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[Lamplighter]

Hi all, I am anticipating running into problems with my GP shortly about the number of times per week I can use Vagifem - the consultant I've been seeing has written my GP a letter saying I should reduce the amount to the 'national recommendation' of twice per week - currently this is not enough to relieve the symptoms for which I'm using it  .

I know from reading the posts on here that some ladies use it more often than the usual twice a week, and what I'm hoping for is someone to provide links to any kind of official or authoritative sanction that I could cite to support my case for more often use.

I'd trawl through the posts some more but as I'm speaking to the consultant again very soon (tomorrow evening) and hope to convince her that more than twice a week is ok, I'd very much appreciate any info anyone can give to help me out.

By the way, I am also on systemic HRT - four pumps Oestrogel and 100mg Utro daily - don't know if that makes any difference?

Thankyou 

xxx

[Dierdre]

The NICE guidelines do not say twice a week is the maximum.. From memory they say the dose can be increased by the health provider as necessary. My GP said 5 per week is the maximum he will prescibe, this was on instruction from my gynae. I do manage on this amount plus Ovestin for the outer bits, and would struggle on any less.
Can you google and download the NICE guidelines to quote to your consultant.

The fact your on systemic makes no difference you can use both together, it says that in the NICE guidelines too.

[CLKD]

Your Consultant is completely still in the Ark!  Is he a Gynaecologist?

We are able to take 'vagifem' every night for Life if necessary.  Twice a week is guideline but many ladies can't cope as it isn't enough to ease symptoms.

It makes absolutely no difference as to your HRT regime.  Treatment for vaginal atrophy is independent of any other. Have a read of our thread on VA and print off if your GP is sniffy!  He/she may however, be more aware than the consultant, let's hope so!

[Dierdre]

NICE GUIDELINE 


Urogenital atrophy

1.4.9Offer vaginal oestrogen to women with urogenital atrophy (including those on systemic HRT) and continue treatment for as long as needed to relieve symptoms.

1.4.10Consider vaginal oestrogen for women with urogenital atrophy in whom systemic HRT is contraindicated, after seeking advice from a healthcare professional with expertise in menopause.

1.4.11If vaginal oestrogen does not relieve symptoms of urogenital atrophy, consider increasing the dose after seeking advice from a healthcare professional with expertise in menopause.

1.4.12Explain to women with urogenital atrophy that:

symptoms often come back when treatment is stopped

adverse effects from vaginal oestrogen are very rare

they should report unscheduled vaginal bleeding to their GP.

1.4.13Advise women with vaginal dryness that moisturisers and lubricants can be used alone or in addition to vaginal oestrogen.

1.4.14Do not offer routine monitoring of endometrial thickness during treatment for urogenital atrophy.

[Lamplighter]

Thanks so much Dierdre and CLKD for your replies, and also Dierdre  for going to all that trouble of finding and posting the NICE guidelines (I had no idea where to start looking for that, the NICE guidelines seem to be constructed in such a way as to be Lamplighter-proof  ). 

The consultant (a 'she' by the way), despite listing herself as an HRT specialist, does seem to stick to the 'as little as possible for as short a time as possible' ethos, regardless of symptoms.

I'm having a phone conversation with her this evening and my main concern is actually trying to get my points across - she's not very good at listening and tends to cut me off and talk over me. 

CLKD my GP is actually very accommodating, but as she's not as clued up on HRT as she'd like to be, tends to rely on the consultant's directions for authority, which is why I'm hoping to change the consultant's attitude re the vagifem. 

I left the consultant's office the other day thinking, anyone who arbitrarily says that's 'too much oestrogen' in relation to my being on pumps and prog and the vagifem as well, doesn't inspire confidence in me.   

One day I will get it all sorted and life will be normal again.  As we all hope eh?

Thanks again

LL xxxxx

[Postmeno3]

There may not be time now, but Dr. Currie would make recommendations and offer advice if you can contact her and are able to pay her online consultation fee? Might it be possible to postpone your appointment so that you can do that? I found her recommendations were a complete game-changer with the specialist and took all the angst out of trying to plead my case myself. Just use the CONTACT tab at the top on the black menu strip if you want to go down that route. Alternatively, maybe just saying (if you feel you have a fight on your hands) you'd like to get an opinion from her could swing it. It's so stressful and exhausting trying to assert oneself to the extent that seems necessary sometimes! Good luck!

[CLKD]

Too much is what exactly? 

[Lamplighter]

Postmeno3 thanks for replying and for such a good suggestion - I think however you're right about there not being time, the consultant is due to phone me at 6pm and is otherwise impossible to reach - it takes days to get through to her via her secretary, who only works two and a half days a week anyway 

I will however mention Dr Currie (and the NICE guidelines) and plan on saying that I'll go for other opinions anyway if she stays rigid - in that case will follow your suggestion.  I do hope I don't have a fight on my hands, I'm not very good at confrontation and need to keep this woman on side in case absolutely nothing helps and I need to go back for more surgery.  Not that I have a lot of confidence in her at the moment, so I hope surgery won't be necessary.

CLKD, precisely!  How do you determine without investigating just how much too much is?  She was referring to my using Vagifem more than twice a week, which rather flummoxed me as I'd have thought the pumps would have been more likely to overdo the oestrogen than the Vagifem.

Thank goodness for this forum and you helpful ladies, I'd have been browbeaten into going along with whatever any doctor said to me as they are supposed to be the knowledgeable ones - never mind how I'm left feeling/suffering... 

Thanks everyone   

xxx

[CLKD]

"I've been chatting with people at MM and the general idea is to use "vagifem" or "Ovestin" as often as necessary to keep VA symptoms at bay" might be the way to start?  "Because it is localised it is advised to begin with 10-14 nights then as necessary, some can drop to twice a week, others need it nightly".  ;-)

She shouldn't be strict in the 'little as possible' regime, because we are all different with individual requirements.  She needs to go on a Course to get herself up2date!!

[Lamplighter]

CLKD   

xx

[Lamplighter]

Well, just finished the phone conversation, I ended up having to negotiate - if I lower the number of pumps of oestrogel I'm using, she'll recommend my being able to use Vagifem for five days a week.   

Despite my quoting the NICE guidelines (thanks again Dierdre, had them in front of me while talking) and mentioning Dr Currie and this forum she was adamant that continuing to use Vagifem so often for an indefinite time period would raise the amount of oestrogen in my system to 'above what it should be' - meaning something like someone of my age/menopausal situation (65 and 12 years post meno) shouldn't be taking such high doses of oestrogen, amongst other things because it can cause any one of a number of cancers etc. 

She seemed to think that if you take Vagifem for long enough it ends up absorbing systemically and adding to the amount of oestrogen in your system - for all I  know she could be right .  And only agreed to my negotiations under suffrance, ie not happily. 

Anyone have any ideas about how right/wrong she is regarding Vagifem being exponentially absorbed systemically, and about what levels of oestrogen women in my situation should/shouldn't have?  It's the first I've heard of such an argument that because you wouldn't normally have such high levels of oestrogen in your system at this age, therefore you shouldn't be putting so much in.  It strikes me as chop logic because of course I'm going to have b..... all oestrogen in my system at this age, that's the whole point isn't it ? ? ? ? ?

Sorry, am a bit wound up right now hence the running off at the mouth.  Anyway, it didn't go as I wanted but better than I anticipated so all's well - for the moment!   

LL xxxx

[Postmeno3]

I was told by the specialist that a year's worth of Vagifem is the equivalent of ONE systemic treatment i.e. one patch, one tablet etc. There are very knowledgeable people to approach on here like Joaniepat, Dotty etc. Might be worth a PM? Meanwhile, if you can, it would still be worth contacting Dr. Currie for validation and any future reference. Essentially, your "Consultant" is talking twaddle. I am 69 and plan to grab as much as I can for as long as I can before the "shop" shuts down permanently. I hope you can have a wee treat this evening to reward yourself. You did your best against extreme odds by the sound of it!

[CLKD]

I would send a query to Dr Currie ......... this GP is covering her back without knowing much about HRT at all. !!  We shouldn't have to fight.

My query would be to ask her to send me details of the cancer risks as well as asking her how soon the cancer is likely to occur with the regime you want to follow?   She needs to back her 'thinking' process regarding absorption etc. with research details!  It's no good a GP 'thinking' which might be against current prescription procedures. 

Vaginal atrophy is due to a loss of oestrogen which causes the body to become dry: inside and out.  MayB direct her to "Me and My Menopausal Vagina" book ;-)  .  Many GPs are so certain that they know more than suffers might do  .  I could SPIT! Quality of Life!!!

[Dierdre]

Pleased to hear you got your dose up to 5 per week that should make a lot of difference.  Regarding the amount of estrogen, Vagifem is such a tiny dose, for example 1mg = 1000 mcg.  An average HRT tablet dosage taken daily is 1mg but there is only 10mcg in 1 vagifem. 

[Lamplighter]

Thanks Postmeno3, CLKD and Dierdre for your replies (and continuing support - which I really appreciate, as after my phone conversation with the consultant I ended up feeling like some sort of naughty child doing wrong and being punished by those in authority.  I definitely got the feeling she was pissed off at me for appearing to challenge her and that always makes me paranoid  ).

I shall certainly pursue alternative expert validation - I'm also going to look elsewhere for a consultant/gynae who hopefully has more up to date experience - they may not be able to fix it all, but I could really do with medical support, not dissent.  Shall ask my GP to refer me to the local menopause clinic and take it from there - I have lost what was left of my faith in this current consultant (there are other reasons for that, which were the point of the phone call in the first place, but her attitude about the Vagifem finally did me in.) 

I can understand doctors needing to cover their backs, but not at my expense!

Thank you so much again for your lovely supportive posts, I so appreciate it 

LL xxxx