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[Elissa]

Hi Ayesha, it certainly sounds like you need it more frequently so it is great you have the support of the nurse you mention.  If I get confirmed as having GSM I might need to find a new more knowledgeable GP!

I'm actually totally confused now.  Sorry this might be a bit of a rant.

Towards the end of my previous appointment with my GP, 4 weeks ago, I had suggested that maybe my vulva area burning and redness is caused by dryness.  I listed a few reasons (me taking Provera daily and the fact that she had previously commented on how it suppresses estrogen, plus the fact that she commented on dryness during my pap smear a year ago).  I also assume I'm in peri due to my very heavy periods 2 years ago and anaemia.

I had been in pain for so many weeks by this stage and was racking my brains trying to come up a solution. I had managed to establish online that low estrogen can cause dryness and asked if a moisturiser might help. The GP considered my suggestion and said she would try me on some estrogen 'Ovestin'. She never used the words vaginal atrophy or explained anything.  She then made it clear my time was up and I was out the door!

I've then spent the last 4 weeks googling dryness, Ovestin etc and educated myself on VA/GSM and it seems to match my symptoms.  Well everything except the thigh sensitivity (pain when pant/trouser seams rub on them) but that has only occurred in the last 4 weeks.  The rest has been on and off for over a year.

I went in yesterday seeking clarification on my supposed condition by mentioning the fact she prescribed Ovestin last time and I therefore wanted to make sure she was treating me for  Vaginal Atrophy (or GSM).  I expected her to say yes, dermatitis is no longer the diagnosis.  Instead she flummoxed me by saying she thought it is a 'skin thing' and said she'd refer me to a dermatologist.

It makes me wonder why she said to continue with Ovestin but maybe it's just in case it's not a skin thing or even a bit of both.  I'm guessing she thinks that using Ovestin in the meantime is no big deal and I'm not worried.

Thanks for listening.  I understand that getting a diagnosis with these sorts of issues can be a long road for lots of people 

[Ayesha]

The problem you have is the fact you might have GSM (VA) along with a dermatitis issue which makes it more complicated for you, you need a diagnoses and hopefully you won't have to wait too long forthat. At least you have the Ovestin to use which should help if its GSM.

[Elissa]

Hope everyone is going well?  Just wanted to post an update on my situation and see what others think.  Visited a GUM clinic today and discussed my situation with external burning across vulva area (perineum, back area), irritation and a little itchiness for weeks and weeks.  I explained how the GP has been treating me for dermatitis and prescribed steroid cream.  We also discussed my daily use of Provera 10mg (for heavy bleeding) plus my 5 weeks usage of Ovestin.

I explained that I have not had to use the steroid cream for the last fortnight, redness has gone, I don't feel as sore sitting etc. and my assumption is that the Ovestin has improved my general comfort.

So the good news is she cannot see any sign of dermatitis, lichen sclerosus/planus.  The funny thing is she also cannot see any obvious sign of atrophy!  I don't want to sound disappointed by this but I was kinda confused.  Despite this, the GUM clinic GP was quite sure that the Ovestin has in fact done its job and dryness was the problem. 

We've decided that I will have an ultrasound of my pelvis to check lining size etc and to ensure nothing else going on before I have the Mirena inserted asap.  She also does not think I should be on 10mg of Provera daily for any longer.  Because I am having night sweats and some moodiness (rage I would say...here one day gone the next!) she will check my hormone levels via a blood test (4-6 weeks after Mirena in place) and work out if additional hormones required.

The GP says it remains to be seen if I am going through a natural menopause or a medication induced menopause OR a bit of both!  Definitely progress though!

Wondering if anyone else has experienced a decent improvement in atrophy symptoms after 5 weeks of using Ovestin?  Bearing in mind that I had no urinary symptoms and I am only 41.  I'm wondering if maybe it hasn't been quite as advanced with me as it has been for others (and that might explain the lack of visible atrophy today)?  Thank you in advance for your thoughts

[Jules]

I have atrophy and certainly had improvement after a short time with topical estrogen so it's possible.  It plumps up the tissues. Dryness is an outcome of low estrogen too.

[Wren]

Hi Elissa

Your symptoms are similar to mine - even down to sore where knicker elastic is at top of thighs, trying unbleached toilet paper etc., irritation/burn to vulva/perineum/'back' as you describe.  I also have frequency/urgency.
I'm still trying to get answers - my main discomfort is the 'back' which prevents me walking, sitting, sleeping.  Worse at times.

I had an early menopause so no oestrogen for 15 years so that's where I looked first.
 
I've come across a lot of ignorance when seeking help (which has caused stress) so had to self-diagnose and ask for oestrogen as I found bits out.  I think I've mentioned a bit about this in my previous posts.  I didn't mention the 'rear' in my posts though - as no-one else seemed to have this problem and being ignored about it at the GP's didn't give me confidence to be open about it.  I still find it more embarassing to talk about that than the vulva - hence calling it the 'rear'!  Fortunately, I now seem to have got a GP who listens and I'm beyond any embarrassment now and call it by the proper name there!

Am using Vagifem daily, and Ovestin daily to the vulva + trying a little on the 'rear'.  Also been stop/start (due to bleeding) with systemic over the last 2 years.  I've recently got the Mirena and am currently on a low patch till I increase.

I also now get the burning sensation in my thighs which is worse when sitting.

Have you looked into pelvic floor dysfunction? 
Jilly Bond, pelvic floor relaxation info online might be of interest.   
I found when I read 'Heal Pelvic Pain' written by a womens health physio I identified with it so I've started the exercises in that book whilst I wait for a physio appointment.

The underwear/clothes rubbing has got better though.  I found preventing dryness by using an unfragranced body lotion or emolient helped.  I find a thin layer and not dressing till it's soaked in better.  The heat seems to aggravate it.  I also suffered with it around the bra area and the underarms were a problem.  A GP prescribed an antihistamine and that helped when it was bad but I now manage with a light pat of emolient every day to prevent any dryness.

Sorry if my post is a bit rambling.  I haven't much time at the moment but wanted to post quickly because of your similar symptoms.

[Ayesha]

What a positive outcome from your visit to the clinic, you should feel much more relieved now. Yes, the Estriol will certainly show signs of improvement after five weeks use. 

[Elissa]

What a positive outcome from your visit to the clinic, you should feel much more relieved now. Yes, the Estriol will certainly show signs of improvement after five weeks use.

Thanks for commenting Ayesha. I needed some reassurance. 

The thing I forgot to mention in my last post is that I noted (with torch and mirror)  that the skin (internal tissue) at the entrance to the vaginal was very pale before I used Ovestin.  It was pale pink, almost white.  After using Ovestin it's now deep pink/red, so something has definitely changed down there!

I mentioned this to the Dr and she was nodding her head.

Thanks once again for suggesting the GUM clinic.  They seemed very informed on the topic, which was a relief like you say!

[Elissa]

I have atrophy and certainly had improvement after a short time with topical estrogen so it's possible.  It plumps up the tissues. Dryness is an outcome of low estrogen too.

Thanks Jules.  Yes it seems too much of a coincidence that I'm generally feeling a bit more comfortable.  It must be the Ovestin, surely.  As mentioned in my last post, I can see a visual change also.

[Elissa]

Hi Elissa

Your symptoms are similar to mine - even down to sore where knicker elastic is at top of thighs, trying unbleached toilet paper etc., irritation/burn to vulva/perineum/'back' as you describe.  I also have frequency/urgency.
I'm still trying to get answers - my main discomfort is the 'back' which prevents me walking, sitting, sleeping.  Worse at times.

I had an early menopause so no oestrogen for 15 years so that's where I looked first.
 
I've come across a lot of ignorance when seeking help (which has caused stress) so had to self-diagnose and ask for oestrogen as I found bits out.  I think I've mentioned a bit about this in my previous posts.  I didn't mention the 'rear' in my posts though - as no-one else seemed to have this problem and being ignored about it at the GP's didn't give me confidence to be open about it.  I still find it more embarassing to talk about that than the vulva - hence calling it the 'rear'!  Fortunately, I now seem to have got a GP who listens and I'm beyond any embarrassment now and call it by the proper name there!

Am using Vagifem daily, and Ovestin daily to the vulva + trying a little on the 'rear'.  Also been stop/start (due to bleeding) with systemic over the last 2 years.  I've recently got the Mirena and am currently on a low patch till I increase.

I also now get the burning sensation in my thighs which is worse when sitting.

Have you looked into pelvic floor dysfunction? 
Jilly Bond, pelvic floor relaxation info online might be of interest.   
I found when I read 'Heal Pelvic Pain' written by a womens health physio I identified with it so I've started the exercises in that book whilst I wait for a physio appointment.

The underwear/clothes rubbing has got better though.  I found preventing dryness by using an unfragranced body lotion or emolient helped.  I find a thin layer and not dressing till it's soaked in better.  The heat seems to aggravate it.  I also suffered with it around the bra area and the underarms were a problem.  A GP prescribed an antihistamine and that helped when it was bad but I now manage with a light pat of emolient every day to prevent any dryness.

Sorry if my post is a bit rambling.  I haven't much time at the moment but wanted to post quickly because of your similar symptoms.

Hi Wren, thanks for taking the time to post. I'm sorry to hear that you've been struggling also, it's all consuming isn't it!

My burning feeling (like sunburn or someone's taken a blowtorch to the area), redness and irritation has been 100% in the perineum, bottom area and between the buttocks  I have in fact had red burning skin right to the top of the butt cheeks!  The skin actually split there at one point and it was so painful when water in the shower touched the broken skin.  The skin was tight between the cheeks too (swollen?). Have you by chance had anal fissures as part of this too? Sorry if tmi!

The only time my 'front' area (labia area) has been involved is when it has been occasionally itchy and I've had the odd 'paper cut'.

At my worst, I have struggled to wear knickers and change to PJ bottoms in the house.  I find it painful to sit down because it's the back area that we sit on.  I would have previously thought you sit on your buttocks but they actually spread when you sit so you end up sitting on the perineum etc. Who knew?! 

I haven't struggled with the pain when sleeping which must be awful. Instead I get insomnia from the hormones and end up lying awake worrying about it all 

My thighs might be a little different to yours as they don't hurt unless I walk and they rub together or I walk and the seams rub my thighs.  I don't feel a burning all the time like I do in the perineum etc.  My issue feels like chafing and it might just be that!  It just seems strange to have started all of a sudden and to be so severe.  I'm currently assuming it's extremely dry skin due to low estrogen and can only hope it gets resolved in the near future.  I in fact did not mention my thighs at the GUM clinic as I didn't want to confuse things.

I have come up with a work around in the meantime which I hope might help you too...cycle shorts.  I bought cotton cycle shorts and wear them under my pants (trousers).  This is not a solution of course, but allows me to do my housework etc without being in pain.  Because my pain in the perineum etc has reduced and I have my shorts, I'm hoping I can resume walking - haven't been able to for over 3 months! Wish I had thought of the shorts a little earlier but instead I was busy working on a solution without success.

Thanks for mentioning pelvic floor issues as it's on my radar too.  I did in fact have an issue before having kids. 'Vaginismus' was mentioned by my GP when I described the issue hubby and I were having. I attended 2/3 appointments with a pelvic floor therapist/physio and we had discussions about the issue.  She never examined me but whatever she said worked.  I feel pregnant almost immediately after consulting with her! She said come back if you need to but I never did.  Pretty sure I must have tightness still and have read that it can cause burning and redness too! Very interesting.

I think I might go and get an assessment as although Ovestin appears to be working I'm eager to rule out all reasons for the excruciating burning to come back!

Please let me/us know how you get on with your physio appointment when you go. I hope it helps x

Sorry for such a long post. Thanks again everyone 

[Elissa]

Hi everyone, wondering if anyone can advise on when hormonal blood tests can be done please?  I'll explain what I mean. 

A few weeks ago I visited a GUM clinic and was told that my menopausal symptoms (VA - being treated by Ovestin; night sweats and insomnia) are either medication induced (I take 10mg Provera daily due to heavy periods) or early menopause (I am 41).  They suggested I needed to come off the Provera (progesterone) before I can have my blood tested for hormonal levels e.g. FSH, LH, estrogen, testosterone etc. 
I plan to move to a Mirena and they said my hormone levels could be tested 4-6 weeks after being on the Mirena.

Today I visited my regular male GP for an unrelated matter and discussed my issues with VA, being on Provera etc and not knowing my status re menopause.  He seemed quite knowledgeable about the topic and said I could be tested right away i.e. I don't need to come off Provera first.  He said that if I am in fact menopausal I wouldn't need the Mirena.  This has totally confused me as it totally contradicts what the GUM clinic GP said about when the blood tests could be done.  I had the blood test today and go back for the results Monday.  Wondering if anyone can advise on this?  Which GP is correct about the blood test timing?  (and therefore its reliability/accuracy?)  Appreciate any info.  Thanks once again 

[CLKD]

Sorry missed your response on 5 July - use SAVLON or ANUSOL on any affected areas, the former is probably kinder on broken skin.  Has there been improvement there?

Welcome to the world of Peri-menoapuse confusion.  [pity that I can't type, blaming the heat  ]. Your VA will not be medication induced!  The condition is due to the drop off of oestrogen which may make the body dry: inside and out; deep in the ears, skin, vagina, anus, between the toes, eyes .....

If a lady continues to have periods these need to have stopped completely B4 1 can consider being in menopause.  Peri are the years leading up to that final bleed = menopause.  My periods waxed and waned for several years: regular, then nowt for months etc.; I knew it was The Change so wasn't worried.  Sometime during 2002 I realised that they had disappeared  and fortunately, other than a few flushes for a few months followed much later by VA diagnosis, I have in the main been fine.  I know that I am very LUCKY!

Hormone blood tests are reliably un-reliable.  Certain tests need to be done at certain times of the cycle.  Let us know what the results suggest.

Do U have a particular reason to stop the Provera for the Mirena coil?

[Elissa]

Thanks for replying CLKD. 

The GPs I've consulted tell me Provera suppresses estrogen and can therefore mimic menopause symptoms.  That is one reason moving to the Mirena has been suggested as a good idea i.e. to find out whether or not my menopausal symptoms are actually caused by the menopause or instead the medication. Also, taking Provera 10mg tablets daily is considered a high daily dose and not ideal health wise for the longer term.

I've been taking Provera tablets and it's been explained that the progesterone affects my whole body (systemic is the term I think?) whereas the progesterone in the Mirena is targeted at the uterus and that is better healthwise.  My understanding is that any fake/false menopause symptoms from the Provera would subside when on the Mirena if indeed that is what's going on!

I have not had a period in 2.5 years (because of the Provera) and have no sense of cycle so cannot time blood tests right now.

Thanks for asking. Since using Ovestin I no longer have any irritation/burning on the external areas.  I only have a slight itchiness internally and externally that I try to ignore.  Using Ovestin twice a week.  I have used it a couple of times externally for tender areas in the last month or so and it has fixed them up after one application 

[CLKD]

Don't ignore any sensitivity!  Ovestin can be used every night if necessary , internally with a little smeared on the labial areas to stop those feelings. Any hint of symptoms becoming troublesome, slap it on 

Tnx for the comprehensive explanation.  It's all technical to me 

[Elissa]

Hi ladies, thought I might give a quick update.  Still feeling the occassional irritation around the underwear trim area but Ovestin seems to fix those up.  Fwiw moisturiser doesn't help and previously the steroid cream didn't either so quite sure it is dryness I'm dealing with.

My inner thigh irritation has gone completely.  I wore the cycle shorts for a few weeks and moisturised several times a day which seems to have worked. Don't worry I didn't put Ovestin on my legs!!

My regular GP who offered to test my hormones (fsh, LH, SHBG and oestrogen) advised me I am not menopausal.  I didn't get the figures as it was confirmed on a quick phone call.  I have to say I was a little disappointed as I was kind of hoping perimenopause was done and dusted already after all the burning down there!  Seems I might have to suffer some more before I come out the other side!

The same GP said he doesn't think my symptoms were dermatitis. He was convinced dryness.  He gave me Ovestin on repeat, two tubes at a time 

He said my ultrasound showed adenomyosis which he said is common as you get closer to menopause.

So there you go. Mirena to be inserted in the next few weeks to see if that helps.  To be continued....

P.s. he thinks my rosacea is simply rosacea rather than part of some big mystery involving my downstairs, phew!

Would be grateful to hear what you think about the blood test results considering I do seem to be suffering from low estrogen 
Thank you 

[Ayesha]

Glad things are working out ok below stairs but I see your journey continues and I hope the more knowledgeable ladies will be along to help you re blood tests.