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[Busylizzie]

Dear all!
I haven’t posted here for many years but am really struggling right now and am looking for advice on how to proceed.
I am now 66 and had a late menopause at 58, am hypothyroid on combined T4/T3.  Also have oral lichen planus and had a bad flare recently.  Had a R hip replacement in 2013.
I was given Vagifem due to painful intercourse which had little effect and was changed to a low dose Estriol cream 0.001% instead.  I used it about once a week and all was well until a year ago when I suddenly became very red and inflamed with burning internally all on the right hand side.  Pain was going into my R hip and down the side of my thigh, also R lower abdomen.  I was seen last March by GP and ruled out Vulval Lichen Planus.  I had one session with the practise physio last April on my thigh and I redid a loading course for 2 weeks and then have used the Estriol cream twice weekly ever since and everything settled until five weeks ago.  I also have used the Balance pessaries which helped.
Mid February I woke in the middle of the night with agonising clitoral and urethral pain, I went back to a two week loading dose of the Estriol cream but the pain spread again into my Right hip and period like cramps but no bleeding or discharge.  Then I became red and inflamed on the right side of vulva again.  I spoke to pharmacist who thought I may need a stronger estrogen cream.  I contacted GP on an econsult and received an email prescribing Ovestin for four weeks and then use it once a week.  I am two weeks into this following two weeks of old cream every night and the hip pain has eased but not a lot else.  It’s painful to sit and I’ve had to stop my walks for now.  I am finding the Ovestin is finally helping the deep pain but as it’s a small amount does not have much effect on the outer area.  I have read on here about using extra cream and so have started using the weaker cream on outer areas.
As this is the worst it’s ever been, am wondering how long it could take to settle,  it’s really getting me down with the pain.  It’s been a rough few months as had gastritis before Christmas and reflux so am not taking ibuprofen any more, then a bad flare of OLP and difficult time trying to see my dentist.
Any advice would be really welcome!
Sorry this is long winded!  Ooh meant to ask, has anyone used vaginal Vitamin D pessaries?  I read a study saying it could be beneficial for VA. 
Thanks for reading anyway.

[CLKD]

Keep using the 'ovestin' nightly, internally and externally.  Ignore the once a week idea, that's old hat by someone who has NO IDEA how difficult VA can be to treat.  Some ladies require 'yes', 'sylc' or 'ovestin' around the labia.  When I get the need2P feelings I take 2 Nurofen capsules every 3 hours ......... until that eases.

I have found 'savlon' around the vaginal area helps.  Little and often. 

Every medic should read 'Me and My Menopausal Vagina' ;-)

Never heard of VitD Pessaries.  I wouldn't add anything to an already unhappy vagina, because some symptoms can be aggravated by fillers and coatings, rather than the active ingredients. 

I have deep pain in the R thigh down the leg at night, it's been diagnosed as bursitis, nowt to do with atrophy. 

[Gracie]

Some women are lucky if they can get away with only using VA treatment twice a week. For me its an every day treatment of Vagifem pessary and Ovestin cream used locally, alongside lots of moisturiser.
If I didn’t stick to this regime I would suffer one flare up after another.

You can’t mess about with this utter miserable condition, get yourself a regime going, stick with it and hope it works for you.

I've never heard of VitD pessaries, I can't see how it would make a difference to relieving VA. 

[Joaniepat]

I agree with Gracie and my regime is similar. Having improved significantly over the last couple of years, I have now reduced to 5 Vagifem per week, Ovestin externally every other night, and an emollient during the day. It took some doing to get to this stage. (Am also on systemic oestrogen.)
JP x

[Haydo]

I agree with Gracie and Joaniepat.  It sounds like you need to use the ovestin internally and externally, together with moisturiser.  I think you mean vitamin E pessaries.  I have used them in the past and they can be soothing, although messy when they melt, but what you really need to do is increase the oestrogen. 

[Nas]

Agree with all the other ladies, VA is the absolute miserable pits and only local oestrogen
can offer relief in my experience.

My routine is daily vagifem, YES and Ovestin cream. Last week I had the most awful flare up of atrophy, to the point where I was weeing every 30 minutes ( at work!) In between the wees, my bladder was irritated. All because the vagirux applicator is crap and the pessary wasn’t going up high enough. It only took a few days for that flare up to occur!

This is one symptom that just isn’t going to ease. Blast it with all you’ve got... even twice a day if you have to.

Yes products are ace as they contain zero nasties and balance the ph in the vagina I  think. You can get them on prescription.

Best of luck 🤞🤞🤞🙂

[Busylizzie]

Good morning and thank you so much for all your replies, they are much appreciated and enlightening.
I think the answer then is to use the cream liberally and more frequently to get it under control and then maintain. 
They told me last year it could be also an inflamed pudendal nerve causing the pain in my hip and thigh muscles caused by the VA.  That pain is now settling but I find it odd that the VA is worse both internally and externally mainly on the right side, that is where the burning and electric shock type pains are the worst.  I guess I expected an improvement much quicker but will have to be patient.
I was getting so stressed by it all especially when the period like cramps joined the party.
This is the paper from 2015 that stated Vitamin D pessaries helped VA but that estrogen replacement was the mainstay for treatment.
https://pubmed.ncbi.nlm.nih.gov/25878698/

I take Vitamin D all year round as I use up my stores quickly, I have a genetic high calcium level so I can’t take high doses as it sends my calcium too high.  My mother had severe osteoporosis and many spinal fractures so I try to keep my bones strong by walking.  I do wonder if low Vitamin D over the winter months triggers a lot of this as it’s exactly the same time of the year as last year.
Thank you all again, I will contact GP and see if they will put the Ovestin on repeat.  When the Vagifem didn’t help several years ago I wasn’t aware that it could be added too and my GP never informed me that I could use a cream as well.  It was one or the other.

[CLKD]

GPs don't know much about HRT and VA  .  Sadly 

Let us know how you get on.  If U meet with any resistance ask for a referral to an NHS menopause clinic. 

I would suggest that you have a lookC at the appropriate UK-based support for osteoporosis too. 

[Haydo]

I’ve never heard of vitamin D pessaries, hence thinking you meant vitamin E!    Interesting.

[suzysunday]

Agree with what has been said about managing VA.  It needs constant treatment and it's miserable if it flairs up.  Whoever made us women with vaginas must have had a warped sense of humour.

[Gracie]

I was watching an episode of The Good Doctor where a young woman was given the choice of losing sensation in either her thigh or her vagina, she chose her thigh.
My immediate thought on hearing this was she will regret that decision when she gets older!   

[CLKD]

What's the programme Gracie, can you explain?

[Minusminnie]

 
They told me last year it could be also an inflamed pudendal nerve causing the pain in my hip and thigh muscles caused by the VA.  That pain is now settling but I find it odd that the VA is worse both internally and externally mainly on the right side, that is where the burning and electric shock type pains are the worst.  I guess I expected an improvement much quicker but will have to be patient.

As your hip operation was on the right hand side i would be questioning that nerve/s may have been compromised/irritated then but maybe not to the point where you felt it at that time.

Health Unlocked forums have information on pudendal nerve as have the forum on HOPE (Health Organisation for Pudendal Education).  The later is an american site the moderator is Violet a nurse with experience.  It is a good forum for information but maybe looked at in small doses as it can be quite grim.

[SallyPickle]

So sorry you are having all these problems.  I use Yes VM applicators on the nights I don’t use Vagifem and use Yes VM from a tube around outer areas every night and sometimes in the day for comfort as well.  Might be worth giving it a try to see if it works for you.  Take care, Sally x

[CLKD]

'ovestin' and 'vagifem' replace oestrogen, the idea being to plump up the tissues = less dryness ;-)