Advice needed

[jasper100]

I am about five years post menopausal, 55 years old and childless. I have had regular smear checks, the last one five years ago. My doctor gave me Ovestin recently for urinary and dryness issues (many thanks to mumsnet menopause section for this information) and it's been brilliant. I've had to stop it for a couple of weeks because the smear test results wouldn't be precise if I've used this. So, I had my appointment the other day and it couldn't be done because it was so painful. They've called me back at the end of the month and they're going to try a smaller speculum. I'm dreading it as it hurt so much and I'm tempted to cancel it. Does anyone have any advice or should I just grit my teeth and get on with it?

Please don't cancel. Perhaps ask the nurse if she/he can suggest anything you can do you to make it less painful? but you really shouldn't cancel.

Thanks for your reply. I know it's important and I've never had problems before with smear tests but since menopause everything is much more uncomfortable and something as basic as having this done is very painful.

Are there any over the counter things? Maybe the pharmacist could help.

Thanks for your response, I was anticipating it being painful and read on the menopause matters site that taking some painkillers a short while before helps. I tried that and it still hurt like hell.

Jasper who told you to stop the Ovestin?

I'm afraid yet again this is a case of a GP not knowing what is what and women are suffering.

The instructions from my consultant (a top meno specialist) is to use Ovestin for around 10 days (daily) before he does a smear and stop only 3-4 days before the smear.

I've had several smears with him over the years and this has always been the regime.

I think you need to either find another GP, or do your own thing and use Ovestin, or make an appt before the smear date and tell your GP their advice is incorrect.

Polly, I was hoping you would see this.

I've read this section on Mumsnet and went to my doctor who quickly recognised VA and prescribed Ovestin. She said you are due a smear so we will send you a letter. When I went for the test the nurse said "you need a clear two weeks off the Ovestin otherwise the test results won't be clear" so I stopped it and went on Tuesday this week where it couldn't be carried out. I can't see how a smaller speculum will make a difference and I'm dreading the end of the month when I've got to go back. I'm still sore from the previous attempts.

This is why nurses need more education on things like this.

I actually had one smear some years ago when I'd used Ovestin the night before - smear was sprung on me :) - and my gynae who did it said it would be fine. I also had a smear when I'd only used Ovestin twice a week (as you do) and that smear didn't 'take' - not enough cells. After that my gynae said use for 10 days then stop 4 day before.

This is Harley St- someone who knows that they are doing.

Just use Ovestin as I've been told to.

Great, thanks Polly.

I always ask for a small speculum as I have a tilted womb and take a couple of paracetamol beforehand. It doesn't stop it being uncomfortable but it doesn't last long.

Life time risk of cervical cancer is 0.75% so no I would never agree to a smear. It is rare cancer.

befair Maybe shout that to the women who have died from it. Oh, you can't, they can't hear.

For good sake. All screening does harm. My decision not to be screened and yes I have treated Cervical cancer patients. Dr Margaret McCartney book a Patient Paradox is an excellent book to read reviews for and against. It is on Kindle. She is a GP in Glasgow and RCGP Council Member.

I'm sorry but I think it's irresponsible to suggest women forgo screening for cervical cancer. The risk may be small (less than 1% you say) but nonetheless women do die from it- read some of the other forums here where young women had it caught just in time.

It's your choice but there is no harm from taking a smear.
I don't know what you mean by you have 'treated' cervical cancer patients- dr? Nurse? In any case, it's not an argument for saying don't be screened. It's your personal choice.

Women deserve the right to receive all information to make an informed decision we are not children. Dr Margaret. McCartney book The Patient Paradox is excellent. Yes screening does do harm for some women the psychological distress, pain having a smear, treatment for CIN that may return to normal. It also does not pick up all types of cervical cancer such as an adenocarcinoma. Women need balanced information so they can make an informed decision.

I find it hard to understand why you advocate no smear tests when you say you have treated women with cervical cancer (whatever 'treated' means.) Even if they save one life, that life for the individual woman is a life saved. The other side of the coin is that cervical cancer cannot be seen until symptoms are quite serious. I know someone - an acquaintance - in her 50s who had cervical cancer and had a full hysterectomy; without a smear she would likely to be dead now, or in a much worse state than cured.

Polly it's rare a cancer. Symptoms need a colposcopy. I am not putting myself through smear tests. The other side of the story re screening re harms are never heard. RCGP have an overdiagnosis working group. I have worked in oncology. Screening does not pick up cervical adenocarcinomas which is what Jady Goody had. You really should read "The Patient Paradox" by Dr Margaret McCartney who is a Glasgow GP, RCGP Council Member and part of the overdiagnosis working group at RCGP. It is fully referenced and very readable. Available on Kindle. Women deserve to be able give fully informed consent and make their own decisions.

befair I am of an age where I probably won't need smear tests. I've had dozens over a lifetime and have never even felt I was 'putting myself through' anything. Over and done in 2 minutes.I 'm not interested in the book thanks because I've got a great consultant and I trust his judgement having discussed this with him.

I fail to see what you hope to achieve by advising women not to have screening. Whatever you and the book say, there is always the other side to the debate.

It's entirely your prerogative to not be screened Befair. But i to think it's irresponsible to advice others not to either, particularly as you are apparently a medical practitioner.
A smear test will not give lasting damage that could leaD to further, more complex and serious conditions. But it can alert a woman to a medical condition that needs treatment. In turn this can prevent the condition from becoming life threatening.

I am not saying others should be screened. I am saying woman are entitled to ALL information so they can make a balanced informed choice.

Please read what I am saying woman are entitled to ALL the information. I am NOT saying women should be screened. It is NOT any old book it's written by a leading GP and RCGP Council Member whose professional interest is over diagnosis.

Quite Polly the other side of debate is never heard hence why women do not receive balanced information!

For the record I use vagifem and I’ve never been told to stop it before a smear. I also prefer it to the ovestin cream which I think is a bit messy, although I do keep a tube for a dab of outside area easing every now and again

befair we know that screening doesn’t pick up all cancers. I have a bi yearly mammogram and I know that along with the radiation there’s also a chance it won’t pick up very tiny cancers or those in hard to scan areas at the sides of breasts. I still have them though!

SCREENING SAVES LIVES END OF

befair Your source (the book) is a GP. No more, no less. I think there are better informed medics out there.

You say you worked in oncology; with respect that could be anything from an admin role to a consultant. It doesn't add to your argument to say you were in contact with cancer patients. What about those of us who know women who had cancer?

You clearly have an issue with smears- hence you 'don't want to put yourself through it'. I don't. I'd rather know if there were changes THEN decide what to do next. I've come across you and your views on other parts of MN.

My argument is knowledge is power. It's the same for breast cancer; DCIS is over-diagnosed and the progression to invasive cancer is 50%. But then a woman has a choice over treatment or not.

You seem to forget that women are able to refuse treatment once a scan of any kind has picked up changes.

I have worked in clinical role, thank you. I disagree as we both know some Consultant Gynaecologist are appalling on HRT as can be seen from the Menopause Matter forums equally they may not be experts in screening however are group of RCGP are experts. To ignore one side of the argument and expert opinion is fool hardy. I respect your right to be screened clearly you do not respect other women's right to make an informed choice based on available fully informed information.

Yes I agree breast screening equally has issues. As does most screening programmes. To make an informed choice about any screening programmes I want access to all available current medical information.