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[Sadiemoto]

Hi All

I am new and need your advice.

• I have urethra irritation for 9 months or so now.
  Also have symptom of Overactive bladder.(this symptom is controlled by Vesicare now)
  Urethra irritation is not outside and inside. I would say it is not as bad as some of the ladies here are experiencing.
  Sometimes it gets worse and then urine test comes back with bacteria but no white cells. 
  When I take antibiotics, irritation disappears for a short time but then comes back. 
  I would say it is usually bearable but really gets me down. I am scared of it gets worse because I do not know what to do. 
  Recently I have problem with antibiotic side effects of vertigo and I cannot take them.

So far I tried:

• I have been trying D mannose. But did not make big difference.
  Started taking Oil of Oregano but this has not made huge difference yet.
  Updosed Vagifem to everyday perhaps for 4 weeks to see if it makes difference.
  

Any other suggestions?

Questions:

Would Ovestin cream applied outside do any good when irritation is inside?

Do ladies using vagifem, do you take progesterone with that? I was told the dose is so small and no need to take progesterone.  Is that correct even if I use Vagifem every day?

I am here alone not being able to discuss my problem with anyone.

Any comment will be appreciated.

[Dancinggirl]

Hi and welcom to MM Sadiemoto
Do look at the thread I did, ‘ The Burning Club' - there are many other threads on MM that also deal with this problem.
In creasing Vagifem local oestrogen would definitely help and using vaginal moisturiser, like Sylk, can also help. Try doing Vagifem everyday for a couple more weeks and then try doing 3 times a week.  Use Sylk everyday after showering.  If you feel itchy or generally sore then you may have BV which can be treated with Multi Gyn Actigel (you can get all these things online).
You don't need progesterone when using just Vagifem.
There are many strategies that we ladies, who have this problem, use to control and prevent the burning from emerging but it is about managing the issue.

Try drinking a glass of water with half a teaspoon of bicarbonate of soda a couple of times a day when the burning happens.  Avoid washing the ‘lady bit's' with anything scented.  Avoid tight trousers.  Make sure you empty your bladder really well each time you pee. Drink enough water but avoid caffein, alcohol and fruit juices - so avoid anything that is acidic. Put your feet up in the middle of the day for half an hour - I think the urethra becomes hot inflamed when sitting, so it's good to relieve the pressure.
Antibiotics will probably make the situation worse as it upsets the natural flora in the gut and vaginal area - you need to maintain a healthy environment to prevent infection taking hold. 
I hope others will be along with support. DG x

[Anna02]

Hi,
I had similar symptoms to you and tried Vagifem which helped a bit but my doctor then suggested I switch to Estriol cream which I apply vaginally but she also suggested a rub a little bit on the tip of my urethra to help reach the bladder. All I can say is that it seems to have worked.

[Dancinggirl]

Unfortunately I found the cream made the burning much worse (probably the fillers in the cream were irritating) but I know many other women find using the cream alongside the Vagifem really helps.  Sadiemoto - it could be worth trying.  WE all have to find the strategies that work for us - it's trial and error.  All I can say is that this type of urethral pain is quite common with menopause and it's down to oestrogen deficiency.  Some find they need full systemic HRT alongside local oestrogen to really get to grips with the problem. Oestrogen deficiency does terrible things to the body.  DG x

[dahliagirl]

Hi - I have bladder problems but have avoided the meds for overactive bladder so far.

I have vagifem, and use that in conjuction with Actigel when things are iffy.  I use moisturiser other times - usually sylk or yes.

I use vagifem every three days.  I also went onto systemic hrt.  Whilst that has not cured the problem either, I have not had a complete disaster (full bladder explosion  ) since the day I started taking it over 2 years ago.  I found vagifem good on its own, but it could not compensate for the ups and downs, so I would wake up feeling perfect, and wet my knickers by lunchtime  )  My bladder is much calmer and predictable on full hrt.

I also drink enough water to keep my urine pale during the day.  I have a glass by the bed at night (used to use it to cool down with the night sweats in days gone by  )  If I am working on the computer, I have a glass and sip it, and if I go out, I take water with me.  This is in addition to the usual tea and coffee breaks.  If I have an irritable day, I find that drinking enough to have a couple of full bladders calms it down.

Things that make it worse are: relying on tea all day (easy done in the winter when you want something warm) and drinking strong instant coffee - so much so that I NEVER drink it.  I only drink home brewed coffee from my cafetiere served with plenty milk and a big spoon of sugar (like French coffee) - it is my one weakness (apart from the chocolate and crisps  ) so I have it as a treat once a week (or sometimes twice  ).  The other thing that makes it worse is a drop in hormones - it can go from a slightly-not-making-it to a change-the-trousers and was a big problems during my non pill days in the last years on oral contraceptives.

Being constipated can also not help - probably makes less room for the bladder.

[Hurdity]

Hi Sadiemoto

  from me too.

Just to add that I use estriol cream as well as Vagifem and systemic HRT (ie oestrogen and progesterone) - but the cream I use is the generic one which is weaker than Ovestin - (ie generic estriol is 0.01 %  as opposed to ovestin which is 0.1%) so easier to use liberally around the external areas than Ovestin and does have different fillers in. There is also the Estring vaginal ring (which you insert yourself and it stays active for 3 months - but you can remove it if necessary!) which delivers almost as much as a Vagifem every day (approx 50 mcg per week).

Hurdity x

[Sadiemoto]

Dancinggirl, Anna02, Dahliagirl and Hurdity, thank you very much for your suggestions and support.  Oh, I feel so much better reading all the replies and know there are ways to manage the problem! Also I feel I am not alone. I have some questions:

DG, How many weeks in total should I use vagifem every day? 4 or 6 weeks. Also I use Replen MD vaginal moisturiser.  Is this same as Sylk you recommend? I have already ordered a free sample of Sylk on their website. I have no itching, so perhaps no BV, I think.

Anna02 and Hurdity, Estriol cream, is this the name of the cream? on prescription? or from chemist?

I see many of you are on systemic HRT. I have an impression that it could cause breast cancer? How are you managing this problem? My GP would not prescribe it. Who prescribe that for you? Gynaecologist?

Thank you all.  Look forward to your reply.

[Dancinggirl]

Sadiemoto
HRT doesn't necessarily cause Breast Cancer, however there is a small increased risk of developing breast cancer if you are using HRT beyond the age of 60.
You haven't told us how old you are or where you are in your menopause journey i.e. are you peri or post meno?
Sylk is similar to Replens but I find it easier to use and less messy - I sometimes use it morning and evening.
Though the recommended dose of Vagifem is; 2 weeks daily and then twice a week after that, many are advised to use it daily for around 4 weeks to really plump up and restore the whole urogenital area and from then on 3 times a week as a maintenance dose. I believe that full systemic HRT is often necessary to help the bladder, as local oestrogen isn't sufficient.
I assume you have had full investigations by a urologist?  A referral to a urologist/gynaecologist might be advisable so I would ask your GP for this if the local Vagifem treatment doesn't improve things one the next 2-3 weeks. DG x

[Sadiemoto]

Hi Dancinggirl

Thank you for your reply.

I am 65years old and postmenopausal. Oh, I am too old for HRT then.  But I hope I can solve my problem without HRT. Fingers crossed.

All my problem is vaginal atrophy(controlled by Vagifem), overactive bladder(controlled by Vesicare) and urethra irritation. All started this year at around the same time.

I have seen urologist and had scan done. Everything was OK.  He put me on Vesicare and low dose of antibiotic to prevent UTI which I now stopped without telling him. Every time I had cystitis-like symptom, the urine culture result was some bacteria but no white cells. I think it means there was no infection.  He still put me on to low antibiotic.  He now recommend cystoscopy to investigate my sore urethra.  I really don't want such evasive test at this stage when there might be other way to solve my urethra problem. Hence I am asking you all for help.

My urologist referred me to gynaecologist but I will not see her until the end of January.  I cannot wait until then, so I have to take this matter in my hand and decided to use Vagifem everyday for four weeks. After that 3 times a week as you suggested.

My urethra is already feeling better today - Vagifem 5th day.  It may be coincidence and may come back tomorrow but at least today it is not bad.

Thank you for all the suggestions and support.

[Sadiemoto]

Hi all, I have been using Vagifem every day as advised and nearly the end of four weeks now. It worked and I have been feeling much more happier. But today urethra is worse especially after seeing uro-gynaecologist. I was pinning my hope on her understanding of my condition.

I should have insisted on seeing consultant but ended up seeing young registerer.  She said:

Recurrent UTI and Overactive bladder are nothing to do with oestrogen deficiency.

Is this right?  My understanding is that urethra and bladder are made of same kind of tissue as vagina and need oestrogen to keep them healthy.  And the oestrogen deficiency likely to cause mimicking of Overactive bladder and recurrent UTI. Am I wrong?

I am confused and don't know what my next step should be.  I thought I could solve my problem only by dealing with oestrogen deficiency. The young uro-gynaecologist is sending me back to the urology department for cystoscopy. Ahh!

I might not have explained myself well but just had to write as I feel down and insecure.
Any comment is appreciated.

[dahliagirl]

That does not sound fun - it is what my practice nurse said and she suggested the over-active bladder meds.  I think it is something that does not figure large in text books, but doctors with more experience seem to know.

I still have problems from time to time - I usually fix it by drinking more - it seems to calm my bladder.  Along with the vagifem and Actigel.  I know it is hormonal because it is something that started on my off-week when I was on the pill in my 40s, and continued more dramatically later 

As I understand it, with repeated symptoms of uti, vaginal infection etc that come back with a negative result, they should consider using vaginal oestrogen.

https://www.nice.org.uk/guidance/cg171/chapter/1-Recommendations#assessment-and-investigation  see section 1.7.21

http://www.bladdermatters.co.uk/content.php?id=155g=0/Influence-of-menopause

http://www.menopausematters.co.uk/article-bladder-problems.php

I have seen local guidelines for vagifem that recommend using it alternate nights for a while after the initial boost.  I did this in the end and now use it every three days. Over time, it does seem to get more reliable.  I am 53 and not post meno yet (as far as I know  )

[Dancinggirl]

Oh Sadiemoto - I despair sometimes - the ignorance of doctors - even if they are supposed to be specialising - is often appalling.  Of course your problems are related to urogenital atrophy.  If you look at the new NICE guidelines ( dahlia girl has kindly given you the links) it clearly states that local oestrogen is needed with your type of problems.
Overactive bladder is common but is particularly prevalent among women in post menopause - that young register should have known this.
If your symptoms have been better generally having used Vagifem for a few weeks then you are clearly doing the right thing.  Your previous investigation of the bladder was clear - if the tests from urine samples came back clear of infection then urogenital atrophy is the problem. It makes perfect sense.
Talk to your GP, write down your experience with this registrar - list your symptoms and what has been helping you so far and all your questions.   Do take a urine sample with you and ask if it can be tested for infection at the lab - there could be a ongoing low grade infection.
My feeling is, if your GP is any good they will continue giving you the Vagifem and ask to monitor you over the next few months and if you continue to have problems then you may need to see the urologist again.
Keep us posted.  DG x

[Maryjane]

As Dancingirl has said , I truly despair with many of these so called

" specialists" .😡😡😡😡

[Sadiemoto]

Dhlia, DG and Maryjane, thank you for your input, infos and support.

I was doing really well using Vagifem every day since 9th Dec, but suddenly from yesterday the urethra discomfort came back. It really gets me down.  I cannot understand why. I am drinking a plenty of liquid. I am dabbing urethra with Ovestin cream at morning and night and lunch time too. Trying everything been suggested. I wonder if this is another infection?? Oh no!

I have no problem getting Vagifem from GP as it is in the repeated prescription list. But my GP do not have much idea in this area and cannot expect any good advice at all.

I am seeing urology clinical nurse on Tuesday.  I will mention how I was disappointed to hear what  the registrar said.  I suppose they will try convincing me to have cystoscopy.

Has anyone had cystoscopy done? Do you think it is necessary?  If all my symptoms are caused by oestrogen deficiency, I would thought all I need is hormonal treatment.


 

[Dancinggirl]

Sadiemoto - I had a cystoscopy and it's not a big deal.  It's probably a good idea to have this investigation just in case there is something else going on - if there is some ongoing infection then this may show.
Unfortunately, it is common for this flare up of burning to return now and again - it can be for many reasons but just keep doing what you are doing and it will hopefully settle down again.  I find sitting for too long can make me burn a bit or if the flora balance in my vagina is not quite right then this can irritate as well.
DG x