Ovestin cream

[bananaskin123]

Started using this about 10 years ago when I saw a urologists. She prescribed it for post meno symptoms of extreme dryness, soreness and some bleeding. Managed without for quite sometime but in the last four years or so have had quite a few courses. It has really changed my life. Originally I thought I had cystitis but once I started the Ovestin all my symptoms disappeared. Its quite a long course over more than three months then I believe you are supposed to stop for two months before recommencing. I spoke to my GP regarding this and she has said there could be a slight risk of cervical cancer if you used continually but may be I should use it just once a week after I had completed the course as a top up. Don't want to take the risk but also I know if I stop for two months all my symptoms will come back in about the first month.

Just wondered if anyone else uses it continuously or maybe know of another treatment which is just as effective but can be taken long term.

Current thinking (by leading menopause specialists) and statements from academic menopause societies is that you can take vaginal oestrogen indefinitely - although there are no data on long term use.

As far as I know there are no data that suggest there is a risk of cervical cancer from vaginal oestrogen. Most women being prescribed any vaginal oestrogen use it without a break and with the sanction of their doctor. There is minimal systemic absorption as the dsoe is so low.

Vaginal atrophy and associated bladder symptoms are due to long term oestrogen deficiency and can't be "cured" in the way that some conditions can be cured by medication. As you have experienced, the symptoms will return on cessation of use.

Many women (myself included) are on systemic HRT as well as vaginal oestrogen long term - in order to remain comfortable down there - and I am in my 60's.

Using vag oestrogen once a week is not sufficient to keep your tissues plumped up. It needs to be used daily for 2 weeks and twice weekly thereafter, for ever - or for as long as you want to keep VA at bay!

Just to confirm that what Bellaciao says is completely correct.

The 'old' thinking on vaginal HRT was that it was only to be used short term or with a break. This wasn't anything to do with the cervix, but with the possible build up of the uterine lining which could- unchecked- perhaps lead to endometrial overgrowth then possible cancerous changes.

This has now been shown to be unlikely and most consultants are now happy for women to use vaginal HRT long term. If you or they were worried, I've heard that it's possible to take a short course of progestogens maybe once every year or two, to bring on a 'period' to ensure the lining is not building up. But very few drs would go down that route.

Many women in their 80s use vaginal HRT but if you do use it long term and then have any irregular bleeding you ought to have it checked out.

Hi, Bananaskin123 whilst there are vaginal products that are now used long term, the product Ovestin is 15 times stronger than some other creams.

Therefore, I'd ignore the previous two comments and have a chat with your GP about the best vaginal treatment that is safe for you to use long term.

*OP I'm sorry you are on the receiving end of conflicting advice.
I'm unsure why some posters think they know better than consultant gynaecologists.

I'd ignore comments that have no foundation and which are suggesting you use a weaker dose of something when the dose you have been given is safe and has worked for you- the most important thing of all!

Ovestin is a safe treatment and if it's worked for you then it's quite unlikely that something '15 times weaker ' would work. There is nothing actually that is 15 times weaker: Ovestin is 0.1 % estriol and Gynest is 0.01%. Many women find the latter doesn't work nearly so well.

You will find information that is up to date about the use of Ovestin on the website of the Chelsea and Westminster menopause clinic which is led by consultant Nick Panay.

THis is part of the information on the guidance for patients at that clinic: www.chelwest.nhs.uk/gps/find-a-service/womens-health-services/links/MenopausePMSclinicguidelinesGnRHA120310.pdf

Vaginal Atrophy
Local vaginal estrogens e.g. Vagifem pessaries, Estring vaginal ring, Ortho-gynest vaginal cream and Ovestin vaginal cream will effectively treat atrophic vaginal symptoms.
Local vaginal estrogen is NOT absorbed systemically there does not
have a risk for
o Endometrial cancer or breast cancer
o Local vaginal estrogens may be use concurrently with systemic HRT.

I suggest that you search for info like this online and take it to your GP if they are not up to date and you want to continue with its use. I have used it for 8 years under the care of a consultant gynae and if it wasn't safe then I'd not be allowed to do so.

Bananaskin I'd go back to your GP and get an appointment with a gynae if I was you.

As pink frocks says, "I'm unsure why some posters think they know better than consultant gynaecologists" and for once I agree. No poster here knows better than a qualified professional what will be best for you.

The fact is that some random posters on the Internet are unable to diagnose your condition, and will therefore be unable to prescribe any medication or treatments.

All posters on here have for you is anecdotal advice based on their own experience, and therefore it's not relavent to you, because their own gynae has examined them and made personal recommendations tailored for them. Dr Google is an option of course, and you can google to your heart's content anyway, same as they can and have.

In order to get the best treatment for you, you really do need to get an personal appointment with a qualified professional to find out what will be best and most suitable treatment for you.

No one here has your answer, same as they wouldn't for a problem with your personal eyesight for eg.

product Ovestin is 15 times stronger than some other creams

I can't see that anywhere - ovestin 0.01% estriol is 10 x stronger than gynest 0.1% estriol, but the applicators are smaller. So they are probably the same.

Vagifem 10g is estradiol so not directly comparable but equivalent dose to those above.

Estring is 7.5g/day, equivalent of appx 5 vagifem/week.

All posters on a forum are by definition ' random posters'- whatever that means.

No one has diagnosed the OP on this forum. She has already been diagnosed by a consultant -see her first line. The problems has arisen because her GP is not up to date or well informed about the use of Ovestin. It is actually shocking that a GP thinks that vaginal HRT is implicated in cervical cancer when it isn't.

That is why it's helpful to read the prescribing advice of a consultant- in this case Nick Panay who- if people are not aware- was until recently the Chairman of the British Menopause Society- and who leads the Chelsea and Westminster Menopause Clinic.

The comments posted here are far from 'anecdotal' and have nothing to do with being examined or receiving 'recommendations' by someone's doctor. They are guidelines that are available for everyone to see of they look at papers or advice online. This is not 'Dr Google'. There is a vast difference between rather dodgy health sites written by journalists and proper scientific papers or advice written by consultants. I personally would not link to the former.

The OP is not asking for a diagnosis, she is asking if she herself is right to think that treatment should be limited to 3 months and then a break. Two of us have posted to say this is not the case.

This is not 'anecdotal' - it is the current recommendation. Those of us who have been prescribed this way are quite capable of having a mature discussion with a consultant to ask if this regime is 'for me only' or if it is standard practise.

OP I recommend that you go back and see another GP at your surgery who is more up to date on the use of Ovestin and similar products, but at the same time, read as much as you can to inform yourself.

Again, bananaskin, your gp prescribed the treatment. The best product for you - and the dosage you need to use long term - will be best suggested by your gp.

If your gp thinks Ovestin is right for you - long term, great, but let your gp dictate the dosage, frequency of use etc. not a stranger. If not that product, then your gp will offer the best treatment for you, personally.

Anyone trying to be pedantic about things hasn't got your best interests at heart, your gp has.

One last thing, bananaskin as VenusRising says, 'All posters on here have for you is anecdotal advice based on their own experience, and therefore it's not relavent to you, because their own gynae has examined them and made personal recommendations tailored for them. Dr Google is an option of course, and you can google to your heart's content anyway, same as they can and have'.

Cherrypicking paragraphs from other websites and quoting numbers left, right, and centre, might look good but it isn't my cup of tea.

And thanks, Daylillie for clarifying that Ovestin is only 10 times stronger than Gynest not 15.
Yes the applicator is smaller, but the product is also used externally. Therefore, someone using a one inch strip of gynest externally would suffer the painful consequences if they used the same one inch strip of ovestin!!

bananaskin123 you might like to look at the easily digested info from Menopause Matters website - which is written by a leading NHS gynaecologist and based on the latest research and current thinking:

Here is a link to info on vaginal problems & treatments:
www.menopausematters.co.uk/dryness.php

Just to quote the relevant section:
"For creams, pessaries or vaginal tablets, the initial dose is 1 application nightly for 2 weeks, followed by the maintenance dose of 1 application twice weekly. Low dose vaginal estrogen preparations can be used long term without causing any known systemic effect, and without needing any progestogenic protection of the lining of the womb."

As I said before - this is the recommendation, even though there are no data on long term use - because of minimal systemic absorption.

There is a world of difference between personal opinion, personal experience, personal diagnosis, and scientific trials and peer-reviewed papers together with NICE recommendations and prescribing guidelines (as pinkfrocks has already said).

Well-informed women can research this information and use it as a guide and discussion or to express a preference, when their practitioner comes to prescribe for a particular condition.

It is also important to know the difference between a consultant gynae (who defo knows what they are talking about!) and a GP - who is just that, a general practitioner, and may or may not know much about menopause. I have seen (from another forum) too many instances of GPs misprescribing or refusing to prescribe based on outdated information. I know more about menopause and HRT than my regular GP, as do many women who have made it their business to become informed.

Those of us who have read a lot about menopause and treatments can try to help by sharing what we have found - fortunately there are enough of us about who can distinguish between any old "Dr Google" sites - of which there are many, and reputable information - and of course anyone is free to follow up links which are provided. Some of us even have science (or other!) degrees and research doctorates and so can understand the science.

Also want to agree with DayLillie about the info on the different products (and these are all listed on the link I provided for you).

Good luck bananaskin and please do ask if you want help with anything else

The OP was prescribed Ovestin by a urologist- not her GP. The OP has gone to her GP to ask if it is safe to continue beyond 3 months. The GP is misinformed about the risks- there is no recorded risk anywhere of Ovestin increasing cervical cancer risk.

OP you ought to go back to the consultant who prescribed this in the first place, or ask your GP to speak to them to clarify the situation. I can tell you though that long term use is okay as shown by this consultant gynae here:

www.menopausematters.co.uk/dryness.php Read the last 3 lines of paragraph 1 which refers to safety of long term use. Take it to your GP if necessary so they can read it.

In general , it is not good advice to tell someone to go back to their dr when that dr has shown quite clearly that they are misinformed about the risks of a treatment.

Time after time we read on forums countless examples of GPs giving inappropriate treatment, only to be corrected when women either a) do their own research which may include asking 'random posters on forums' or b) taking themselves off to a consultant who gives them the correct treatment.

If the only advice anyone can give on a health forum is 'see your GP' then there is really no point posting - is there?

And the same could be applied to any forum on MN- ie Relationships= see a psychotherapist, AIBU= see a judge or a mediator, etc etc.

People come to forums for advice and opinions- they don't have to accept either but it's a bit hypocritical to take part in discussions on any part of Mumsnet if you aren't following your own 'advice'- ie- only post a reply if you are 'qualified' to do so!

sorry Bellacioa- posted while you were posting- my typing and finding links isn't as fast as it could be!

By the way the applicator for Gynest is huge- it requires a full syringe of the product - more like 4-5 inches which some women find unacceptable because of leakage of the product and possible side effects from the 'fillers' used to carry the estriol, compared to around 1 inch of Ovestin - and 1 inch of Ovestin used externally is quite acceptable if this is what the dr suggests.

Perhaps it's worth noting the paragraph which starts off each part of the menopause preparations section of the site quoted/linked to;

Please note: Patients should consult a health professional to decide on the appropriate treatment option to be prescribed.

Now where have I heard that advice before?

The OP cannot get Ovestin or any other type of HRT without having to consult a dr- it's prescription only.

That is why I and Bellacioa have suggested she goes back to see a dr- not necessarily the same one as before- with some information that we have linked to from consultant gynaecologists.

OPI am really sorry that you appear to be caught up here in the middle of some unpleasantness by a poster who has some other agenda, and keeps trying to score points for want of a better term, against posters who are both sharing their experience and knowledge, and linking to medical websites to help you. I do hope this won't deter you from posting again if you have any questions.

A very good evening to you all
Just a reminder of our talk guidelines and to emphasise that Mumsnet's raison d'être is to make lives easier.
Peace and love please.

I have been to the GP yesterday and been prescribed Ovestin 1mg cream and told that I can be on it for the rest of my life - I'm 57. That should reassure you.

Hi is Ovestin the best thing to use on its own for menopausal symptoms or do you need to take some other form of HRT as well.

Don’t know. Just been prescribed Ovestin with a view to taking HRT as well in a mouth or so’s time. Already have the mirena coil and just want to see how I get on with the cream before starting the cream

HRT!