Temporary break from Vagifem - what to use?

[MandyMayflower]

I've been on Vagifem since last June and it's really helped my VA symptoms. I've now been asked to take a 6 week break before having vascular surgery due to the possible complications of DVT. Also, I won't know when I can resume the Vagifem until I speak to the surgeon.

My GP has prescribed Replens which seems to have really poor reviews. Any recommendations please for another vaginal moisturiser to get me through the next couple of months?

Thanks

What a load of bollocks!
the amount of oestrogen from topical vagifem that gets into the blood stream is teeny and so low even breast cancer with oestrogen specific cancers can use vagifem. I'd go back to the doctor and challenge that

There is a risk of DVT from my surgery.

The Vagifem instruction leaflet states: "If you are going to have surgery, tell your surgeon that you're using Vagifem - you may need to stop using Vagifem 4-6 weeks before the operation to reduce the risk of a blood clot."

I won't be challenging a highly experienced vascular surgeon.

I find ‘Yes’ moisturiser to be really good. You can buy it or get it on prescription.

Thanks PurpleRainDancer - had a quick search and there seem to be water based and plant-oil based ones in that brand. Which one do you use?

@MandyMayflower You really don't need to stop using vaginal estrogen before surgery as none is absorbed in the bloodstream.

Even women using full HRT aren't asked to stop before surgery nowadays AND estrogen actually prevents clots by keeping the arteries flexible.

Also, women have pelvic surgery for prolapse are actually often advised to use it, because it helps healing.

The information on the leaflets is the same for ALL HRT- so what you read for Vagifem is the same info that's on all HRT. There is a bit of a to-do going on at the moment with drs to try to get this changed.

Your surgeon is a vascular expert. He's not an expert on hormones or vaginal estrogen. You have every right to question him and he would then talk to a menopause expert to clarify.

The other thing is, estrogen in Vagifem (or any HRT) does not cause blood clots in healthy women. There is a tiny, tiny risk of clots in older women using tablet form HRT (not vaginal estrogen) which is why the advice now is to avoid tablet form of any HRT.

I think you ought to talk to him again.

Jingling is correct. Just because someone is a specialist in their field doesn’t mean they know about hormones etc. Ovestin and vagifem are very safe, very low oestrogen and suitable for women to use even when they are at risk of clotting. I know - I have lupus and have issues with blood clots and I use Ovestin safely and even take HRT in the form of oestrogel and utrogestan as there is no risk of clotting with these.

Replens isn’t bad. I use that in between the days I use Ovestin and I find it quite good. The only annoying thing is it’s quite runny and messy so I tend to use it overnight and at first you can get white clumps from the liquid as it’s absorbed - apparently these are dead skin cells - but this doesn’t bother me. It’s worth a try.

Agree with all the previous posters - I work in pharma industry so have huge experience in these things and also used to sell a vaginal atrophy product so know about HRT absorption from topical treatments - there is no risk from dvt from topical vagifem - even newer preparations of systemic HRT are low risk for dvt now especially if they are absorbed through the skin like a patch of gel

The issue @MandyMayflower is that vaginal estrogen is not HRT.

The problem is the leaflet (which needs updating) and menopause experts would know that. A surgeon who's doing vascular surgery is unlikely to.

If you use Vagifem for a year, the amount of estrogen you get is equivalent to ONE microgram of estrogen that is ONE day's dose of systemic HRT- that's how small it is.

You can read all about this on a medical site- Dr Louise Newson's website (My Menopause Dr) if you search for vaginal estrogen etc- there is a fact sheet.

Thanks for all the replies.

Your surgeon is a vascular expert. He's not an expert on hormones or vaginal estrogen. You have every right to question him and he would then talk to a menopause expert to clarify.

I can ask the surgeon to talk to a menopause expert - however, given my previous experience of waiting for one doctor to discuss an issue with another and get back to you, it will take some time. Meanwhile the clock is ticking towards my surgery date next month and if the surgeon (for whatever reason) insists that I shouldn't be on Vagifem (and I haven't already stopped it), then I will miss my surgery date. I've waited over a year for this surgery (which will massively improve my quality of life) - if I miss this date, I've been told I'll be placed on a shorter waiting list but there's no guarantee when I'd be called again. For me, the discomfort of VA symptoms possibly returning for while is a very small price to pay compared to the benefit of finally having my surgery - hence my original question.

This question about safety of vaginal estrogen has come up a lot and there is info on medical menopause sites online if you want to dig around :)
The issue is that the leaflets are not up to date.

Vagifem is not HRT. The problem is that manufacturers have not updated their leaflets properly, they are out of date, and tied up by red tape.

Using it for a year is 1mcg of estrogen- a low dose of daily HRT.
There is no way that is absorbed into the blood stream and could cause a DVT.

You've had a reply from someone working in pharma, saying that.

Your choice of course, but for other women reading, it's worth clarifying this.

Good luck with your operation anyway.

insists that I shouldn't be on Vagifem (and I haven't already stopped it), then I will miss my surgery date.

This dr needs to update himself too. Sounds very old-school and misinformed, sadly.

To answer your recent post - I think if you can put up with VA symptoms for a few weeks and use a non hormonal moisturiser then I am sure this will be ok. I think the Yes products are good based on what I used to hear from menopause clinicians last year. But when you go back into vagifem remember you will need the 2 week loading dose to give the vaginal tissue the oestrogen its needs then twice weekly from then on x hope that helps and wishing you loads of good luck with your operation.

Thank you.

I've already ordered Yes VM which hopefully will help to some extent. Having also discussed this with my GP, he has no issue with renewing my Vagifem prescription earlier due to needing to repeat the loading dose.

Agree with others, vagifem estrogen, in the words of my Gp, stays where its put. It doesn't travel anywhere around your system. You do you, but if it were me, I would argue my case with your surgeon that I was sticking with the vagifem.

Regarding the yes vm, it made me 10 times worse, I found replens although a bit messy, gave me relief.

Personally I would not want to leave my VA without treatment for that length of time, it can be difficult to get under control again.

I recommend Sylk, it's plant based and really helpful.