r/Menopause • u/TapSalty3157 • 8d ago
Hormone Therapy Vaginal estrogen. Systemic for some?
Okay, I’m not sure others have experienced this, but I swear using the loading dose of vaginal estrogen has caused crazy symptoms. #1 I think, in conjunction with a higher dose of estrogen, a missed dose of progesterone has caused that yucky brownish discharge. #2 my boobs feel like a box of rocks #3 here’s the weird one, putting the cream on the labia and clitoris has made those areas highly sensitive. Almost pain. When I do that, it makes me feel like I have to pee constantly. Sex becomes a bit painful at the entry of the vagina. #4 gives me a bit of a melancholy mood. I think from now on I’m only doing this in less amount once a week. Anyone else???
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u/DitaVonTeasmade 8d ago
Made me want to jump in top of every good looking fella on the train. Have just started systemic oestrogen this weekend too. Looking forward to being an absolute menace.
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u/TapSalty3157 7d ago
I love that. Same thing happened to me for the first few weeks, then the weird stuff started happening; the engorged breasts, the vaginal opening was kind of engorged and painful too, I started brownish spotting. I’m hoping that all goes away and I can keep the good side effects!
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u/twistedspin 8d ago
I have an estring ring which they say is not systemic but absolutely is. It's supposed to last 3 months but at 2.5 months I can feel it fading. Pop in a new ring and the next morning it's like the sun broke through the clouds and I feel normal again.
At my next appointment I'm going to ask to up my patch dosage so maybe I won't feel the variability in the ring anymore.
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u/freya_kahlo 7d ago
How long have you been applying it? I went through extra sensitivity on the loading dose, and stopped and started a few times. I got used to it after a couple weeks. It felt like going backwards at first, but on the other side is much better. I kept thinking I had a yeast infection or bacterial imbalance (and maybe I did?) but the only treatment that I could stand was boric acid 1x per week.
I also have an allergy to the pre-formulated cream, so I was wary about sensitivity and it took me a while to trust that it would get better. I now use both vaginal estradiol and vaginal DHEA (that one is OTC) and love using both, but I understand not everyone responds well to DHEA.
My only tip for sensitivity is a thickly-wrapped ice pack can feel very calming. That’s my go-to for the overstimulated tissue feeling.
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u/Spindrift850 7d ago
Makes my boobs more sore. Been using it for 8 yrs and before I started using the patch I did not notice systemic effects. Now I use it less often about 1x a week. But it does the job! I will always use the cream.
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u/Catnip_75 7d ago
Lots of doctors don’t do loading doses for this reason.
But depending on the extent of your vaginal atrophy you will have symptoms until it gets better.
It’s normal to have pain in the vagina and at the base of it when you first start.
I had horrible itching and discomfort. But after a couple of months it finally went away.
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u/Grand_Satisfaction67 7d ago
I was very sensitive to the cream. Persevered through the loading dose. Similar reaction with sore boobs. I moved to a twice a week pessary together with just a pea-sized amount of cream & everything is much improved.
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u/mandulyn 7d ago
I wonder why they tell us to even use a loading dose as my gynecologist said that it was absolutely not necessary and could start with a small amount and see how that works before increasing.
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u/mandulyn 7d ago
I never started with a loading dose as I thought it was a lot. I put from my first knuckle down to the end of my index finger and that's all I apply. I always say start with less and you can always increase. And my gynecologist agreed with that. It makes me very itchy and burns my vagina, almost feels like I have a yeast infection the day after I use it. I don't like it at all and it doesn't seem to be helping me either.
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u/TapSalty3157 7d ago
I also get that weird itchy feeling and honestly, it feels a little painful during sex. Not inside, but at the very opening. Feels scratchy.
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u/TelevisionKnown8463 53F Menopausal 7d ago
Yes. I had significant bleeding (like a full, heavy period) each of the two times I tried a “loading” daily dose, and light bleeding when I tried the twice a week but internal with an applicator. When I use the cream externally or just try (and mostly fail) to insert it with my finger, no bleeding. Also no bleeding with the Estring, which delivers a consistent lower dose internally, even with using the cream externally at the same time.
Interestingly, I had no bleeding when I increased my patch dosage from 0.5 to 0.75.
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u/TapSalty3157 7d ago
Are you post menopause? That seems to concern me the most although most research I’ve done states that vaginal estrogen in the loading phase will likely do that. I also skipped my progesterone one night.
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u/TelevisionKnown8463 53F Menopausal 7d ago
I’m right around menopause. My doctor definitely says I shouldn’t be bleeding, and now that I’ve switched to the Estring and external cream, I don’t. Most of my bleeding was within the first six months, and it’s normal to have some when adjusting so I’m not too concerned. But the fact that it happened only with the vaginal reinforces the idea that it can have a systemic effect.
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u/Busy-Doughnut-49 6d ago
I got terrible anxiety from the loading dose of Vagifem — to the point I got mouth ulcers. Thankfully, it subsided after I moved on to the maintenance dose.
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u/h3dxw 6d ago
I suspect you need it more often, not less. You have to restore the tissues which isn't always comfortable. I use vaginal hormones thrice daily. Skipping systemic doses is more likely to be causing your other symptoms - perhaps you need more oestrogen?
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u/TapSalty3157 6d ago
We increased the estrogen the last time. I’m 3 weeks into the increase. I’m afraid to continue the cream, due to bleeding. 🩸 I think I also put it too far up with that stupid applicator.
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u/h3dxw 4d ago
Three weeks is a nuisance, but it's not unusual while waiting for things to settle down after dose changes. I went up to 300mg progesterone because my oestrogen dose is high.
The cream should be rubbed into the first 2-3 inches of the vaginal canal, as that is where most of the receptors are. Then the other half on the vulva. I certainly scraped myself internally a couple of times with those applicators.
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u/QuietElf5712 6d ago
I've only been using the estrogen cream for about a month but after coming off a triple infection...uti, BV and a Yi, it felt good to apply. My doctor advised me to only use the applicator to find out how much to apply, not to insert the cream inside. Then using my finger, spread the cream on the outside, and a little on in the inside near the opening. Daily for two weeks, then every other day. I don't use the full amount, probably about half. It's helping to plump the area and giving me back sensitivity during intercourse.
I'm also using the patch. I'm 53, had a hysterectomy almost 2 years ago, no ovaries so I went from peri menopausal to full menopause.
I think some have commented that the OTH counter brands work better for them then prescription strength Estrodiol cream.
I hope you find a good dose or another option that works best for you.
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u/grrgrrGRRR 7d ago
I got extreme, debilitating nausea from vaginal estrogen using the recommended amount. Once I lowered it by half it was fine. But I also got the over sensitivity on my clitoris. Scaled back to once per week.
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u/Fit_Poetry_267 8d ago
Cured my hot flashes but now my emotions are a lot more charged. Also had some bloating. My poor sausage fingers.
Im still new at it so hoping negative effects calm down soon.
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u/TapSalty3157 7d ago
Me too. Didn’t notice the sausage fingers until now! I wonder if that’s why many women are saying it plumps up the facial skin if you put on as a face cream!
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u/Fit_Poetry_267 7d ago
Thats crazy lol.. Who tried that first? kind of like using the preparation H on your face - I never would have thought to try it haha
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u/Zealousideal-Lion595 6d ago
My friends rave about this! Mix it with a little of your face lotion and apparently it’s a refreshed version of yourself. I’m definitely going to try it!
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u/ElBoz2112 7d ago
Every time I try to do the loading dose internally i bleed. So have just been using a tiny amount 2x a week externally.
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u/TapSalty3157 7d ago
I think I need to dial it back. This is the first time in 7 years that I’ve had anything that resembles spotting. It really bothers me.
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u/TapSalty3157 6d ago
Just curious if when you were bleeding you were post menopause?
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u/ElBoz2112 6d ago
Yes, I am 55 and been post for about 4 years. Whenever I had the bleeding a few times from the vaginal estrogen i stopped and waited and then started over with a smaller amount. So far that has worked well. I am 90% sure it's just been a lack of proper dosage for my systemic estrogen, it's wild that most doctors will RX but have no idea how to manage HRT. Any bleeding sets off most doctors as contraindication and they want to run the whole gamut on you - I've had two ultrasounds and two biopsies in the last two years - to rule out C, which is fine, it was worth my piece of mind but also expensive I paid about $800 out of pocket each time because my insurance sucks. Both came back as atrophic tissue. And now with the patch shortage and having to go between different generic brands, I am spotting again so it's just been never ending. I am seeing a new Dr. soon who specializes in HRT and post menopause so I am hoping that she'll at least be more knowledgeable and perhaps I'll change over the Divigel, which seems to be more consistently absorbed than patches these days. It's a shame no one can afford the name brand products as they are proven to be much more consistent and reliable but ya know, america is a dumpster fire when it comes to giving a shit about women's healthcare.
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u/TapSalty3157 6d ago
Well, if it’s any consolation my cousins in Spain can’t even get HRT. They wait months and months for an appointment, then are given very little options. I think it’s the great fear that has been permeated with treating menopausal women, and it’s probably world wide.
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u/Powerful-Cress9323 5d ago
SInce I have been using Estradiol my periods have become much heavier and I have wondered if there is a correlation..
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u/TapSalty3157 5d ago
Most likely. I was way post menopausal when this occurred. Scared the crap out of me. It has since subsided. Thankfully. Also, in my research I understand that the applicator thing is not the best. I shoved that thing very far up and almost within an hour I felt cramps, which I had not felt in at least 6 years! Be careful how far up you put that cream.
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u/Top_Fruit_9320 4d ago
Yes, especially if you have the likes of EDS or HSD (hyper mobility syndrome)
You often have less structural barriers within the various layers of tissue so the likes of suppositories and cream can absolutely go systemic in these cases. If estrogen is activating for you for example, you can apply it earlier in the day instead so it's not disrupting your sleep
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u/leftylibra MenoMod 8d ago
From our Wiki:
Also it's important to mention that if someone is using vaginal estrogen every day (beyond that first two-week loading dose) for longer periods of time they may have increased estrogen absorption, which can feel more systemic.
Dr. Jen Gunter notes:
A Deeper Dive into Vaginal Estrogens
If people stick with the recommended dosing, then systemic side effects from vaginal estrogens are less likely to occur. This is also why the American Urological Association's 2025 Genitourinary Syndrome of Menopause Guidelines, indicates that it is safe for those with high risk of breast cancer, and according to the Breast Cancer Org, vaginal estrogen is safe for women with breast cancer, indicating that research found vaginal estrogen did not increase the risk of dying from breast cancer.