Vaginal HRT

[tessaraas]

I have been using Vagifem pessaries for vaginal atrophy,over a two year period,on and off. As I still have uterus,how safe is this? I didn't have dryness,but had an unpleasant smelling discharge. Swabs revealed no bacteria were present and on clinical exam Atrophy was diagnosed. I now use Vagifem once or twice weekly.

[Mr. Hugh Byrne, MRCOG]

Ideally you need progesterone to oppose the estrogen, otherwise the estrogen you are absorbing throught the vagina will stimulate the womb lining to overgrow. I would advise occasional estrogen use if you need it, estriol cream 0.01%, but only every 2-3 weeks. To reassure yourself, I would also advise and ultrasound of the womb lining and perhaps a biopsy if it is thickened. Also, beware in case the discharge is a sign of the womb lining overgrowing.

[tessaraas]

Thanks for advice. I had a scan and biopsy a few years ago,before I started the pessaries,and it indicated a slightly thickened endometrium. Consultant told me to return if I had any more vaginal bleeding,which I haven't done. My GP prescribed the pessaries for treating the atrophy. I've been using them intermittently over a two year period. I think I will stop them.

[Dr Sarah Gray]

I would disagree as there is no evidence that the very low dose of estrogen in vagifem will have any stimulant effect on the lining ot the womb with twice a week use. Addititional progestogens are not necessary.

It is possible that the change in smell relates to insufficent estrogen to restore the natural acidity and organisms to the vagina.