Oestrogen pessaries/cream to make cervical screening more comfortable for menopausal women

I was wondering if anybody who has gone through the menopause has experienced the use of eostrogen pessaries or oestrogen cream to make the smear test more comfortable? If so, did you find that it made the test more comfortable to go through? I have been through the menopause and found my latest smear test very uncomfortable. I am sure it was partly due to anxiety but the nurse also mentioned that ladies who have been through menopause can find the smear test difficult due to change in tissues which take place - apparently tissues become tighter and this can cause the smear test to be uncomfortable. Because I found it so difficult I came home and did some research and saw some information on prescriptions being available for oestrogen pessaries or oestrogen cream for those who have been through the menopause as it can make the smear test easier to go through. As you have to obtain a prescription ahead of the test, I was also wondering why this isn't made known to women of menopausal age when they are booking their smear test appointment? Another concern is would using the pessaries or cream possibly interfere with the sample being taken - e.g. could it get onto the cells that have been taken and mean that sample could not be used for testing? As I said, has anybody experienced using the oestrogen pessary/cream and did you find it made the test more comfortable to have done please? Thank you.

Hello

I have been prescribed these and now use them on a regular basis at the recommendation of the consultant I saw at the hospital as they thought dryness may have made my screening seem like more severe cell changes than they found. After some research I upped my HRT to also using a progesterone tablet and oestrogen gel to alleviate other menopause symptoms - for me aching joints and fatigue. To my surprise I discovered that GPs are not trained in menopause. I can recommend the book Menopause by Dr Louise Newson who is a menopause specialist. I have also downloaded her app which helps me to manage symptoms. I have also discovered the NHS squeezy app which reminds you to do your pelvic floor exercises and guides you through them. Dr Philippa Kaye has also written a book called The M word which I can also recommend. From what I have read you should not use the pessaries for 2 days before your screening to avoid messing up the smear sample but probably best to ask the smear taker for advice. My last smear was a bit uncomfortable but I was only just post menopausal at 55 and I think the fear that it might hurt made me tense up more. I have also found that the pessaries have helped me with the need to wee more frequently which was caused by my depleting oestrogen levels. I was surprised how much better I feel for the HRT. I was told by my GP that the pessaries are very low risk HRT and can be used by women well into their 80s. As I have to have another smear in 3 years time I am determined to work on making it as pain free as possible so I am sticking with the HRT. Ironically it took quite a big health scare to educate me about the changes in my own body. I really hope this helps you and anyone else out there going through the menopause. I am finding the app a good source of motivation by signing up to some challenges such as committing to doing my pelvic floor exercises every day for a week. All the best

A x

PS when you book an appointment with your GP surgery to ask them to prescribe the pessaries/cream it's worth asking if they have a GP who specialises in menopause

Hi Laceey

Very good point - WHY isn't it the use of oestrogen creams/pessaries (and possibly other methods) to facilitate smear tests for menopausal women made known to them.  This is a very emotive (hence the long reply - apologies) subject for me because, partly on account of an extremely painful smear test when I was 47y and perimenopausal, I sadly stopped going for smear tests only to end up with a stage 2 cervical cancer age 60y - see my back story.  I take my hat of to you for finding out about oestrogen cream - the first i ever heard about it was when I was pouring my heart out to a lovely lady in a cancer support centre shortly after my cancer diagnosis; I was telling her all about my difficulties and regrets around smear tests and she said 'Oh, but you should have been offered oestrogen cream'  - 'omg' says me - 'if only I'd known....!!!!!'. 

A lot of menopausal women experience what is termed vulvo-vaginal atrophy (VVA - often shortened to VA) due to lack of oestrogen which includes thinning and drying of the skin in that area and oestrogen should help to reverse those changes.  I've never used oestrogen cream myself albeit, ironically, I've just (only about 17 years late!) been officially diagnosed with VA on account of problems with self catheterisation (a fall out from my cancer treatment) and have a prescription for Ovestin (contains oestriol) - I haven't used it yet because I want to understand more about it first because my lady bits are compromised by my cancer treatment and I'm not sure how well I can tolerate any side effects the cream may have.  To aid my understanding of the topic I have recently bought a book called 'Me and My Menopausal Vagina' by Jane Lewis: https://www.mymenopausalvagina.co.uk/

Also relevant is a blog on this website: https://www.jostrust.org.uk/about-us/news-and-blog/smear-tests-after-menopause

Since my cc diagnosis I've done a lot of awareness raising about the importance of smear tests.  Quite a lot of the older ladies I've spoken to describe their smear tests as very painful and there is evidence to show that pain is a significant reason for older women (like me) avoiding the test.  I think your nurse did well to explain that menopausal ladies especially can find the smear test difficult because otherwise you might have gone away feeling you were maybe some kind of oddity - that's how I felt after my painful, and what was to be my last, smear age 47y. I know I bear some responsibility for not going for smears after the age of 50y but I also feel very let down by the lack of information and support from the NHS for the menopause.

In answer to one of your questions, as to whether the cream/pessary can interfere with the sample being taken: I believe you simply stop using the product about 2 days before the smear test - best to check with your GP.

It's good you have posted on this subject - I think it's VERY important

x

 

 

Hello Laceey and Jazza

I would just like to add to answer your initial question Lacey that yes after using the pessaries I had 2 more smear tests last year (to check my treatment had worked called 'test of cure') They wanted to be especially thorough because of the discrepancy in my results and the pessaries did make it less uncomfortable. However the last two smears were done at the hospital colposcopy clinic and I found the colposcopy less uncomfortable than some smear tests - probably because they are experts in their field as well as because I had been given the pessaries. I really can recommend Dr Louise Newson's app (called Balance) as a source of information and support for all things menopause including atrophy. She has also recently set up a menopause charity and has done several you tube interviews which are informative. I agree with you Jazza WHY aren't post menopausal women given this advice in a leaflet from public health England when they are invited to their smear tests? I feel fortunate that I have the means and resources to find out information for myself but how many other women are out there who are unaware of treatments which can help them? I think it all comes back to the taboo and embarassment which surrounds women's health or possibly because the leaflets are produced by men who don't have smear tests and so don't realise what the issues are. Apparently the menopause is now required on the school curriculum for the first time in health education but I think there is still quite a long way to go for our society to treat menopausal and perimenopausal women with a bit more kindness and understanding. I think employers are now being encouraged to be more understanding of women's health needs in the workplace too but I think many women are too afraid or embarrassed to speak up. Lorraine on ITV has raised some awareness of the issues and talked openly about HRT and helped to open up the conversation. There is also evidence that cervical screening should not stop at 65 as more lives could be saved if it continued for longer so it is crucial that women and GPs are supported in the health care needs of menopausal women. Recently the RCOG published a report called Better For Women in which it outlined several recommendations to make it easier for women to access healthcare to support them with their reproductive and screening needs. Perhaps menopause needs should be included in these?

Sorry if this has been a bit of a rant but I have been shocked to find out how many of us women (myself included) are unaware of the symptoms of gynae cancers and have to ask myself why this is and I think it all comes back to this taboo on talking about women's health. Anyway I hope this information helps

A x

Hello Laceey and Jazza

I would just like to add to answer your initial question Lacey that yes after using the pessaries I had 2 more smear tests last year (to check my treatment had worked called 'test of cure') They wanted to be especially thorough because of the discrepancy in my results and the pessaries did make it less uncomfortable. However the last two smears were done at the hospital colposcopy clinic and I found the colposcopy less uncomfortable than some smear tests - probably because they are experts in their field as well as because I had been given the pessaries. I really can recommend Dr Louise Newson's app (called Balance) as a source of information and support for all things menopause including atrophy. She has also recently set up a menopause charity and has done several you tube interviews which are informative. I agree with you Jazza WHY aren't post menopausal women given this advice in a leaflet from public health England when they are invited to their smear tests? I feel fortunate that I have the means and resources to find out information for myself but how many other women are out there who are unaware of treatments which can help them? I think it all comes back to the taboo and embarassment which surrounds women's health or possibly because the leaflets are produced by men who don't have smear tests and so don't realise what the issues are. Apparently the menopause is now required on the school curriculum for the first time in health education but I think there is still quite a long way to go for our society to treat menopausal and perimenopausal women with a bit more kindness and understanding. I think employers are now being encouraged to be more understanding of women's health needs in the workplace too but I think many women are too afraid or embarrassed to speak up. Lorraine on ITV has raised some awareness of the issues and talked openly about HRT and helped to open up the conversation. There is also evidence that cervical screening should not stop at 65 as more lives could be saved if it continued for longer so it is crucial that women and GPs are supported in the health care needs of menopausal women. Recently the RCOG published a report called Better For Women in which it outlined several recommendations to make it easier for women to access healthcare to support them with their reproductive and screening needs. Perhaps menopause needs should be included in these?

Sorry if this has been a bit of a rant but I have been shocked to find out how many of us women (myself included) are unaware of the symptoms of gynae cancers and have to ask myself why this is and I think it all comes back to this taboo on talking about women's health. Anyway I hope this information helps

A x

 oops sorry I posted this twice!

 Hi 55

Just to let you know there will be 'delete' and 'edit' facility to the bottom right of each of your posts should you wish to do same.

x

 

Hi - thank you for replying! 

I am sorry to read of your past health problems. I had mild cell changes in my twenties after my very first smear (now 53) which was successfully treated with Interferon injections at the time, I don't know whether that is still a treatment today. Basically, it harnesses your immune system to go and fight in those areas where the injections have been administered into the cervix. Three appointments for injections based two weeks apart and injected on each appointment into four areas of the cervix. I have always found the smear test uncomfortable but this latest one more so. I don't just find it physically difficult but also the prospect of each smear fairly traumatic based on "will everything be ok because it once wasn't"? And, of course, finding it psychologically traumatic always impacts on the body by telling it to tense up - whereas to relax is what's needed - but because the whole thing feels like such an intrusion I find the whole thing very "alien" and so does my body!

I haven't always attended on schedule either. I did at first after the treatment I needed to correct the mild changes but when a few tests came back clear down the years I ended up leaving it a very long time before stealing myself to go to an appointment and so after a long absence I made myself attend again in 2011. It came back clear and I reverted to type and didn't attend again until a few days ago. So please don't be hard on yourself for those times you were due to attend and didn't - it is more difficult for some than others to face, I know it is for me even though I too am telling myself off now for having waited so long. I even removed myself from the list to be called for screening for a time as the screening letters were a reminder of the past that traumatised me. I actually fainted one time in my twenties upon receiving the injections - it wasn't the injections that were at fault - it was the person administering them who inserted the speculum with too much speed and force. I immediately started to sweat and not feel too good and when the process was completed I stood up, felt very dizzy, announced I felt very faint and very unceremoniously did pass out before I had the chance to get dressed again. The last thing I remembered was the nurse/consultant who had done the procedure saying to me when I told her I felt like I was going to faint "do you think you could get dresssed and make it across the corridor first as we have a full length bed there that you can lie on to feel better?" Well, I did end up on the bed she recommended but I didn't get there by myself! Whilst I was unconscous I went into a dream where I was being chased in a hospital by people I didn't want to catch me! When I woke out of my dream to my horror there were approx. 10 hospital staff standing around the bed they had carried me to and they were all looking at me - of course, I was very disoriented and until I properly came too I thought that the people I had just been running away from (in the dream) had caught me! I was horrified! To add insult to injury, the staff member who had treated me found it all quite humorous and said to her colleagues "can you imagine her having a baby?" Honestly! Just so unprofessional. Had she not been so gung-ho there may not have been this spectacle to start with! Oh my word, what a carry on, I am grateful for screening and know it is a great thing - but following that no wonder I'm not keen to put it mildly! I was told my blood pressure must have fallen, hence the fainting. When I had to go back to the next appointment it had been put in my notes to let me rest on the bed following treatment and for me to have a cup of tea and biscuit before leaving!

Another reason I haven't been often to screening is that I became abstinent and so I had wrongly assumed that as tests had come back clear since that decision that I had no reason to keep attending. I thought that the treatment having worked meant that the HPV had also been cleared from my body and couldn't come back again due to abstinence. I went on to discover more recently this year that this is not the case and that it can lie dormant in the body and cause further problems if the immune system becomes lowered. I also read that the immune system does tend to become lower in those who have been through menopause - oh joy! Hence I booked an appointment. When I was in my twenties with the mild cell changes I had never even heard of HPV, it wasn't spoken of then but I did see those letters on a medical letter sent to me at the time to take to my GP - that was when I first heard of it. 

I have learnt something new from reading that you were recommended regular use of the pessaries/cream at the recommendation of your consultant. I am now left wondering are they indicated for regular use when experiencing a difficult/painful smear test as regular use hadn't entered my mind until reading your reply - as I had just assumed that this would be prescribed either in the run up to cervical screening or on the day (having read your reply I realise now it would not be on the day but to stop a few days ahead of the appointment to make sure the sample will be clear to read). The other thing I had not realised is that it would be a form of HRT - but on reflection this of course makes sense. If I may ask, how does the GP reach the decision whether to prescribe pessaries or cream? Also, if you don't mind my asking, if you are familiar with both options, do you recommend the pessaries or the cream.

That's a great idea to ask the GP surgery if they have a GP who specialises in the menopause, thank you for that.

 Also, I don't think that screening should stop at 64, that's ridiculous in my opinion, if the virus can stay in your body for a lifetime as not everybody's system manages to clear it, then the risk is potentially there for a lifetime too. The best thing to do until that changes on reaching 64 is to go for private cervical screening, I believe it costs approx. £100.

Thank you again for responding, it is very much appreciated and if you can shed any light on the queries I have above I would be very grateful.

Best wishes  x

Hello Laceey I wasn't really given the choice of cream or pessary the GP just prescribed the pessaries - they are very easy to use - I just told her the consultant had recommended HRT because of atrophy/dryness/confusing test results and asked her which was the lowest risk and so she prescribed the pessaries. It has been a learning curve for me to. I have been celibate for over 20 years so the HPV must have lain dormant for a long time. At least my treatment got rid of the polyp and helped me to fight the HPV back into dormancy. I thought I was quite a healthy person - the only reasons I can think of for weakened immunity are my age and working too hard and getting stressed with my sandwich generation responsibilities. It really has given me quite a scare but if I can help others through my experiences it feels worthwhile. I certainly don't take my health for granted any more. I'm sorry to hear of your bad experiences. It sounds as though it has put you off screening for a while. One of the worrying things I discovered on this journey is that many women in their 50s don't attend screening because of fear of pain - the good news is that self sampling at home is being developed and will hopefully enablecmore women to be screened from the comfort of their own homes. Did you know that the screening is now testing for HPV first?  So more and more women are finding out they have it but don't always understand that 80% of people have it at some point in their lives and that it can lie dormant and resurface - hence the importance of screening. Jo's helpline is really useful for more information and so are their webpages. If you feel able to do so it's worth having open conversations with your friends about screening to encourage them to go but also to spread the word about topical oestrogen. The Women's Institute joined in raising awareness of the importance ot screening last year. I think we 50 somethings and 60 somethings can be hard to reach and inform. I hope this information has helped you A x

Thank you Jazza I tried to edit and delete but got stumped so I will just have to leave things as they are for now. I did manage to delete some other multiple posts of mine but I was the person at the title bit and so it was easier. My patience with technology is not the best; maybe I should blame my menopausal brain fog!!! Lols Sorry to hear about your experiences with finding out about topical oestrogen after your cancer diagnosis. That must have come as quite a blow. I hope the oestrogen will help your current symptoms. Thank you for your help again

A x

 

Thank you Jazza I tried to edit and delete but got stumped so I will just have to leave things as they are for now. I did manage to delete some other multiple posts of mine but I was the person at the title bit and so it was easier. My patience with technology is not the best; maybe I should blame my menopausal brain fog!!! Lols Sorry to hear about your experiences with finding out about topical oestrogen after your cancer diagnosis. That must have come as quite a blow. I hope the oestrogen will help your current symptoms. Thank you for your help again

A x

 

lols I've done it again!!! laughing

Hi Jazza,

Thank you for replying and sharing.

Yes, it's extremely frustrating that they don't share with us what is availabe (e.g. oestrogen cream/pessaries) when they must know how difficult us menopausal ladies find the test (I have never found it easy at any age - it's a big psychological and physical intrusion after all with worry attached re. what results will be) but even more difficult now and they know what they have can help! And we shouldn't have to do research to find out it is available - we should be informed when an appointment is forthcoming that it is available ahead of the test. I too have had quite a gap in between smears and so completely understand your decision not to attend due to discomfort - before my recent one (awaiting results) I last attended 9 years ago as being celibate and my test 9 years ago coming back clear I didn't see the point in putting myself through something I know I find uncomfortable. I had mild cell changes (treated) in the 1990's in my twenties and clear results since on the appointments I did attend up to 2011, but came across info just this year about the virus laying dormant in the body (if I do have it) - not something I knew about - why don't they have literature on this topic to send out with attendance reminders - I'm sure attendance rates would hugely improve.

Thank you for the book and blog recommendations and once again for replying to my post, very much appreciated.

I'm very sorry to read of what you have been through and really hope all stays well for you going forward.

Hi 55,

Thank you for explaining that your GP decided to prescribe pessaries. Regarding self-sampling at home - is this a urine test that we return to the GP surgery or are we expected to use a speculum ourselves and take the test as a nurse does - if the latter I can't imagine that and don't think I would manage it. I find it hard enough with the Nurse doing that for me and she is a professional, I don't think it's a good idea to put it in the hands of the lay-person - whatever next?!

Yes, I had read that screening now tests for HPV first and just how prevalent the virus is with 8 out of 10 people acquiring at least one strain of the virus at some point in their lives. Only very few strains of it appear to cause the health problems and even then a lot of people's immune systems fight it off before it can cause any damage. But not everybody unfortunately. I don't think it's right though to only look for cell changes if HPV is found to be present as 30% of cell changes are not caused by HPV - that's a lot of people whose cells are not being looked at who have gone to the effort to put themselves through an (at the least) uncomfortable test! It used to be the other way around - the cells on all smear tests would be looked at and those that were not 'normal' would then also be tested for HPV - they should never have swapped that around - it's putting peoples lives at risk who have cell changes but through no HPV being present these changes are not picked up as those smears without HPV are just dismissed at that point!! What is the point anyway of looking for HPV (given that they have no cure for it and so can't remove the virus from the body when they do find it - it would be a different kettle of fish if they could as it would then merit the time taken to test for it). Until they have a cure for HPV they should leave testing for it to one side as it is to no avail and screen every test for cell changes and treat accordingly as when they do find HPV it is not this that they treat in any case but the cell changes it has caused. So many people who have cell changes or actual cancer but it's not being picked up because once their tests are shown negative for HPV that is the end of investigation for that person even though they could have cancer but no HPV. And screening shouldn't stop at 64 - HPV does not magically go into automatic permanent hibernation at aged 63 and 364 days!! And people without previous HPV - more accurately without a high-risk form of HPV - could be infected by a new partner/spouse at that age with one of the high-risk strains. A lot of people of all ages do not present for testing - so there are more than enough appointments to go round for those of all ages who do wish to be tested. Rant over...

Hi Laceey feel free to rant as much as you like; I have done my fair share of ranting and venting on here. I agree with you on quite a lot of the points above but after some consideration and reading information on here I understand that the HPV virus is the cause of cancerous cell changes and apparently the body's immune system usually fights off other cell changes by itself - however there are some ladies on here who always had clear smears and tested negative for HPV and still have CC. From what I can gather CGIN is more difficult to pick up on smear tests. So even if we have had clear smears we should still report any unusual symptoms to our medical team ASAP so that they can be investigated. So women need to be aware of the red flag symptoms of gynae cancers - not just CC. The Eve Appeal is a charity which is fighting for a better survival rate for women. They recently published the results of a study linking the health of the vaginal microbiome and ovarian cancer - this was by a gynaecologist so is a reputable source. They have information on their blog about this. So we are part of ongoing medical research aiming to eliminate gynae cancers. However the emotional impact of finding out you have HPV and the myths and stigma surrounding it as you and I both know are the downside of this and are causing so many of us a great deal of stress and stress is not good for our immune systems either. I have the stress of menopause and a bereavement on top of it all and so it has not been easy but all in all I am glad I got tested and treated. I strongly believe that dentists should test everyone for oral HPV as this is a cause of mouth cancer. I wonder how the male population would react if they were to bring in mass testing for them? At least it might help to lessen the stigma. I do feel women bear the brunt of all this and as a diagnosis of HPV has caused lots of relationship issues PHE needs to think about how they can address this!! I know they are busy with a pandemic at the moment but they need to do more to educate the general population about it all. I can recommend a book written by a Dr on the Eve Appeal called The Gynae Geek which is very informative about all things gynae related. In the meantime this forum is an excellent source of support. I do feel our generation were rather let down when it came to sex education and openness but I do think that there is some improvement for the younger generation. What worries me is how many women over 50 are living in ignorance of the symptoms of gynae cancers and brushing them off as just the menopause or just a one off. I do strongly believe that we are all responsible for our own health too so don't blame anyone for my issues but I do feel that women should not feel afraid to seek help and that those testing for HPV and sending abnormal results to people should not assume that we know all the facts. It would be useful to give a layman's translation of medical terminology for example. I am extremely grateful that Jo's Trust contact information was on my test results as otherwise I might have suffered even more. Now my rant is over!!!!

A x