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[heldback1]

Hi there, I am new to this. I am aged 60 and had a completely problem free menopause ten yrs ago. I was shocked to learn in the past year that I may have something called vaginal atrophy. I did not know about it. Up to last year infrequent but happy sex increasingly caused a UTI , I laughed this off but would have used more lubrication with hindsite. Since June 13 I have been unable to do several activities I loved owing to constant burning pain and frequency. Sex is possible with lubrication but I am so afraid of worsening pain and frequency and UTI that it is affecting life there also. On Vagifem from June 13 but I fear it is affecting my mood downwards and giving me eczema. Doesn't appear to be helping. I became fearful I had a bladder problem and Urology were about to do a scope but i cancelled as i felt it might make the area more painful/ UTI s etc. Probably should see a gynaecologist first? Advice welcome?

[Taz2]

Hi heldback  -  welcome to the forum!

Lots of us don't know anything about VA until it hits so don't feel that you should have been aware. The symptoms you describe are typical of vaginal atrophy or vaginal dryness as it is sometimes called. My own GP seemed unaware of it and put me on low dose antibiotics for a year to combat the frequent UTI symptoms and it was through this site that I eventually discovered VA could cause the problems I was having. I went back to my GP and was put on vagifem which sorted things out for a while. The vagifem dosage has recently been reduced and it may be that you need extra - some members on here are doubling up I believe - in order to reduce symptoms.

After a year or so the symptoms were coming back but I then went onto full HRT as my hot flushes etc. were horrible and that once again cured the VA. After another couple of years I needed full HRT plus vagifem to keep things comfy. Now I am off HRT as I have reached 60 and docs like women to try to wean themselves off at that age - this is a subject of much debate on here - and the symptoms are returning. I also find that the low dose vagifem is not as effective but have yet to actually do anything about it!

I had a cystoscopy which didn't make any difference to the VA but did show that the bladder was healthy. I feel it would be worth having something like this done to see how you are doing.

The ladies on here are really helpful - you will find lots of advice I'm sure.

Taz x 

[heldback1]

 Thanks for supportive reply. I need to learn how to use this forum.( I think post went on wrong section? Will try and look at guide). I note Vagifem leaflet says it does not perform so well after 65 so perhaps at 60 it is now less successful also. I would be apprehensive about doubling up the dose . The manufacturers must have reduced it for a reason. Don't like taking it .  I am most afraid of the urinary syptoms ( and also low mood)  than anything . Feared the cytoscope, if they stretched urethra as doctor mooted might make incontinence likely?   Also felt I wanted to try a general slowing down as I have a gap in work life, pelvic floor exercises, diet etc first. I would I think be reassured by a gynae consultation.
Thanks, Heldback1

[Taz2]

The dosage was reduced due to the American authorities needing the lowest possible effective oestrogen dose and then the UK followed suit. In some countries the higher dose is still used. The reason it is probably not as effective in older women is that the oestrogen levels have dropped even further and so need a higher dose to be effective.  You might like to have a look at this thread http://www.menopausematters.co.uk/forum/index.php/topic,22886.0.html  which is all about vaginal atrophy and the various symptoms. It's rather long! Pelvic floor exercises will not make any difference to vaginal atrophy but they are essential to keep the pelvic floor strong and so avoid prolapse - especially if you are not on HRT - as the lower oestrogen levels mean that the pelvic floor loses some of it's supportiveness.

The problem with VA is that it is not something that will disappear again as far as I know. It is due to low oestrogen levels and these will not increase again naturally. I can understand that you are reluctant to use it but it really does help with your pelvic and urinary tract health. The vagina shrinks and shortens after menopause and if you want to continue to have a satisfying sex life then I would think even this small amount will be of benefit.

The cystocope is a tiny instrument and I didn't find that it stretched the urethra and I suffered no side effects -went straight back to work - and it did give me confidence that all was well. The gynae referred me for a cystoscope at my first appointment with him. I think that you are right in that a gynae consultation would put your mind at rest as to what is going on.

Let us know how you get on.

Taz x

[Sarah2]

Sorry you are suffering.

I think many of us here can empathise with how you feel. It really is horrible feeling tied by needing the loo or being in constant pain.

I can- but it took a long time for me to see some improvement- probably 6 months of regular use of Ovestin and then I got blase and stopped using it very much at all and have had to re-start.

You shouldn't be worried about using local HRT. It's not possible that if affects mood- so the probable reason for your low mood is that you are lacking oestrogen.

There are women who use these hormone creams in their 80s - so it's not something to be worried about, and it should still be a very effective treatment at 60 ( or 65!).

I think the consensus would be to persevere with Vagifem and increase the dose because the level you are using is not perhaps enough. It can take a year for symptoms to really improve.

Unless you have blood in your urine then it's unlikely to be a bladder problem especially as you have urethral pain and burning. You can have your urine tested for all sorts and if this is clear than any further  investigations are unlikely to show anything.

You might want to think about systemic HRT too for your moods,  because many of us use that and local HRT for vaginal and bladder symptoms.

To be honest, I'd say you would benefit from thinking about Vagifem etc ( there is a cream too- Ovestin which might be worth trying if you think you are getting eczema- but my guess is it's soreness from lack of oestrogen) in a more positive way and not being afraid to use it long term or at a higher dose.

Hope you see some improvement but keep on with the treatment is probably the best thing really.



 

[Dancinggirl]

Hi heldback1 and welcome
I'm 58 and had a premature meno (peri meno from mid 30s!!!) so had HRT from 37 till 49 then took a break from HRT for 3 years and then went back on HRT for another 4 and half years.  I came off full HRT last November and my meno symptoms are that bad this time so I don't really want to go back on. 
I started to get burning a discomfort vaginally from my early 40s and I now know that, despite being on full HRT, I was suffering from VA!!! I should have been using local oestrogen as well as full HRT!  I had mentioned my urethral pain to several doctors (even at Menopause Clinics) and none of them suggested local oestrogen - VA is often not diagnosed and can lead to many longterm problems.
I have been trying various local oestrogen treatments to help with the burning - particularly burning urethra which feels like cystitis.  The GP is concerned about the presence of blood in my urine so I'm waiting to see a urologist to rule out anything suspicious with the bladder.  I'm not really concerned as I'm pretty certain it is VA causing the bit of bleeding from my urethra.
Vagifem is the preferred treatment for many women as it's easy to use.  I have found that Vagifem, Ovestin and Gynest all make me rather sore - I think I'm reacting to the fillers in these treatments.  At the moment I'm trying the Estring - I'm on day 3 of this - to see if I respond better.  My feeling is that it's going to take some time for my whole fanny and bladder to recover from years of oestrogen starvation. I did read some research somewhere that said it can take up to a year for things to improve!!
Yes, the dosage of Vagifem in now very low so many ladies do use it at least 3 times a week.  I think there was one lady who was told by her gynae to use it continuously for 6 weeks to start with because her VA was so bad but I wouldn't suggest you do this without profession advice.
There are a few self help things you can try alongside the oestrogen treatment:
Don't wash with anything scented - special intimate washes can be good or try using aqueous cream.
Drink plenty of water - particularly early in the day.
Use vaginal moisturisers e.g. Hyalofemme, Replens, Sylk, Multi-gyn Actigel - there are others - these help to keep the correct ph acidic balance in the vaginal area and reduces the risk of bacteria taking hold.
Lots of lubrication for sex is essential.
Look under the heading for HRT Preparations to the left of this screen - you will see a section for Vaginal treatments that may give you some info.
There have been various threads about VA which you could dip into.
VA can be miserable - I sometimes dread sitting down as I burn so much.
By the way, I doubt that Vagifem would have affected your mood as so little is absorbed - it really is very localised - I expect you may be feeling low because you are in so much discomfort.  Where do you get your eczema ? - I would have thought your eczema could be made worse by the lack of oestrogen, as your skin will be far more dry and sensitive. I have to use lashing of moisturiser all over my body these days or my skin becomes dreadfully itchy and flaky.
Depending on when your periods stopped, your oestrogen levels continue to fall beyond your last period and then bottom out, so for those ladies who don't get severe meno symptoms it can be a shock to get VA and skin problems when they feel they have sailed through without a problem - unfortunately these problems are very common and many ladies probably suffer in silence.
As the other ladies have suggested, I would still see the urologist to rule out any problems with the bladder and then perhaps ask to see a gynae for further advice.  A gynae would probably want you to have the bladder checked first anyway.
Do keep posting and let us know how you get on.
DG x