne off repeat - doc just lets me have it when I ask for it. My use to justify to her is I use it on tampons during the withdrawal bleed otherwise I am very dry.
Hurdity x
