Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[CLKD]

I've not required systemic replacement but the VA treatment works 4 me.

[Ayesha]

Same for me, no broken bones, hearts good, mind intact, and I am so old who would have thought I survived all this without systemic HRT 

[SundayGirl]

CLKD and Ayesha - well said.

👏👏

[CLKD]

Thus far I've never broken anything even though we had slides, roller skates, scooters, skipping ropes  .  Also we walked a lot, perhaps that's why my bones are good .  Without symptoms I wouldn't have known about VA which my GP diagnosed over the 'phone.  No resistance. 

[Pixie]

I started with the uti symptoms but not a uti thing around 45. I thought VA came later after the menopause. 60's, 70's etc. Not so. Been using ovestin nearly 2yrs now and much better along with hrt patches.

There's not enough info about it starting earlier. I and the GP thought I had repeated thrush/fungal infections as well due to the soreness and itchy, dry, crawling feeling. She said I didn't look like I had VA on examination. All gone thanks to ovestin. I need to apply some externally as well as internally for max effectiveness.

[Peripurple]

I was 40 when I first got symptoms of VA, I was told by a GP and menopause specialist I was too young!  18 months later and in complete despair a wonderful practice told me she thought I had VA and started me on vagifem. I am 48 now and need daily topical oestrogen to keep on top of it.  There needs to be much more education out there that this is not just a post menopause issue.

[Elissa]

My female doctor was adamant I had dermatitis and/or a fungal infection.  She prescribed a strong steroid cream and anti fungal creams.  I honestly couldn't tell you how many tubes I used (I lost count) over a year or so, on and off.  I kept asking her if I could moisturise down there because something kept telling me it was dry (skin felt tight).  She said absolutely not, the area must be kept dry 

She then ruled out thrush/fungal infection with a swab (even tested me for herpes) but insisted I continue with the steroid cream.

My skin became so sore I was virtually house bound as it hurt to walk around.  It hurt to sit.  I must have visited the GP fifteen times at a guess.

Now I have put this experience plus a lot of other symptoms together and I have recently started estrogel (and had a mirena inserted) that I apply to my arm each morning. I'm still using my vaginal estrogen as well and still have 'hints' of the VA. I will see if 1 pump will be enough but I doubt it at this point.

My other symptoms fwiw were/are occasional rage/very low mood, itchy skin, itchy scalp, crawling sensation on scalp, disturbed sleep, night sweats and fatigue. The estrogel has gotten rid of some of these issues, perhaps reduced some too (like night sweats - still there although less severe).

I cannot believe my doctor didn't consider all this suffering could be related to perimenopause.  When I mentioned the rage she said "we all get angry sometimes".  Thank goodness however, she let me try vaginal estrogen and the new doctor I'm consulting prescribed the systemic estrogen.  Feel I'm on right track now (I'm 42).

[KaraShannon]

Vaginal atrophy occurs when estrogen levels in the body are too low to support optimal health of the tissues, and it is not just the genital tract that is affected or that matters, what about the bones and cardiovascular system etc, all the parts that we can't see.

If that were me I would be at the GP practice showing them the NICE guidelines and insisting that they either follow them or refer me to someone who can.

bombsh3ll, is vaginal atrophy always a sign that the systemic estrogen levels are low?  Genuine ask, not challenging you, it's just that I thought systemic levels could be good but not enough to support the pelvic system.  I have mild prolapse at certain times of the month and that's bad enough but I hope it doesn't mean my systemic estrogen is too low.

I can't seem to take any more estrogen.  I'm only on evorel sequi.  One doctor said I could raise the patches up to 100 estradiol but then I had awful migraines that I couldn't live with and also heart palpitations and hypotension.  This all resolved (well, up to a point that is liveable and reasonably ok) by going back down to estradiol 50. 

I know I need vaginal estrogen though but it's worse for migraines.  I can use the tiniest amount and start getting head zaps and dizziness.  It's unbelievable I know but it happens every time. 

I use estriol now externally but not confident enough to use internally as vagifem, even when cut up tiny would cause really significant migraine, tinnitus, irritability.  I know they say it doesn't get into your system but it happens every time.  It might be something odd about my vaginal wall   but just hope it doesn't mean systemic estrogen is low.  I was told it was too high when I was having all the dizziness.  Told it was too high 'even for an ovulating 30 year old,' so it was definitely too high when on 100 estradiol.

[CLKD]

Elissa - I do wonder often why some become GPs  .  She should be aware that the vagina cleanses itself and is rarely 'dry' ......... until oestrogen levels drop.

KaraShannon - U need to see a dedicated menopause specialist to discuss the correlation between VA treatment and migraines.  Have U reported on the yellow card system?

[Elissa]

Yes CLKD I agree, particularly when she (the GP) advised me I was dry down there during my most recent cervical screen/pap smear prior to my symptoms starting.  After over a year (when the penny dropped after lots of research) I then quoted her, back to herself, suggesting I might need estrogen.  She huffed and puffed and prescribed vaginal estrogen with a "try it, but I don't think it'll work" comment 

The GP is not young either and female.  I would've thought she might have seen it before as the only female GP at the surgery (she has a steady stream of female patients) or it's not crazy to think she might've experienced it herself given her age and the number of menopausal women that clearly suffer from these issues! Obviously I was unlucky on both counts, she did not recognise it as being due to low estrogen.  She didn't even recognise it as dryness

[Ayesha]

Vaginal atrophy occurs when estrogen levels in the body are too low to support optimal health of the tissues, and it is not just the genital tract that is affected or that matters, what about the bones and cardiovascular system etc, all the parts that we can't see.

If that were me I would be at the GP practice showing them the NICE guidelines and insisting that they either follow them or refer me to someone who can.

bombsh3ll, is vaginal atrophy always a sign that the systemic estrogen levels are low?  Genuine ask, not challenging you, it's just that I thought systemic levels could be good but not enough to support the pelvic system.  I have mild prolapse at certain times of the month and that's bad enough but I hope it doesn't mean my systemic estrogen is too low.

Bombsh311 has been asked by another member if she is medically qualified as her posts would suggest she is, up to date she has not replied to the questions asked. Therefore please don't take literally everything that is said on this or any other forum and either research or seek medical advice to put your mind at ease. Most of us here post from our own personal experiences to share what we are going through during the menopausal phase.

[Anabelle31]

I am just 42 and suffer with VA.  I've posted my journey in the new members section.  My recent symptoms (last year and a half) have been vulva focussed (itchy/burning sensations plus redness on vulva area) but I wanted to mention that I also have microscopic hematuria or blood in the urine. 

The first time it came up was back when my periods became heavier and I had iron deficiency (start of perimenopause?).  The doctor did a urine test as part of a general health check and then sent me for a kidney/bladder ultrasound and all was ok.  I would have been 36 at that time….

You're not alone.  Ask for vaginal estrogen.  Good luck.

I just wanted to come back and thank you so so so much for sharing your own experience, this has been incredibly helpful for me - it’s felt quite lonely not understanding what’s going on and having doctors tell me it’s not menopause. A new gynae now sans I’m in perimenopause (based on vaginal scan) and has given me vaginal hrt. So thank you again!!

[Elissa]

I am just 42 and suffer with VA.  I've posted my journey in the new members section.  My recent symptoms (last year and a half) have been vulva focussed (itchy/burning sensations plus redness on vulva area) but I wanted to mention that I also have microscopic hematuria or blood in the urine. 

The first time it came up was back when my periods became heavier and I had iron deficiency (start of perimenopause?).  The doctor did a urine test as part of a general health check and then sent me for a kidney/bladder ultrasound and all was ok.  I would have been 36 at that time….

You're not alone.  Ask for vaginal estrogen.  Good luck.

I just wanted to come back and thank you so so so much for sharing your own experience, this has been incredibly helpful for me - it’s felt quite lonely not understanding what’s going on and having doctors tell me it’s not menopause. A new gynae now sans I’m in perimenopause (based on vaginal scan) and has given me vaginal hrt. So thank you again!!

You're welcome!  The ladies on here have been so helpful to me, I am happy to help someone else!  Good luck with the treatment. Fwiw it took 5 weeks for me to feel a decent benefit and a full 3 months to feel almost 100%.  My whole pelvic region seemed to be affected, inner thighs, buttocks everywhere. I was in a right mess and yes felt quite lonely too.  Come back and update this thread to let us know how you get on 

[bombsh3ll]

[/quote]
bombsh3ll, is vaginal atrophy always a sign that the systemic estrogen levels are low? 
[/quote]

Yes.

Whilst this is not always due to menopause - it can also occur during lactation or medical treatment that suppresses ovarian function - VA is pathognomonic of hypoestrogenism.

Studies have been done in the past looking at the threshold at which this occurs - Philip Sarrell et al in the 1990s tested plasma estradiol in women with and without VA, and found that VA was highly prevalent below a plasma estradiol of 50pg/ml and became much less so as levels increased above this.

Note that this research used US units - this equates to approximately 183pmol/L

This doesn't mean that everyone with VA can or should increase their systemic estrogen levels - obviously if tolerability is an issue or in the setting of breast cancer etc this may not be clinically appropriate, but understanding the physiology and scientific evidence around this is important for making informed decisions.

Particularly in younger women e.g. those in their early or mid 40s and those with concerns about osteoporosis, I believe the presence of VA should prompt a review of whether the individual has an appropriate level of systemic estrogen to optimise their future health.

It is also worth noting that NHS guidance states that "A serum estradiol of at least 250pmol/l is required to promote bone metabolism and reversal of bone loss". https://www.chelwest.nhs.uk/professionals/gp-hrt-advice-guidance although I personally would favour the level recommended by the late Prof Studd of 300pmol/l to be absolutely sure.

[KaraShannon]

bombsh3ll, is vaginal atrophy always a sign that the systemic estrogen levels are low? 
[/quote]

Yes.

Whilst this is not always due to menopause - it can also occur during lactation or medical treatment that suppresses ovarian function - VA is pathognomonic of hypoestrogenism.

Studies have been done in the past looking at the threshold at which this occurs - Philip Sarrell et al in the 1990s tested plasma estradiol in women with and without VA, and found that VA was highly prevalent below a plasma estradiol of 50pg/ml and became much less so as levels increased above this.

Note that this research used US units - this equates to approximately 183pmol/L

This doesn't mean that everyone with VA can or should increase their systemic estrogen levels - obviously if tolerability is an issue or in the setting of breast cancer etc this may not be clinically appropriate, but understanding the physiology and scientific evidence around this is important for making informed decisions.

Particularly in younger women e.g. those in their early or mid 40s and those with concerns about osteoporosis, I believe the presence of VA should prompt a review of whether the individual has an appropriate level of systemic estrogen to optimise their future health.

It is also worth noting that NHS guidance states that "A serum estradiol of at least 250pmol/l is required to promote bone metabolism and reversal of bone loss". https://www.chelwest.nhs.uk/professionals/gp-hrt-advice-guidance although I personally would favour the level recommended by the late Prof Studd of 300pmol/l to be absolutely sure.
[/quote]

Really interesting, thanks a lot!

I'll go get a print out of my blood levels to see if I was indeed way too high before.  I expect I was though as the symptoms lessened when I halved the dose.

You've given me a lot of food for thought about being more precise with my HRT, which wasn't easy during the pandemic and our surgery under way too much pressure.  I have other symptoms of low oestrogen at times.  I really only feel well, energetic and my old self one day a month, if I'm lucky it will stretch to 3 days.  That's around the time I change over mid month from evorel only to evorel combined with norehisterone (synthetic progesterone).  I'm not sure if I'm feeling better because of reaching mid cycle and having had estradiol for 2 weeks, or whether it's the introduction of the progesterone just after.  But after two weeks on this I do feel 'ready' for estradiol only again as that's when prolapse symptoms start coming on.

Anyway thanks for replying