dealing with GP over vaginal estrogen - points to make

[AuntieBiotics]

I have been struggling over the past 6 months with atrophy symptoms. The really severe itching and repeated UTIs have cleared up with vaginal estrogen but I have flare ups of soreness, dryness, thrush. I will make an appointment to see my GP but to be honest I have little faith in their ability to help.

Before I shell out £220 to see a private specialist, can anyone add to my list of suggestions to the GP

1. Up the dose of Estriol from twice a week to every other day. They are not going to like this suggestion.
2. Try another format of vaginal estrogen - might work but again they are only going to prescribe to the manufacturer recommendation.
3. Up my dose of main HRT - I am on 75 patches so there is room to up to 100 within the standard NHS guidelines but all my other symptoms are stable on 75 so I'd rather not.
4. Swabs to rule out other conditions.
5. Referral to menopause clinic (which in Scotland will be 18 months at least) or a gynaecology/dermatologist/urologist specialist.

If none of that flies, quite happy to go rogue and buy my own estrogen but would rather not. From all I have read the vaginal estrogen is very low risk and I have read of women using it daily.

Hello, I truly feel your pain. VA was one of my more horrible peri symptoms and I faffed about for months trying to find a solution. Like you, I thought using the oestrogen cream more often would solve the problem but it didn't.

In the end coconut oil worked! I looked it up and google said yes safe to use, so every day I rub a little on my palm and then stick it on the outside and I have had no more discomfort or pain. I do this maybe three times a day, anytime I feel I need it.

However - I mentioned using coconut oil on mumsnet and someone said it can cause infection etc, but for me it has been a godsend, truly. I even have a tiny pot in my handbag and won't walk anywhere without applying it.

If you dare risk it, why not try a bit just in case it works?

I don't use the oestrogen cream anymore than twice a week now. Thank goodness for coconut oil!

Are your symptoms internal or external or both? The vaginal oestrogen tablets or creams are very safe as they don’t enter the blood system in very large amounts. My GP says I should use the tablets twice a week or I can use them up to five times if needed. For external symptoms, the only thing that helped me was Clobetasol 0.05% cream, however my GP is concerned about over use so she will only prescribe one tube per year. I’ve had the current tube since December and there’s still a little bit left so that seems to be working out okay for me.

Good luck getting treatment, I don’t think some doctors realise just how disabling the symptoms can be. When I have a flare up it’s painful to walk any distance and even sitting can be painful.

Do you actually have thrush with all the thick white discharge etc? You need to get vaginally swabbed and tested because peri can change things and I needed a course of antibiotics as was suffering with itching, soreness and a watery discharge on top of everything else. I use oestrogen cream as often as I need to. Sometimes it's every day some weeks it's just a couple. No one else knows how my vulva feels so I'm the judge of what I need and my gp is ok with that.

So my symptoms are mainly external, burning sensation around the perineum mostly and vulva, pain when I urinate. When I am having a flare-up of those symptoms I also notice a change in internal/urinary symptoms - needing to wee more, getting up in the night when I don't usually, urgency. I have had a hysterectomy so would that affect any discharge? Don't know. I was also diagnosed with a grade 1 prolapse which doesn't need any attention other than exercises. When the urinary symptoms are bad, cutting out caffeine helps.

I am also consciously trying to apply the estrogen cream lower down rather than shoving the applicator as far up as you would a tampon. I have been moisturising using Cetraben cream which helps. But yes, in a flare up it's bloody miserable.

Why don't you increase the estriol?

You can buy it online/ OTC for £20 so cheaper than seeing a consultant.
You don't need to use it daily- every other day might make a big difference.

If you try that you can then do whatever you need to with your NHS prescription to get enough- or worst case mix and match buying it and your free NHS tube.

There is no risk in using more especially as you're already on hrt. The progesterone from your HRT is giving you womb protection- that's always been the minor concern for women using more (who aren't on HRT.) EDIT- SEE YOU DON'T HAVE A WOMB.

You can also buy tests for thrush at the supermarket or online.

EDIT-after your update. You need to insert the cream higher up. This is so it passes through the front wall of the vagina into the bladder walls. This helps build up the lining of the bladder making it less irritable and more stable.

You also need to use some externally, as you seem to be doing.

No one else knows how my vulva feels so I'm the judge of what I need and my gp is ok with that.

This is how I feel. I also feel that I have had better advice from women on here than I have ever had from my GP. But they are unlikely to prescribe more than one tube of cream every 2-3 months. Although at £20 a tube I am prepared to buy this myself, I have spent more in the last week on canesten, vagisil and various other vaginal moisturisers.

Is your GP unwilling to prescribe more? Have you asked and explained how you feel?

If you're getting a lot of thrush it's worth looking into some pro-biotics and pre-biotics to try to improve your gut health if you have had a lot of antibiotics lately.

Just ask your GP to prescribe more. Say you use a tube faster than 3 months and if you use less your symptoms come back.

They might say no but you don't know if you don't ask. And you can always just buy extra.

Yes, last time I saw a GP was when I had a course of antibiotics for a UTI and still felt the symptoms hadn't gone. She tested my urine sample (clear), examined me, found the prolapse. I asked about upping the estrogen dose as I felt it helped and she said no, twice weekly was the limit. That was just one GP in the practice though, I may have more luck with another one.

I would ask them to ensure there are no signs of lichen sclerosus. And would advise the same for PP using regular clobetasol cream.

I use the cream every other day, I found twice a week wasn't enough as I ride and cycle.

Side note - how INFURIATING is it that we have to figure all this stuff out for ourselves?

When I first started on Vagifem, I had to use one every day for the first two weeks, only then on to twice a week.

Perhaps using it daily for two weeks might help get you back on track?

I use the pessary and just prefer it, as its not so messy although you don't have the option to use it on the vulva itself like you can with cream.

I thought lichen sclerosis as well

Your GP sounds ill-informed, OP.

Twice a week is the maintenance dose once symptoms have resolved. You can use it daily for 4 weeks prior.

OP, I had exactly the same symptoms and the Clobetasol 0.05% sorted it out really quickly. Could you ask your GP whether you could give it a try?

For those prescribed clobetasol, were your vulvas very red? I have an appointment next week with my GP having been prescribed a flucanozole three days ago and not seeing much improvement.

I'm still trying to find the right topical oestrogen for me, but I wonder whether I need a steroid first as I'm so inflamed. But then I've also read that steroids can thin the skin further...

She would say that I am in the maintenance dose as I have been using it for 18 months and did the initial 2 weeks every day, then switched.

Hi op. My GP was VERY happy with your number one suggestion. I'd go with that if you can.

Or just do your repeat prescription more frequently for a while and don't tell them.

Could you try a different GP? I've had success in the past with another condition, working my way through the surgery until I found a doctor who agreed to try a treatment with me.

It's a pain in the arse, of course, and we shouldn't have to do this - especially for this particular problem.

How often do you use the steroid cream, @StuntNun ? I'm wondering whether that's what I need. I'm so red and sore. I'm terrified to put anything other than hydromol on at the moment.

I used it twice a day until the soreness cleared up. Every few months, I start to get sore again and a couple of applications is enough to resolve it. I also use the oestrogen pressures twice a week.

I’m very fortunate with my GP. Shes’s sympathetic and helpful. I use vaginal oestrogen cream wherever needed inside and out (applied with fingers not applicator) 2/3 times a week and hyalofemme ( hylauronic gel) otherwise. These are prescribed but both can be bought over the counter, which I have done in an emergency.

It’s not a magic cure for VA but it really helps reduce UTIs, dryness and soreness , ‘plumps up’ and definitely makes sex more appealing and enjoyable!

Thank you for replying. I'm glad you found something that worked. Did it take very long to clear up once you started using it?