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[Platespinning]

Help please!

I'm 47 and peri. I've been trying various things for vaginal dryness, mainly local estrogen before having to resort to systematic late last year as started with uretha burning. Thought I'd got it settled with estring and 3 pumps of oestrogel but have struggled with utrogestan part of cycle. First month caused severe dryness so skipped a month and tried qlaira but that caused pruritis vulvae (external itching) so switched back. This month it caused burning from around day 3. I tried using vagifem alongside estring which seemed to help a bit but the filters irritate me in that and it wasn't 100% effective.

Luckily I got my period 9 days in (so I thought) and it seemed to settle however I'm at the end of my period now and it's started again badly (no Utro yet as cyclical). I've still got my estring in and it's only been in less than a month so should still be working. I wondered if I'd got an actual UTI so started some pivmecillinam I had for emergencies but neither than nor vagifem last two days seem to be settling it.

I could really do with some advice as I'm not booked in at the doctors till 31st and that's only a telephone appt with the one doctor who has half an idea at our practice. I'm so uncomfortable and it's really affecting my sleep 😭

[CLKD]

Morning.  Vaginal atrophy mimics repeated urine infection-type symptoms really really well.

Some are sensitive to the fillers: or it may be that the vaginal walls are so dry that the insertion/product stings.  The idea is to ease the product into the vagina as far. up as is comfy initially, every night if possible.  Once the vaginal walls become moister they will relax and soak up the VA treatment.

Some require nightly insertion as well as a smear of estriol or similar to the outer labia.  Whilst the body is bleeding the vagina will be moister which dries out once the period stops. I would get intense itching high up 2 days after my period with a brown smear. 

U may require estriol rather than other treatments.  It is important to persevere beyond those irritating UTI-type symptoms.  When my symptoms become troublesome I swallow 2 Nurofen to ease the. nip as the urine flow shuts off.

Do U Use KY Jelly ever?  Whilst it won't replace oestrogen loss = dryness : skin, deep in the ears, scalp, vagina, eyes etc : it mayB enough to moisten the vagina/vulval area to help those feelings.

[bombsh3ll]

I would get an urgent face to face appointment somewhere whilst you are symptomatic for an examination and urinalysis in order to confirm the diagnosis.

If it is purely VA I would increase your estrogen gel to 4 pumps and use daily vaginal estrogen.

The estring is a good idea in principle but so large and hard that it can cause erosion of the vaginal walls and prevent full emptying of the bladder and bowel, which increases the risk of infections, so I would consider whether this is really serving you or adding to your discomfort.

At 47 if you have no contraindications to combined hormonal contraception you could even use the Nuvaring if you wanted and just change it every 4 weeks instead of using multiple other products. This delivers systemic ethinylestradiol and is really slim and soft compared to the estring.

But if you are continuing with estrogen gel you really need to find a suitable progestogen - is there any that you have tried in the past for example desogestrel? Many people have used this as the mini pill.

[Platespinning]

Thanks so much both, I really appreciate your help!

You might be right bombsh3ll about getting a more urgent appointment. I've tried upping to 4 pumps a few times around my period and haven't had any adverse effects so maybe I'll try that for longer. The problem is mid month this almost makes me too wet (sorry tmi). My symptoms are weird - I don't seem dry internally but experience the dryness feelings externally and around the vaginal opening. Having said that I've been using a vaginal disc for my periods for quite a while now as was finding tampons really uncomfortable and pads giving me a chafing effect. Maybe that's part of the problem!

It's only relatively recently that the added joy of the burning has come to the fore which adding the systematic estrogen seemed to help with. I've tried Cerezette previously (desogesterol) and Qlaira (COC dienogest) but both seemed to exacerbate my symptoms.

CKLD I thought I'd cracked it with the estring for my vaginal estrogen as was using vagifem previously and despite using it for quite a while the irritation continued and I want getting enough relief. I'm not sure there would be enough estrogen in nuvaring to help as think there's even less in that.  I struggle with a lot of them as they have sodium hydroxide in which causes a severe burning reaction ☹️

I have tried some estriol creams but as I said they caused a reaction. Maybe I need to look for one without sodium hydroxide 🤔 I also use yes vaginal moisturiser too make things more comfortable generally.

I know it's trial and error with these things but it's so uncomfortable at the moment it's making me tired and miserable!

[chopsuey]

Hi Platespinning

You could try the 0.01% estriol cream by Marlborough Pharmaceuticals, which doesn't contain sodium hydroxide. I was previously troubled by burning in the urethra/bladder/vagina, which was very much exacerbated by both Utrogestan and the 0.1% estriol, which contains the sodium hydroxide. For the first time in over 5 years, I no longer have any burning. I had a Mirena fitted to replace the Utro.

[Platespinning]

Thanks chopsuey, I haven't heard of that one. I'll look into it! I'm really scared of trying the mirena as had such trouble with all the other progesterones I've tried and worried if it didn't suit me I'll be stuck with it for weeks until my practice can take it out. Plus heard a lot of reports about terrible spotting.

[chopsuey]

I wasn't at all keen on the Mirena for various reasons either but had run out of options. For me at least, it has been absolutely fine - minimal spotting, which stopped after maybe 3 months. But I absolutely get the concern about lack of control over having it removed in a timely manner if needed. I'm also post meno, which may make a difference on the bleeding side of things.

[bombsh3ll]

The nuvaring is in the same league as a combined oral contraceptive pill. It contains ethinylestradiol which is many times more potent than estriol, plus a progestin.

It might just be worth a look if you are comfortable using a vaginal ring and also need systemic treatment.

The IUS is another good option for endometrial protection, however this isn't always easy or quick to get removed if it doesn't suit you, as opposed to something self administered that you remain in control of.

[Platespinning]

Thanks bombsh3ll and chopsuey! I really appreciate all the advice - I'll look into these x