Vagifem:Novonordisk on withdrawing 25 mcgs

[susan]

This is Novonordisk on why they are ceasing production from 31st December 2012. I have copied and pasted the link from their website rather than put the whole of it in the post.

www.novonordisk.co.uk/documents/article_page/document/hrt_pro_common_questions.asp

A few things that were of personal interest to me on reading it through.

One is that Vagifem 25 mcgs has been in useage for 20 years, so it seems odd to me that many UK GP's never seem to have heard of it.

It also astounds me that there has been no research into this

Can we double up or increase the dose if Vagifem 10 does not work ?

Their response - Available clinical data shows that 10mg is effective therapy for the treatment of vaginal atrophy at the approved dosing regime, which is once a day for the first two weeks and twice a week there after.

We have no available data on the use of double dosing of 10 mcgs.

We know from what we read on the net that some women are already using 3,4 maybe 5 of the 10 mcgs a week under direction of their GP's, because they felt it was in some way 'safer'. I have never understood this as I have never felt vaginal oestrogens unsafe in anyway, I feel they are a positive product that if taken at the right time in life can even help prevent awful things like prolapses.

But we have to be mindful that there is (albeit small amount) of risk averse women that are terrified of any form of HRT.

Finally the other products they say are clinically effective for vaginal atrophy are:

Premarin Cream (conjugated oestogens 0.625mcg/g Wyeth Pharmacuticals
Gynest Cream (estriol 0.1% cream) - Marlborough
Ovestin Cream (estriol 0.1% cream) - Merck Sharp and Dohme Ltd
Ortho Gynest (estriol 0.5 mg pessary) - Jassen-Clegg Ltd
estring (estradiol 7.5 mg vaginal ring) - Pfizer Ltd


There is also a link on their site on how to switch from 25 mcg to 10 mcg.

A 25 mcg tablet costs 63p
A 10 mcg tablet costs 69p

I am not even going to state the obvious on the pro-rata figures for this.

Maybe l'oreals 'because you're worth it' says it better !!! (not)

xxxx

[susan]

Hi sweetpea

I cant give an opinion in the sense of having tried them, but in terms of the reading I have done over the last few years, I would say all would work for vaginal atrophy if you did the 14 days followed by the 2 a week forever.

This as it is hardly a clinical trial but a numpty GP clicked on the wrong button & prsecribed me 6 months worth of the ortho-gynest pessaries, DH collected & filled the script, so I didn't notice till I had them !!!

Not liking waste, I put an O-G in on a night I was due a vagifem, & I had to to quickly yoick it out as it appeared to be 'fizzing' & it seemed to be was burning me.

I must stress though that I had been on vagifem 25 for approx a year & I strongly suspect that is why I had those sensations.

I found them to be totally un-user friendly compared to a vagifem.

In that respect vagifem is in a different league than messing about with your fingers pushing something in that is 20 times the size of a vagifem, they have no applicator. However I am aware that it is all a matter of what you get used to and if Ortho-Gynest pessaries were the only thing out there for Vaginal Atrophy. I would be on them like a shot rather than suffer.

I'm convinced the ease of use of a Vagifem is one the reasons it is so popular. There is no leakage at all and IMHO within seconds of insertion you have forgotten about it and do not need to think about it for another 3 or 4 days.

However the general consensus was is that Ortho-Gynest is a less strong oestrogen which some like so I don't want to put anyone off.

I also know Bella uses Ortho-Gynest pessaries and finds them great & her opinion on these matters is to be trusted, so maybe she will post her views and why she likes them.

Back to me, if I cannot get on with the Vagifem 10 mcgs then I will ask for ovestin cream next, i've no idea why, I guess it is just becuase you have to try something & see if it works for you.

I dont think 10 mcgs of vagifem a week will be enough for me and I am also on systemic HRT which should be helping.

xxxx

[susan]

Aug 25, 2012 15:29:02 GMT @sweetpea said:

Thanks for your advice Susan - I don't think the lower dose would be enough for me as I still get a little itching and dryness at times and usually end up putting an extra 25 mcg in. If we ended up doing the 5 vagifem a week to achieve the same aim then what is the point of that.

Is the Ovestin cream in a pessary form too? I was thinking of asking for some Ovestin cream (to apply locally and not internally) to compliment the vagifem so it may be as well going on it altogether. I have heard it is messier and that is why, as you point out, that many women go for the vagifem.

It seems to be one long fight for us with this HRT malarkey.

I am not on any other form of HRT as I seem to be one of the luckier ones in that I am, other than having VA, OK. I had an early meno at around 43ish - went on full HRT for five years, weaned off gradually over a few months and have been fine ever since.

Glad to hear you are managing well without systemic sweetpea. Although I use the vagifem 25 mcgs I have actually got a tube of ovestin that I brought back from holiday. I am keeping it in reserve incase I want to smear a little on my external area. It only comes as a cream I'm afraid, not a pessary.

The tube is tiny, but I guess when on the maintenance dose you only need 8 applications of it per 4 week.

The good news is it comes with an applicator ( just gone and got it from the bedroom to check for you as I hadn't investigated it). But it's a reusable applicator so I guess you have to wash it and let it air dry every time you use it you use, unlike the vagifem ones that you can use and then pop on the bedside table to chuck away the next day.

I think it you attach it to the neck of the tube and it has a plunge action so you get the exact right dose each time.

My gut feeling is anyone who is on it for 5 or 10 years will end up using their fingers so they don't have to mess about washing the applicator/plunger.

I suppose I will have to ask my GP for 6 of the little tubes as I normally get six months of vagifem. Assuming one tube is a months supply - can't read the leaflet as it's in Spanish. Doh !

Bella, I didn't realise how funny that sounded until you quoted it back at me. You have to laugh at the written word sometimes.

xxxx

[susan]

Yes I am sure it's a done deal even my poor math tells me they will make 100 % more on this product. I could be panicking unnecessarily and the 10 mcgs twice a week might do it for me, but I'm not confident.

Very good point about using the ovestin for vaginal atrophy proper ( rather than just a bit of external smearing).

It needs to be an exact dose and to be inserted as high up as possible.

I wonder if the ovestin applicator is dishwasher proof. Ewwh !

The vagifem ones look like they would survive a nuclear blast.

On the plus side I quite like Novonordisks website. Not much of a plus though.

xxxx

[susan]

Your welcome sweetheart. I have to admitt to already having a stockpile

If you have severe vaginal atrophy, when you go for your appointment maybe you could discuss the 'estring' with your GP?. In a way if you are prepared to have a small coil inserted that is the least obtrusive way of all. You don't even have to remember to pop in the two vagifem a week.

It's something I will consider if I can't get on with two x 10 mcgs a week or ovestin cream.

I might put up a short thread on it just incase women are looking about for viable alternatives to vagifem 25mcgs.

xxxx

[susan]

I think sadly it is down to money pinky, they can make far more from the 10 mcgs. They are only a few pence cheaper per unit than the 25 mcgs but of course carry less than half of the amount of the real hormone we are after, the estradiol.

With regard to your own situation, I do agree that at the beginning of any treatment programme, it's hard to work out if it is the condition itself ie the vaginal atrophy getting worse, or some kind of initial side effect from the product. I think this is why all medical professionals say to stick with things for 3 months, provided it is not making you extremely ill and it's only minor discomfort you are going through. Then you can assess if it's really the product for you.

If after that time you really think its not for you than move on to maybe ovestin or ortho gynest or even try an estring.

I am wondering if the trout pout (love that expression) is an initial reaction to re-intoducing oestrogen to the area and will calm down of its own accord.

xxxx

[susan]

Oh my goodness that must be the IPad talking it is called the Estring not the G String.

I would imagine the E is for estradiol.

xxxx

[susan]

My gut feeling is that the trout pout came about from the inital consecutive days treatments and that once the 14 days was completed and you had gone on the 2 a week regime it would have all calmed down.

I love the comments from your Dr's. Nothing is TMI for me.

I have had a few classics in my time, just as well I have what I think is a good sense of humor.

Whilst having a trans-vaginal scan "Hmm Mrs Bloggs, I don't seem to be able to find your ovaries, can you lift your bottom up a bit so I can see better? I think they must be hiding behind your bowels" - i was desperately trying not to laugh.

Having smear - "Mmm, I cant get in there properly your vaginal walls seem to have collapsed" - I was so desperate to make a crude comment about other things that had been able to make their way in there I had to bite my lip.

Perhaps we should all get together and write a Comedy book on inane things that have been said to us whilst dealing with Gynea issues.

I am going of to see if I can find out anything about the Estring which I will now fondly think of as a G String. [/IMG] But need to cook first.

xxxx

[susan]

Thats so funny sweatpea. You must have been so proud.

When I was in the anasthetic room last year being put under for my hysteroscopy (camera thing), they asked me if it was OK if a couple of medical students could have a look while I was under.

I am embarrassed to say that I was in such a foul mood that I just said no.

Felt a bit bad after as they have all got to get trained somehow otherwise there will be no gyneas in the future.

They probably thought cos I came accross as a nice middle aged old dear i would be easy meat.

xxxx

[jacksfullofaces]

Aug 26, 2012 12:34:28 GMT susan said:

Thats so funny sweatpea. You must have been so proud.

When I was in the anasthetic room last year being put under for my hysteroscopy (camera thing), they asked me if it was OK if a couple of medical students could have a look while I was under.

I am embarrassed to say that I was in such a foul mood that I just said no.

Felt a bit bad after as they have all got to get trained somehow otherwise there will be no gyneas in the future.

They probably thought cos I came accross as a nice middle aged old dear i would be easy meat.

xxxx

Susan
You easy meat ;D bet you would be tough at a poker table
Jacks

[jacksfullofaces]

Having smear - "Mmm, I cant get in there properly your vaginal walls seem to have collapsed" - I was so desperate to make a crude comment about other things that had been able to make their way in there I had to bite my lip.

Hm I went one further
" Mrs Pokerplayer could you please spread your legs"
me
"hmm I usually only get this request from my husband"
shocked silence and room burst out laughing.

[susan]

[/quote]
Susan
You easy meat ;D bet you would be tough at a poker table
Jacks[/quote]

I have my moments Jacks. I have to be careful as to when to pick my battles so I don't come of worse though.

xxxx