What is the Best Treatment for Vaginal Atrophy and Why Are Docs so Bloody Cautious About HRT

[HelpHedgehogsByFeedingThemCatBiscuits]

I've noticed that everyone talking about menopause focuses on hot flushes etc which are easily dealt with by HRT but the thorny topic of vaginal atrophy (sounds grim I know) is rarely discussed.

At 63 I'm dating for the first time in years and most disappointingly cannot manage penetrative sex. My gynae says my atrophy is fixable with topical HRT (along with systemic) and yet has prescribed a low dose vagifem (10MCG) , the equivalent of Gina which is available over the counter. Why on earth did the 25MCG get taken off the market when there were no known side effects? The hysterical restrictions and cautions around HRT - are just maddening.

Meanwhile Sea Buckthorn pessaries and treatments like red light therapy have had good reviews but of course my gynae had never heard of any of this.

Can anyone give any insight into the strongest form of localised HRT and any treatments they have found helpful?

I use vagifem and ovestin cream and it's worked a treat. Ask your doctor for the cream as well as the inserts. I use it far more frequently than the leaflet advises and my doctor said its fine to use as much as I want/need.

Thanks. I've been using both so will continue.

I would suggest purchasing a sex toy and using it for dilation with plenty of lube, also orgasms increase blood flow to the area which helps the situation. That along with oestrogen locally should improve things.

Is it possible to up the Vagifem dose safely be inserting two pessaries?

@HelpHedgehogsByFeedingThemCatBiscuits I don't know why the manufacturer reduced the dose. That was years ago.

However, there is info on this on the Menopause Matters website from consultant gynaecologist who runs the site. It was in reply to a post and although I've tried to find it for you, I can't. There are too many threads there.

What she says is that the 25mcg was used 2 x a week = 50mcg over a week.
Now, you can use 10mcg x 5 x a week =50mcg.

There is nothing stronger but you can use it more often.

Are you also using systemic HRT? if you are, there will be no risk of hyperplasia with your womb lining because you'll also be getting progestogen with the systemic HRT.

You can also buy medical dilators that are used to stretch everything- they must be available online- most things are now!

I bought a joylux, it’s basically a vibrating dildo with red light therapy. When I remember to use it it is really good. You work up to a nine minute cycle, but if you can’t manage penetration it won’t work for you yet as the red lights are at the base. Take a look, you couldn’t get the app in the UK when I got mine, it’s an American one but this may have changed. Good luck.

The change from 25 to 10 mcgs was over 15 years ago.

You can try estriol cream if that works better for you?

Yes the red light therapy sounds really helpful.