Vagifem pessaries

[talkhealth]

My question is relating to Vagifem pessaries. Briefly had a hysterectomy at 42 (ovaries left in situ), went into a menopause about 18 months later. Had an oral HRT (very low does, but can't remember the name), but only took it for a few years as the surgery I was under had no ongoing care or monitoring for HRT and I felt I'd been left using something without a back up. 2 years ago I started spotting and bleeding and it was found that the vaginal tissue had atrophied and become so thin that even walking would induce bleeding, let alone intercourse. Was prescribed Vagifem pessaries to be used twice weekly. In the summer of 2014 I was refused the prescription with the information that this was not to be used longterm (contrary to the advice given by my consultant who was happy for it to be used longterm). I am now in the position of having this prescription refused, and the bleeding/spotting returning. I am 64 and wonder if I can press for this prescription as I am concerned that if the bleeding/spotting returns will I then be vulnerable to infections in this area as the tissues will thin even further. I am willing to reduce the Vagifem and have (until the script ran out) reduced it to using 1 pessary every 3 weeks, with no breakthrough bleeding. I have also researched and found that Vagicap is less of an issue as it is less systemic absorption, but am reluctant to ask my surgery for this as they are not very open to any suggestions. Any advice please?
With thanks, Janice

[Infertility Network UK]

Hi Janice. I’m afraid I do not know lots about the uses of Vagifem, only that they are not recommended for long term use. I feel that as it has been some months since you were originally prescribed the pessaries, perhaps now is the time to seek further advice from your consultant, armed with the information you have been given by your pharmacist. I do hope that this is soon remedied, so as to prevent you from further discomfort. Diane

[Mr Stelios Doumouchtsis]

As your symptoms appear chronic and quite significant I would also recommend a gynaecological clinical assessment prior to considering further treatments.

[Mr Peter Greenhouse]

At the time you first received your advice from the GP, the Vagifem pessary dose was 25micrograms of estrogen - although most gynaecologists reckoned that this was safe to take lifelong, it wasn't officially passed for this use.
Now the dose has decreased to 10micrograms per pessary, Vagifem can officially & safely be used lifelong even in women with breast cancer because the total amount of estrogen absorbed by the body is minuscule (around 1.5grams over an entire year).
So, as advised by my colleague Stelios, get yourself to a gynaecologist and start the treatment as it will make a huge - and entirely safe - difference to your quality of life.

[Heather Currie]

Completely agree with Peter, Vagifem is licensed, and recommended to be used long term. If not, the symptoms just keep returning. Suggest provide this information and, when prescribed, continue using it twice weekly.
Best wishes
Dr Heather Currie
MD Menopause Matters Ltd www.menopausematters.co.uk
Chair Elect British Menopause Society www.thebms.org.uk