Smear too painful - what's in the pessaries?

[SaltyCrisps]

Hello all.

I went along for a smear y/day, but the speculum was far too painful and the nurse couldn't open it. It's 7 years, apparently, since I last had a smear. This should be the last one I'll have.

The nurse has told me that this can happen as we get older and has prescribed some kind of pessary or cream (I've not got it yet, so not sure which). She said that I'll need to take it daily for a couple of weeks, and then twice weekly until about November. She said I should then return and things should be easier.

Does anybody know what kind of side-effects the drugs in the pessaries might have? Obviously I'd like to be able to have my smear to know that all is well, but on the other hand I've been quite lucky with menopause etc (now over), and I don't want to run the risk of messing things up hormonally for the rest of my life.

Any insights very gratefully received.

There is a small dose of oestrogen - using as directed, an initial "loading" of the cells in the area and then twice weekly going forward, for one year is said to be the equivalent to one or two days' worth of HRT. So a tiny, tiny dose.

It is helpful for general comfort, as well as during smears, and for preventing UTIs, as well.

Unfortunately, the leaflet of possible side effects is the same one they put in for the vastly larger doses of HRT and birth control pills, and looks quite scary. Doctors have being lobbying for years for the insert information to be updated to reflect the reality, but change is slow or stalled.

You can get the same tiny dose in a cream (called Ovestin), which can also be used on the vulva, if you find for whatever reason you don't like the pessary.

To me, there are no downsides. I was prescribed the cream after an excruciating smear, and wish I'd known to use it years before I started on it.

It could be the Vagifem pessary which is a low dose of oestrogen which is like a little pellet inserted into the vagina. Many women use them as the walls of the vagina get uncomfortable and dry out after menopause (atrophy) It helps restore the tissues. It's not HRT. There's also a cream you can use instead. It's also used if you get uncomfortable or say twitchy urethra symptoms after menopause.

I had exactly the same experience as you in as much as it was a painful smear that made me realise I had vaginal atrophy. (Sex had become painful, but didn't click what was going on until a smear test).

I take Vagifem which is prescribed, and used in exactly the way you describe - inserted before bed daily for a fortnight, then twice weekly. (I use it Mondays and Fridays). It's been a godsend. Will use it indefinitely.

When I was first prescribed it, I was told to ignore the list of possible side effects in the leaflet because it hasn't been updated. Vagifem is now sold over the counter from the pharmacy, so a prescription isn't even necessary. Although it's very low dose oestrogen, it doesn't absorb into the bloodstream as it's localised application means it stays in the vaginal walls. Am actually dealing with breast cancer at the moment and although I have been made to stop HRT, am still allowed to use this (despite my cancer being oestrogen +/hormone receptive).

Thank you very much, all three of you. That's very reassuring and informative! I'll definitely take the pessaries. Sounds like I could be suffering from this vaginal atrophy thing (and if lack of use has anything to do with it then it sounds more likely than not 😂)

Also ask them to use the smallest instrument that they use for the smear as it makes a big difference as I get so anxious and now try to just do deep breathing and relax and it does make it easier. Hope it goes ok for you.

What is the actual point of having a smear any more? They only look at the cells if you are hpv positive, which can be diagnosed in a urine test.