Vaginal oestrogen, is the dose enough?

[Flowertrees]

I’ve started on vaginal oestrogen, for about 2 months so far. The first two weeks of using every day was great, symptoms seemed to get better quickly but now I’ve gone to twice a week, everything is rubbish again. V dry, wiping after a wee feels like I’m using sandpaper.
has anyone had their doctor approve a higher dose? I’m using the tablets if that makes any difference

Use it as frequently as you need - there is no contraindications because it’s not systemic (not going in your blood)

Nice menopause guidelines advise to use treatment for three months and then review with your doctor. Moisturiser can also be applied at other time as often as needed, for example emollient ointment like Epaderm or Hydromol (available OTC) externally on the vulva and Yes VM internally in the vagina. If symptoms haven’t improved at the review point, treatment frequency might be increased or a different treatment tried.

If you are using the estradiol 10mcg tablets, you might also need an oestrogen cream to use on the vulva - or the estrogen cream could be used internally and externally instead of the tablets.

There is a downside speaking to a GP is they won't know and will go by the book. If you want to do that however, @Flowertrees, do.

I wonder if NICE is combining systemic HRT with vaginal estrogen re. the 3-monthly review?

The risk of asking a GP is they don't know. Yet consultants who know far more are much more relaxed about it and say use as needed.

There have been many posts here from women who have been advised the same by gynaecologists.

It's a topical treatment, not absorbed and safe to use as needed.

Definitely get some of the estrogen cream @Flowertrees

You can apply it to all parts of the vulva, but also on the perineum/anus area

It’s magical stuff, I’m not sure why the doctor didn’t give you the cream straight away. The internal pill is fab for your bladder etc, so keep using that, but you need the cream for your external skin x

I have Sjogrens which means I don’t produce any of the usual saliva / vaginal mucus etc etc and I’m in a health group for women with Sjogrens and all of us use vaginal oestrogen cream 4-5 times a week, or as needed, more than the recommended 2 times a week. Our rheumatologists have okayed this as the oestrogen dose in the cream is so low.

Thanks for the replies, looks like I should ask for the cream as well then

I use cream internally and externally 5 times a week. No issue 2 times a week is not enough for most women.

Generally you use the cream on its own instead of the pessaries - it comes with an applicator that you fill with the cream and insert it internally and then you can use it externally as well. Personally I’m always a bit 😬🤦🏻‍♀️ when doctors etc prescribe the pessaries at all because they require some degree of self lubrication to dissolve them. If you’re having vaginal atrophy - which is why women use them in the first instance - you’re likely to struggle to dissolve them and they can be quite uncomfortable. The cream is generally much better all round.

I think the cream is way, way better. It comes with an applicator but I found that a faff and just use my finger. The really glorious aspect of the cream though is you can use some of it on your vulva, clitoris and anywhere else in the vicinity which gets sore. Absolute game changer!

I am on systemic HRT and I use Vagifem pessary and the topical cream as well.

Vagifem has done wonders for me but 2 times a week is not enough for me - I use it 4 times a week. It's true that if you have atrophy the pessary is awkward at first

I was advised, and prefer, to use the cream on the external bits - added this after speaking to a specialist, because my clitoris had shrunk!

So my advice would be to use both

I use it daily. Get four tubes a month from GP. gynae told me to use it as liberally as I liked.

Many women use it on their face too.

Estriol cream saved my sanity and my life.

Do they? Tell me more…

100 per cent

Is the cream instead of oestrogel or in addition to?

Can be either. I have tried systemic HRT and can’t get on with it but the vaginal oestrogen cream is amazing and I will continue to use it. Women who can’t use systemic HRT for whatever reason can still use vaginal oestrogen cream as the dose is so low (I remember reading somewhere that if you use it for a whole year, 3 times a week, it’s only equivalent to less than half a patch of HRT). But if you want to you can use both systemic HRT (ie oestrogel / patches etc) AND the vaginal oestrogen.

I dab a bit under my eyes and around my mouth. It ‘plumps’ the skin apparently. I don’t really notice the visuals but it does feel much less dry than if I was just using facial moisturiser. And oh boy I’ve tried them all.

I use the vaginal cream daily and have done for many years.

It makes me wonder what women used in the past to alleviate the pain of the dryness.

Yeh I often wonder how women coped in the past. I always wonder if the number confined to lunatic asylums was something to do with the relentless burning and stinging and weeing. It’s hell on earth.

Life expectancy was around 40 and very few women lived for another 35 years after menopause.

Aah that’s true.

Fascinating subject. It suppose it depends on whether or not the 'average age of death' includes infant mortality, and what century, country and social class you're looking at. There is evidence of post-menopausal women in the historical records and also in the archaeological records. Not as many as today, as @JinglingSpringbells says, but enough to make me wonder what they used.

I've got a book somewhere on mediaeval nunneries and how they provided sanctuary and refuge in religious, legal and medical terms for many 'older' (post-menopausal) women, particularly widows who didn't fancy being married off again. A lot of them seemed to live well for longer. And then nunneries were heavily affected by the dissolution of the monasteries under Henry VIII - most of them closed down apparently. All that knowledge - where did it go, and what was it? And then, as you say, centuries later we had the rise of the mental institutions and non-voluntary incarceration. In between, there were the witch hunts. What a world.

@JinglingSpringbells I really owe you one btw - it was you who wrote on this board that vaginal cream could be used daily, longer-term. Thank goodness you did.

Amen to that x

The inappropriate treatment still lingers a bit today because many GPs reach for ADs for women rather than HRT, seeing it as a mental health issue- called 'nerves' in my Mum's day. Many of her friends had 'nerves' and were on Valium or sleeping tablets for decades.

I do know though that vaginal estrogen was available a long time ago but whether women asked for it or were offered it is a different matter. There was a lot more embarrassment then about such things.

I know @Whosthetabbynow I often think the same. Those poor women.

It's pot luck with GPs. My last appointment was with a young, newly qualified doctor who really didn't know what to prescribe after I reacted badly to Blissel. She told me I could just carry on with Yes VM on its own. But when I told her I wanted to try another local oestrogen cream because I'd read that vaginal atrophy is one of the symptoms that is progressive without treatment she said: "Oh it's not progressive - it's just something that gets worse as you get older." 😐

I came away with a prescription for Estriol cream but I've yet to try it after my reaction to Blissel. I'm so nervous about making things even worse. Has anyone else had success with Estriol after not getting on with another treatment?