Vagifem - return of hot flushes and feeling angry!

[AutumnH]

I've had no periods for over 4 years and I have had hardly any hot flushes for a long time. My emotions were very stable and actually better than when having periods as I used to get terrible PMS.

However, I've been prescribed Vagifem due to recurring UTIs. I've been taking the loading dose for 4 days and am already getting hot flushes again, sweating at night and am feeling very angry/irritable with DH! I know the theory is that it's a tiny localised dose of oestrogen which has no effect on the rest of the body but this can't be a coincidence after so long of no menopausal symptoms! And isn't HRT meant to relieve menopausal symptoms, not cause them? Confused!

I will persevere but is it likely these symptoms will wear off as was feeling so much more mellow (and cooler!) before? 😟

So I've read that research found that, after 2 weeks of a daily dose, the vaginal tissues have plumped up and the oestrogen then doesn't move into the overall body system so much. I will report back in case anyone is interested!!

It seems obvious to me that it will not stay local, and I seem to remember when I read the leaflet that it actually mentions cancer elsewhere in the body, despite what the doctors say.
I was prescribed some, but was put off by the leaflet.

Yes I don't blame you. I'm just a bit stumped on how to treat these frequent UTIs and other bladder symptoms. Don't really want to be on antibiotics all the time but perhaps that is less risky than even the local HRT??

When I started taking HRT (the full dose not local) I was really emotionally wobbly the first month or so but then yes it did calm down. So I’d recommend just sticking with it for a couple of months, but it is a pain.

Taking vaginal oestrogen for 4 days will in no way have got into your system and be causing hot flushes, it is a tiny dose. It will be coincidental, sometimes women go for a ages without overheating then can get a flurry for a few months. There doesn't seem ro be much rhyme or reason it's just those fluctuating hormones. Many women also go a few years after their last period without symptoms then once oestrogen has totally dropped off that is when problems arise.

I would stick with vagifem and review in 6 months. It's really is great at treating localised issues. Taking antibiotics repeatedly can just cause resistance.

Have you considered systemic HRT if the constant urinary problems are impacting on your life?

I'm not convinced that a sudden return of heat multiple times a day on the same day as starting Vagifem after nothing for over a year is a coincidence. Also definitely more volatile in mood. I've always been very sensitive to hormones in contraception so it doesn't surprise me. I have been feeling so much better emotionally without the monthly fluctuations of hormones - better than when young so really don't want to go on any stronger HRT than the Vagifem.

I will keep going in the hope that things settle down

I started bleeding after 3 days of one pump of the HRT gel. I don’t think that’s coincidence either.

I'm not convinced that a sudden return of heat multiple times a day on the same day as starting Vagifem after nothing for over a year is a coincidence.

There is no connection.

What seems to be happening is that now, one yeat post menopause the loss of estrogen is now giving you symptoms. This happens. Not to all women, but certainly some because your own estrogen levels continue to fall , post menopause. Some women have no peri symptoms but start flushes etc further down the line.

You'd have to use Vagifem twice a week for a whole year, to get the same amount of estrogen that is one estrogen tablet (1mg) - which is what women on HRT use in a day.

During the first couple of weeks if using vaginal estrogen, some (a minute amount - just a few micrograms) may be absorbed until the vaginal tissues thicken. After that, none is absorbed.

Also, just to correct a point- Vagifem and Ovestin are topical estrogen - they are not classed as HRT.

There are no risks to using local estrogen. Old women in their 80s and 90s use it. If it's helping it needs to be used for life, or the symptoms will just come back.

There is a lot online on medical sites about it, so if you are still worried, maybe have a dig around and a read?

@KangarooKenny The leaflet in topical estrogen is going to be changed. Menopause consultants have been pushing for this for a long time.

It's not applicable because vaginal estrogen is not HRT.

From later this year, women over 50 are going to be able to buy topical vaginal estrogen over the counter with no prescription - it's brand name is Gina.

@JinglingHellsBells Maybe the few micrograms you say can be absorbed at this stage is enough to have disturbed my equilibrium a bit. I'm not one year post menopause, my periods stopped 4 years ago. I haven't had hot flushes for a considerable time - I said a year as an estimate but it's probably well over that. I had flushes to a mild extent all during my 40s, these seemed to pretty much stop not long after my periods finally came to an end.

I accept it's not classified as HRT and not with the same potential side effects. I wouldn't say I was worried, just irritated to be hot and sweating again! As I said, I will persevere. Not least because the blasted UTI has returned again 😟!

Have you had a test to confirm UTI. For me, I had recurring bladder issues that turned out to be (in part) an overactive pelvic floor, which a women's physiotherapist has helped to sort, along with vagifem and HRT and supplements to help reduce bladder irritation (these are antihistamine tablet, slippery elm and marshmallow root). I'm not sure if it's one or all of these which has made the most difference.

Re the vagifem, once you've done the loading dose, you can just use it twice per week to maintain.

The leaflet that come with her is scary as shit. I recommend binning it - its out of date anyway

@ImAvingOops thank you, I will look into those supplements. I don't think my pelvic floor is overactive, more the opposite, but I think my bladder could be 'irritable'. Will attempt to discuss with GP. I have given urine samples which confirmed infection.

You probably need more HRT in the form of gel, patches or spray and progesterone.
Supplements won't make your body start producing oestrogen again.

Vagifem is only a v low dose and remains local. It won't improve hot flushes.

Have you considered other possible reasons for being hot and sweaty? A virus? Mild Covid? Could be all sorts of reasons.

As a by the way, estrogen in HRT is not the same in any way as estrogen in the Pill.

Following this with interest

I also have reoccurring utis and am picking up vagifem prescription tomorrow from the chemist

I've not gone through the menopause but am now also taking d-mannose and probiotics which my urologist said should help

Also having cystoscopy to check bladder

Hoping the estrogen doesn't come with any of these side effects

@AutumnH I don't want to be a 'doom monger' but many women have flushes etc for life. There are menopause consultants online (in video interviews) who discuss their patients in their 80s and 90s who use HRT for that reason.

I know you have had a year feeling fine, but symptoms do tend to arise both during peri and then also post meno, in some women. In peri, the symptoms are due to fluctuating levels of estrogen. As the years go by, some symptoms (and new symptoms) can come back as estrogen falls lower and lower. This is why the risks of heart disease and bone loss occur years after a final period.

The loss of estrogen to your bladder and genital areas, making you more susceptible to infections, is a sign that your levels have fallen.

I hope you find the Vagifem helps!

Thank you @JinglingHellsBells. I know I need to be more open to having to take HRT, I am just a bit disappointed, which is silly. I've switched to using the Vagifem at bedtime which I found was recommended so hope that helps a bit. I appreciate I will probably have to continue this forever, so hopefully I will get used to it!

@ClingyClingy I hope it's helpful for you and there are minimal side effects 😊

Is there a reason why you don't want to try HRT? It's all made from natural substances.

I said I would report back so after 9 days, side effects have reduced greatly, only one flush per day on average and emotions stable. Hopefully there will be improvement in the localised urinary issues too. Still on antibiotics so too early to tell on that.

@cleowasmycat I didn't want systemic HRT as I previously had had no menopausal symptoms for a long time other than the urinary ones. I didn't want a return to flushes and unstable emotions. Luckily my body seems to be getting used to the Vagifem and these have reduced.

Thanks for everyone's comments.

@AutumnH I've read your update. I hope everything continues to settle down.

I'm linking to some info here that might be helpful. The references to vaginal estrogen come halfway down under the 'learn about menopause and decide on your philosophy'. There is an interesting comparison with a mouse swimming around in a vat of vaginal estrogen!

The gynaecologist who wrote this is a highly qualified NHS gynae (who also does some private practice.)

www.drmortons.co.uk/blog/menopause-does-not-have-to-be-like-this/

Thanks for the update @AutumnH. I understand about the low dose etc but I am on day 7 and have seen changes, particularly re temperature and cramps. Its reassuring to know they have calmed down for you and I'm pleased to hear it, for your sake.

I have started using Vagifem, but has anyone else got really itchy and sore after the two weeks of using them every night?