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[Sage 🍃]

Hi, I'm looking for some reassurance. I'm 4 years into menopause, have hot flushes day and night, but they're not as bothersome as they used to be. I also have stress incontinence that gets worse when I cough, sneeze and laugh. I'd like to know your experiences dealing with these issues, if there's anything I can do to cope with them other than HRT and if these problems are going to last forever or they can be managed with diet, specific physical exercises, and so on. Thanks.

[jaypo]

Hi sage,welcome to the forum. Same here,although I'm 6 years into meno, I was put on vagifem,which is a very low dose oestrogen and is a pessary,my stress incontinence was gone,I also didn't need to go to the loo as often, I was prescribed it as I had a bit of blood and sex was getting uncomfortable,unfortunately as small a dose as it is,it seemed to bring on anxiety which I suffered a few years back,so I came off it and now the spotting of urine has come back,there is also a cream,again,very low dose oestrogen,maybe worth talking to the dr about it? Do you do pelvic floor exercises? Also can help with incontinence

[Joaniepat]

Hello Sage, and welcome!

Local oestrogen treatment can help with stress incontinence, as the entire area, bladder, pelvic floor, vulva and vagina, has many oestrogen receptors and needs oestrogen to function correctly. Local oestrogen is absolutely not the same thing as systemic HRT. There might be a teeny bit of systemic absorption at first, until the tissues become plumped up, but it should not be a cause for concern and those who have had oestrogen receptive BC, nursing mothers etc, can all use it safely.

Regarding exercises, you should do this under the supervision of a women's health physio, as it depends on the reason why one has a weak pelvic floor. An overtight  PF can become weak because it is under stress the whole time, so it is important to learn to relax the PF. Don't do kegels unsupervised as they may make things worse.

JP x

[Sage 🍃]

Thank you so much for your kind replies, jaypo and Joaniepat. Vagifem is not available where I live (overseas), would estriol cream do the same? I have never heard of kegel's, I will ask my doctor to refer me to a physio. How do I know I have an over tight pelvic floor? Does it have anything to do with being stressed, I feel like I have tight muscles in general, clenching teeth, my hands are numb in the morning, etc.

[jaypo]

Yes,estriol is the other one,I wasn't on that one too long as it stung a bit but it could just be what you need,good luck and keep posting x

[Sage 🍃]

Thanks again, jaypo. I've been reading the leaflets available online (Blissel, Gynest, Imvaggis and Ovestin) and none of them mention incontinence? The therapeutic indications are vaginal dryness, atrophy, kraurosis (?) and dyspareunia (which I believe is pain during sex?). I don't have any of those, unless kraurosis is related to incontinence?

[jaypo]

Yes,those are the main things they help with but the vagifem sorted out incontinence too,you should have an equivalent where you are? It's just the oestrogen helps with the thinning of the the lining of the bladder walls etc plumps things back up,I'm sure ovestin does the same,definitely ask the dr but atrophy is also covers leakage

[Joaniepat]

Thank you so much for your kind replies, jaypo and Joaniepat. Vagifem is not available where I live (overseas), would estriol cream do the same? I have never heard of kegel's, I will ask my doctor to refer me to a physio. How do I know I have an over tight pelvic floor? Does it have anything to do with being stressed, I feel like I have tight muscles in general, clenching teeth, my hands are numb in the morning, etc.

An overtight pelvic floor sounds likely judging from the other muscular problems. (I'm a jaw clencher too.) Kegels are exercises often recommended for a weak PF. Imagine stopping the urine stream in mid flow and clenching your bum, and it is a bit like that. This is not a good thing for folk with a tight PF, as you need to learn to relax it, along with correct breathing.

Regarding products in your country, it might be a good idea to join Jane Lewis's Vaginal Atrophy facebook group. It is a private group, just google Vaginal Atrophy Facebook and it should come up and you can ask to join. It has more of an international membership than this group and is a valuable resource for information. (Jane Lewis is Maryjane on this forum.)

JP x

[Joaniepat]

Thanks again, jaypo. I've been reading the leaflets available online (Blissel, Gynest, Imvaggis and Ovestin) and none of them mention incontinence? The therapeutic indications are vaginal dryness, atrophy, kraurosis (?) and dyspareunia (which I believe is pain during sex?). I don't have any of those, unless kraurosis is related to incontinence?

I just had to look up kraurosis! For the VA nerds amongst us, "kraurosis vulvae" is an old name for lichen sclerosis. We live and learn. Sage, it's a skin condition, nothing to do with stress incontinence.

JP x

[Sage 🍃]

Thanks, lovely ladies. Unfortunately I don't have a FB account. How do I know I have a tight pelvic floor? Sorry, if you have just explained it, I'm confused. Are there any exercises specific for tight pelvic floor?

[Sage 🍃]

Joaniepat, thanks for the explanation. Haven't heard of lichen sclerosis either, maybe I need to enrol on a menopause course.

[Joaniepat]

Thanks, lovely ladies. Unfortunately I don't have a FB account. How do I know I have a tight pelvic floor? Sorry, if you have just explained it, I'm confused. Are there any exercises specific for tight pelvic floor?

Sage, I have bumped a topic for you.
JP x

[Harmony]

I found an answer to stress incontinence purely by chance. I realised that when I was wearing a menstrual cup when still having periods, I didn't leak when I coughed or sneezed. I wear it all the time and it hasn't caused any problems. If I take it out and cough or sneeze, I leak more than a few drops!  You don't feel it at all, and they're not very expensive, the decent brands start at about £15. They're also brilliant for dealing with periods!  One of my best discoveries ever.

[Taz2]

Hi Harmony. It sounds as if you have a bladder prolapse as the cup will work the same as a ring pessary which some women choose to use instead of surgery. If in the future the cup stops working you've always got the choice of the ring pessary.

Taz x

[jaypo]

My daughter uses one of those cups for her period,loves it,saves a fortune on sanitary towels