After discussion with my GP about things like depression and vaginal soreness, she started me on Estrogen vaginal pessaries and cream.

She suggested oral HRT for me but I refused because I haven't had any bad menopausal symptoms, and another reason I didn't want HRT is because my mother died from cervical cancer, and my cousin is being treated for breast cancer right now. Both no-nos when it comes to predisposing causes of cancer, when HRT is introduced.

I've had bowel cancer and a basal cell cancer myself. My father and brother died from different types of cancer but I don't suppose that's relevant. I think my family history of cancer is too great for me to think about HRT when maybe it's not that necessary.

But.....after telling my doctor that I didn't want HRT for all the above reasons I see when I read the warnings on the literature that comes with the cream and pessaries, all the same risks of oral HRT are relevant with the pessaries and creams, and my family history of cancer practically precludes me from using them.

With all of these risks in my brain, I did however decide to try them for a little while. Those along with the Evening Primrose Oil that I also take.

I've been using these pessaries and cream for 2 weeks now and I've broken out in acne!

I wouldn't have thought that hormones introduced vaginally would have the same effect on the body.

Are things like acne normal reaction to someone starting HRT, and if it is, does the acne go away?

We're talking about a 57 year old Grandma with acne here! I ain't 17 any more!

Hi Koala,

I have used Vagifem in the past and now use Premarin cream. The Vagifem is a tiny little pill that is inserted and very little is systemically absorbed. However, with the Premarin cream there is more that is systemically absorbed. The way the ob/gyn and urogynecologist explained it is that it depends on how thin your tissues are. If very thin (have had that before), the Premarin cream CAN be rapidly absorbed UNTIL you have used it for awhile and as your tissues become more thick or rather plumped up as they put it. I have never had the acne problem but I would think it is very possible that the additional estrogen may be part of it. I think over time or as you continue to use it you will adjust. I should add that at first I was told to use 1 gram 3 times a week. Now it seems all I need is 1/2 a gram 2 to 3 times a week...sometimes even less than that. All in all and even though I said some is absorbed it is actually a lot less than any oral tablet or transdermal patch. I hope this helps a little.

Thanks Kathy. I have used Vagifem before but this one is a much higher estogen dose from what I can work out.

I was told to use it every day for now, but will probably go down to twice a week in a little while.

I didn't have any side effects from the vagifem. Definitely no acne.

absorbs drugs very well.... it does not have to be thin to do so.

In fact because the absorption from this route, bypasses the portal system (liver)....much lower doses are needed.

This is an article that explains it:
http://www.medscape.com/viewarticle/504375_6

The cocaine connection is REAL.... a man killed his wife this way and was convicted of murder!
http://en.wikipedia.org/wiki/Lowell_Amos
A convenient way to kill a woman!

Koala,

What is the dose that you came up with? The Premarin Cream I use is 0.625 per gram. I was told originally to use 1 gram per day for two weeks but am now using half a gram 3 times a week. The way it was explained by my Urogynecologist is that when you first start using it, it is like going through thin tissue paper. But with time, and as tissues plump up, it is more like trying to push it through cardboard...his words not mine. My Reproductive Endocrinologist also explained it in much the same way. So, with time you should be able to go a bit lower; more of it will stay local yet you will still get some systemically although not as much as when you FIRST begin it. This was also one of the preferred ways to come off of the HRT patch I was using; still getting the benefits of estrogen but not having to use both. It has worked very, very well. Oops, forgot to add...it is also helping a great deal with minor prolapses I have. As of the last checkup they have not worsened but I have also done pelvic floor PT as well.

Thank you ladies.

I didn't realise that the vaginal route would bypass the liver so I daresay there's a lot to be said for using that way if you think of in that context. I always knew that medications administered rectally were well absorbed and usually absorbed quicker than the oral route, so why not vaginally? I just didn't think of it in that manner.

That was terrible about that murder verdict but I thank you for sharing those links Mrsd, even though I wasn't able to access the Medscape one. I hope you enjoy your vacation, and I thank you for taking time out to answer this question for me.

Thank you as well Kathi.

The Vagifem pessaries I was using are 250 micrograms of Oestriol, where the Ovestin pessaries I'm on now are double that at 500mcgs of Oestriol, and the Ovestin cream administers 15G of Oestriol in each application (I think).

I don't know if those doses are large enough to exhibit hormonal changes like acne, but I daresay it would be possible if used in large enough doses. I'll let you know if I get sore breasts!

Does anyone know if Evening Primrose Oil would cause hormonal changes as I haven't been taking that very long either?

Thank you for your replies.

This is a quote from the article.... you can sign up for
Medscape for free.

Thank you Mrsd.

Koala,

1 Microgram = 0.001 Milligrams.

It SOUNDS like your doc has your right around 1 gram per day to start with. But with time and as you said, you will be taking that down to 2x a week. I have to laugh because when I first started using the Premarin Cream, I was told to use 1 gram per day which equates to .625 per day. Oh, boy, did I ever get "hits" from that. I was having PMS like symptoms those whole two weeks. I hadn't had PMS for ages so I didn't recognize it for what it was. But that's when the doc explained that the vaginal mucosa acts like a sieve. Since my tissues were very thin I was abosrbing it fast and often of course. But then when I started the "maintenance" dose as he put it, 2x a week, I was much, much better. Over time and of course after stopping the Vivelle dot patch .025, I now use the .625 3x a week but at HALF a gram. I no longer have the "hits" at all and again, at the last checkup my tissues are in great shape...so he said.

Anyway, I have no doubt that acne could occur but I just didn't have that happen at all as I never even used 1 gram of the Vivelle dot. It was always .05, then down again and finally to .025.

A friend of mine called yesterday and she was talking about the Premarin Cream. A bit OT I know. But she had issues with the Vivelle dot and can
t use any form of transdermal patch or oral estrogen. So, she is also using the Premarin Cream and sees the same Urogyn and the same RE I do. Anyway, it was also a balancing act for her so I suggested to try it the way I was doing. She was using 1 gram (.625) twice a week but then went ahead and took it down to half a gram. She told me she is doing much, much better using that amount 3x a week. It seems to the both of us that it is just enough and more consistent. Forgot to add too...both of us have had total hysterectomies so it has been a real balancing act through the years.

And know too, our requirements have changed. That was something else that was mentioned by our doc. In the beginning we were taking or using higher doses. But since 8 years have passed since our surgeries we were able to go much, much lower.

Anyway, what it all comes down to is what is the lowest and most effective dose to treat our symptoms. Everyone is sooo different.

As for the Evening Primrose Oil, I tried that a LONG time ago. I can't really comment on it since I didn't take it for very long. Maybe Mrs. D. can explain more about it.

Thank you Kathi.

I'll give I a bit longer and see how I go, but as I said before I daresay I'll be dropping back to twice weekly soon.

I wonder if there would be any benefit with alternating the Ovestin and the Vagifem. I still have several boxes of that one. Just a thought.

Thank you again. I do appreciate your taking the time to reply.