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.

It took a while to completely clear up, maybe a couple of weeks, but my symptoms improved very rapidly.

Thanks - that's really good to hear!

Did anyone have thick discharge with their symptoms? All thrush bv etc clear

I’m sure other topical steroids would also be effective. They can only be used in the short term though.

@AuntieBiotics It's very unfortunate that GPs are not experts on this.
You won't find many consultants forcing this 2 x a week on you.

The reason the licensing says 2 x a week is that is all the trials did when it was manufactured decades ago. There is no further research on using it more often.

Decades ago (I've used it for 20 years) there was a 'caution' with it - to prescribe a course of progesterone every now and then to thin the womb lining. This was a 'just in case' directive but even then, very few doctors did that. (Mine didn't.)

There is now no guidance on prescribing a short course of progesterone. This is because there appears to be no risk of it thickening the womb lining. Obviously if anyone with a womb uses it more than 2 x a week and has bleeding it needs investigating.

You've had a hysterectomy so the risk doesn't exist!

Would progesterone help sore nether regions??

Good grief- NO. 😁
It raises body temperature and is likely to make any soreness a lot worse.
A lot of women find bladder issues worse when on the progesterone phase of HRT.

Ime vaginal estrogen really didn’t really help the burning stinging pain. I ended up using 1% hydrocortisone ointment- the Vaseline containing one, for a few days and that made the problem go away. It still flares up every now and then.

Just to add- my symptoms were all external

I can concur with my own experience. I've used it many times a week for the last few years and on my last ultrasound I was found to have a very thin endometrium.

Do you still use vaginal oestrogen too? Most of my pain is external. It's so sensitive to touch - particularly when I apply my first lot of hydromol of the day - that it sets of off a pelvic floor spasm that makes sitting down extremely uncomfortable. It eases off as the day goes on.