Menopause Matters Forum
Menopause Discussion => Postmenopause => Topic started by: TnToast on May 15, 2024, 04:22:30 PM
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Hi everyone
I have had VA for many years now, since perimenopause.
Over time I have been prescribed: Estriol 0.01% Cream (made inflammation worse and resulted in having to have a vulval biopsy)
Vagifem (resulted in too much of a discharge to be coped with)
Estriol 0.1% Cream- Ovestin (initially I used every day for about 6 weeks, then dropped to 2x per week, it took 12 months before I felt any significant improvement and it burned a lot at first)
I also use YES VM and wash with Dermol or Cetraben.
Although I have had some comfortable days with Ovestin, I have felt it to be less effective recently. After a small bleed I found out I had a bacterial infection and following a trip to Gynae it was suggested that I try Vagifem again, as it is a stronger estrogen.
I've been using Vagifem for a couple of weeks now on alternate nights with no discharge this time (although the gynae told me to only use it 3 x per week). I'm thinking of it as a sort of loading dose, but not sure if this is necessary if I've just swapped from Ovestin.
I'm also still using Ovestin externally and YES VM on the night I don't use the other two. However I'm feeling even less comfortable than I did on Ovestin alone. Whenever I sit down I feel like I have sunburn down below and the other night it was so sore that I couldn't get to sleep. Is it because the Vagifem isn't a cream and so doesn't have instant moisturising properties like Ovestin? Or is it the ingredients?
I mentioned trying the Estring to my GP but she just raised her eyebrows at the cost and said that she/the practice had never prescribed it before.
I just don't know what to try next.
I really need some advice - should I give it longer or go back to Ovestin which did give some comfort, and maybe ask to use that more frequently? Another concern though is that on the YES website it says that glycerin at high concentrations is a mucosal irritant which can damage skin and at low concentrations it is a nutrient for thrush...yet this is an ingredient in Ovestin. I'm now worrying that long term, more frequent use of Ovestin will cause more damage...
Also, does anyone have any recommendations for a soothing moisturiser for the outer skin, which also feels like it is burning?
Really - is there any answer to this depressing condition?? And why after so many years of women talking on here and the subject being brought into the open by people like Jane Lewis, Dr Louise Newson and Davina McCall, do GPs and Gynaes still feel reluctant to allow more frequent use of treatments or limit the options available?
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Get the treatment up there every night for at least 3 weeks. It really can be Trial and Error and many medics are totally unaware of how VA impacts on daily life or how to diagnose effectively.
Put a pessary up now and later this evening as well as the YES VM if it helps. Some require vagifem internally with a smear of 'ovestin' on the outer regions every night. Or a moisturiser along with one of the products - every night.
If you are using the YES product externally it shouldn't infiltrate enough to cause problems. GPs etc. are worried that women may over dose on Oestrogen !!!!
Your GP should be referring you sooner rather than later: due to waiting lists : to a dedicated menopause clinic - not a gynae - if the symptoms have improved by the time the appt arrives, U can cancel. Let us know how. you get on.
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If you can use all your VA treatments every day without problems then do so, for me its the only way to control the symptoms.
The problem when your VA symptoms become more complicated and the methods to control it don't work, that's when I think an appointment to a menopause clinic or even a GUM clinic is the next best option for you. A friend years ago went to the GUM clinic and they discovered she also suffered with eczema.
Yes moisturiser is one of the best on the market and safe to use, I find it works brilliantly alongside my other VA treatments.
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Thanks for your replies. :)
The problem is that, although Ovestin every third night wasn't controlling my symptoms well enough (alongside the moisturiser and emollient in the shower), now I've switched to the supposedly stronger Vagifem they are worse. I am burning externally much more... this is where I am most uncomfortable.
I think I will have to go back to Ovestin and try and get a referral, as you suggest.
I have used YES VM internally as well as externally on nights that I don't use a hormone treatment - can it stop the hormone being absorbed?
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The vagina is self cleansing so if well plumped up, will get rid of anything it doesn't require. It may be the fillers or packaging of the vagifem which are causing any problems. 'ovestin' internally and around the dryer outer parts every night should help. Don't give up!
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Thanks for your replies. :)
I have used YES VM internally as well as externally on nights that I don't use a hormone treatment - can it stop the hormone being absorbed?
No I would say its ok to do both, I use Yes moisturiser when using Ovestin (Estriol) and it doesn't seem to have any effect on its efficiency.
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It's trial and error finding what works for you.
Reading everyone's routines on here has been invaluable.
Although I think some of my vulval burning is from a tight pelvic floor, as mentioned on another thread, I also have dry skin and find things irritate because of that and only use emollient to wash.
I currently using Vagifem at night & Yes VM in the morning internally, to dilute the fillers.
I apply Ovestin in the morning to the vulva, wait 15 mins for it to absorb, then apply Yes oil based or Olive & Bee to protect the skin and add more through the day.
For me, the Yes VM doesn't provide lasting moisture externally. It's PH balanced for the vagina - isn't that a different PH to the vulva/skin?...
My body and facial routine's a doddle in comparison 😁
Hope you find what works for you.
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Hi TnToast, from my own experience I would advise that you should ask for a referral to a GUM clinic. This might be helpful for you. I don't know what services there are near you, but after a lot of persistence (including being seen in a vulvoscopy clinic by a very good Dr and told 'you're fine'..i was not 'fine!) I was seen at a GUM clinic by a wonderful Dr and diagnosed with vulvodynia (I don't want to hijack your thread so won't go into details). It sometimes takes a different approach to assess what is going on so I would advise asking to see someone at a meno or GUM clinic as they really are thorough and will identify if something else is affecting the area. I would just add that for some of us, the topical/local oestrogen products and moisturisers can create problems, sadly...and as Wren mentioned, tight pelvic floor muscles can play a part in vulval pain too..
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Thank you so much for your replies.
You have given me a few things to think about. I felt a bit more comfortable today after using YESVM internally and externally last night, so I am going to just use Vagifem tonight without Ovestin and then use the YES again in the morning as you suggest to dilute the fillers.
I remember that when I first started using Ovestin a couple of years ago it was very uncomfortable at first for a few weeks. Maybe the swap has just caused irritation to my very sensitive skin. So, on the back of a better day I'm going to persevere and try your suggestions.
If I they don't work for me I will ask for a referral to a GUM/Menopause clinic and go back to Ovestin in the mean time. I'm hoping that having made things worse by swapping meds it will settle back down quickly and that I won't have irritated everything so much that it will take a year again....
It's amazing how this affects your mood too. Yesterday I was miserable and desperate because of the soreness, today after a bit of relief, I feel more optimistic. :)
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I also have dry skin and find things irritate because of that and only use emollient to wash.
For me, the Yes VM doesn't provide lasting moisture externally. It's PH balanced for the vagina - isn't that a different PH to the vulva/skin?...
I have dry skin too which does make things worse. I do wash with emollient but will try something like Olive and Bee afterwards. I agree YESVM doesn't provide lasting moisture externally, just a bit of soothing for half an hour or so.
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My advise is, insist on that Estring ring. It works!
Don't know how they calculate costs. Yes, it seems expensive but it lasts 3 months! Estriol which is ca third lasts less than one month! ..times 3 or 4 it 's actually more expensive than Estring! Same goes for other pessaries, etc. even Vagirux which seems dead cheap but not if you need to take it everyday!
🤗
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I use vagisil prohydrate. I mix it with my ovestin/estriol cream and apply at night. I've had no irritation. It's around £10 and the tube isn't big though. I use vagifem too. The vagifem won't hydrate the outside. Both areas need treating separately.
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Thanks for your replies. :)
I have used YES VM internally as well as externally on nights that I don't use a hormone treatment - can it stop the hormone being absorbed?
No I would say its ok to do both, I use Yes moisturiser when using Ovestin (Estriol) and it doesn't seem to have any effect on its efficiency.
Perhaps try the WB Yes, I can't tolerate the VM one, it irritated and made me sore but I'm fine with water based.
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Thanks for the advice.
As an update, in case anyone else is going through the same, the Vagifem has stopped burning. It took about a month to get used to it. I found I needed to use the YES VM more frequently once I swapped from using Ovestin internally as Vagifem isn't a cream and doesn't have immediate moisturising effect.
I use the Ovestin externally only now. I still find I burn there though - mainly after a brisk walk or sitting for more than a few minutes. Has anyone got any advice for this?
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I use the Ovestin externally only now. I still find I burn there though - mainly after a brisk walk or sitting for more than a few minutes. Has anyone got any advice for this?
A layer of emollient, such as Epaderm or Hydromol, would give protection against the friction of walking, and it's much longer lasting than a water-based moisturiser. Or try an oil-based moisturiser such as Olive & Bee?
JP x
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Thanks for the advice.
As an update, in case anyone else is going through the same, the Vagifem has stopped burning. It took about a month to get used to it. I found I needed to use the YES VM more frequently once I swapped from using Ovestin internally as Vagifem isn't a cream and doesn't have immediate moisturising effect.
I use the Ovestin externally only now. I still find I burn there though - mainly after a brisk walk or sitting for more than a few minutes. Has anyone got any advice for this?
How much ovestin are you applying? I'm finding it hard to apply the amount I need. And I need it more often but trying to follow the guidance
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I squeeze 'ovation onto my fingers so that my vagina/vulva is moist enough. A insert internally with the applicator then a smudge where necessary. If necessary at lunch time and again in the evening. KY Jelly also helps ......... Little and often initially can really make a difference then as necessary. We cannot over dose on oestrogen vaginal replacement ;-).
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What works for me is to apply the moisturiser first then the Ovestin/Estriol cream on the outside. I actually find that the cream is quite a dry consistency which is not ideal but the added moisturiser sorts all that out. One tube will last me three to four months along with the Vagifem.
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That should be 'ovestin' ::) ........
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What works for me is to apply the moisturiser first then the Ovestin/Estriol cream on the outside. I actually find that the cream is quite a dry consistency which is not ideal but the added moisturiser sorts all that out. One tube will last me three to four months along with the Vagifem.
Mine is only lasting just over a month. I'm finding as I'm aging and obviously it's a deteriorating condition, I'm needing more to keep it at bay.
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It did come as a great surprise to me that after stopping the Estriol treatment for four days at how much the nasty symptoms of VA started to come back and how the discomfort was becoming as intense as it was before treatment. I did begin to wonder what was the Vagifem doing because its without doubt I need treatment for the outside area.
I suppose without the Vagifem the inside would be uncomfortable but most of my pain and discomfort emanates from the outside and with a half pea sized amount of Estriol twice a day that was and is enough to get me back to feeling normal again.
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Maybe I should use less but twice a day
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The same Jules but twice a day for 3/4 days .......... it's about managing the condition and with regular treatment, it is not a deteriorating condition.
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The same Jules but twice a day for 3/4 days .......... it's about managing the condition and with regular treatment, it is not a deteriorating condition.
It must be as my treatment has worked for 9 months and now it's not as effective
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It did come as a great surprise to me that after stopping the Estriol treatment for four days at how much the nasty symptoms of VA started to come back and how the discomfort was becoming as intense as it was before treatment. I did begin to wonder what was the Vagifem doing because its without doubt I need treatment for the outside area.
I suppose without the Vagifem the inside would be uncomfortable but most of my pain and discomfort emanates from the outside and with a half pea sized amount of Estriol twice a day that was and is enough to get me back to feeling normal again.
The vulva and lower part of the vagina have a different blood supply from the upper two thirds of the vagina, which is why so many people need the estriol cream as well as the estradiol pessaries.
JP x
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Well that explains a lot, Joaniepat, and certainly makes more sense to me.
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The same Jules but twice a day for 3/4 days .......... it's about managing the condition and with regular treatment, it is not a deteriorating condition.
It must be as my treatment has worked for 9 months and now it's not as effective
Its most definitely a deteriorating condition which is why its vital to keep up with the treatment and if not, you go back to square one!
I've proved a lot to myself by my little experiment of stopping Estriol, it means I can never be without it. They say treatment is for life and I can now confirm that.
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The same Jules but twice a day for 3/4 days .......... it's about managing the condition and with regular treatment, it is not a deteriorating condition.
It must be as my treatment has worked for 9 months and now it's not as effective
Its most definitely a deteriorating condition which is why its vital to keep up with the treatment and if not, you go back to square one!
I've proved a lot to myself by my little experiment of stopping Estriol, it means I can never be without it. They say treatment is for life and I can now confirm that.
My GP told me I'd need to use vsgifem for life.
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Now that I know its the Estriol I need the most I have started to reduce the Vagifem to six a week and in time reduce further to five. Hopefully this experiment will work better than the last one as it will be nice to have a break from the daily regime (grind) of inserting the pessary every day for the rest of my life.
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:thankyou: Joaniepat!
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It's interesting, isn't it. I'm the other way round from Ayesha - only using external estriol every fourth night, and the rest of the time need the estradiol inserts. As we always say, everyone is different.
JP x
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Now that I know its the Estriol I need the most I have started to reduce the Vagifem to six a week and in time reduce further to five. Hopefully this experiment will work better than the last one as it will be nice to have a break from the daily regime (grind) of inserting the pessary every day for the rest of my life.
I'm currently doing every 3rd night with vagifem, every night with estriol but some days a little in the morning too. The thing worth mentioning is that I felt fine on twice a week vagifem until I happened to need an internal examination and was told it wasn't looking good. So how we feel doesn't always represent what's inside.
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I know I was starting to feel terrible again after four days of no Estriol cream, and that was just a smear twice a day but what a difference it was making to controlling VA symptoms. This time it will be interesting to see what develops not using daily Vagifem.
As you say Jules, I don't feel anything inside but I imagine the deterioration would start to happen if I gave up using Vagifem and the only way to find out is to experiment, again!
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Hi I’m on the slippery slope again after two years battling this condition. If I reduce the amount of estriol cream at all it messes me up. There are clothes I can’t wear and foods that also have an impact. After a time of symptoms easing I’m on my second UTI and a full flare up of VA. So having a rethink - daily estriol internally and also started externally - was doing ok then wore leggings and sat in an uncomfortable chair for too long and all symptoms back and on antibiotics again. I know this is lifelong I know it can be managed but boy it’s exhausting.
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Bunny Lady - has an infection been confirmed in a Lab.? ABs will ease any inflammation but are being overprescribed and won't replace any oestrogen.
Why did you reduce the cream? I use 'ovestin' internally with a smear on the vulva every 3rd or 4th night.
Which foods seem to impact the problem? It may be that your urine is acidic which may aggravate VA symptoms.
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I know I was starting to feel terrible again after four days of no Estriol cream, and that was just a smear twice a day but what a difference it was making to controlling VA symptoms. This time it will be interesting to see what develops not using daily Vagifem.
As you say Jules, I don't feel anything inside but I imagine the deterioration would start to happen if I gave up using Vagifem and the only way to find out is to experiment, again!
I darent reduce the estriol. Im worried about a regression. The progress Ive made has taken so long with nightly applications that I dont want to have to start again. I have no discomfort, Im not getting UTIs (though I use a prophylactic AB after sex because that was the trigger). The atrophy is still an issue though some improvement, nothing like before. If only Id known about treatment!
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If a regime works, stick with it!
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CLKD - have test strips at home and show infection. Doctor wants to do further investigation for why I’ve had these recurrent UTIs - my thoughts are GSM but they want to do blood tests and scans etc. I always note changes in my routine that can link back to possible reasons why things flare up. As things get back to ‘normal’ I forget and then slip in routine. I am now trying to get back to that ‘normal’ and try not to forget that actually it is not normal anymore and without the strict regimen I will be back to the discomfort again.
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Morning Girls - which investigations does your Doctor propose? If U are using VA treatment, then try 2-3 weeks of every night. Some need moisturisers too. [what's GSM ? it's early for me to get brain in gear ::) ]
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[what's GSM ? it's early for me to get brain in gear ::) ]
Its how we are to refer to Vaginal Atrophy in future, GSM meaning 'Genitourinary Syndrome of Menopause'
Another medically named tongue twister for us to get our heads around!
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:thankyou: Call a spade a spade, me. Glad that I'm not doing medical shorthand! ;D
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- was doing ok then wore leggings
All my jeans & trousers gradually went to charity shop a relief not to look at what you can’t really wear anymore.
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I was referred to a Genitourinary consultant probably 6 years ago for recurring UTIs. He did check everything to make sure there was no prolapse or any other physical issues. At the time Id been prescribed prophylactic antibiotics because they were only being triggered by sex. In previous generations wasnt it called honeymoon cystitis. It isnt an uncommon thing in women of any age because of our anatomy. He prescribed vaginal estrogen but at that time, not as much was known about it. I recall him being very short patienced about my fears and snapping at me. No wonder when I read the leaflet, I was too worried to use it, he hadnt filled me with any reassurance. That was a mistake though not to use it. I've recently see my GP about something and we talked about VA and she told me she would not hestitate to use topical estrogen if she needed to and that there has been a big push on womens health the last 6 years because the lives of women have changed, theyve have been extended and different demands. I wondered then why she advised about treatment earlier, or any of those GPs for that matter. There might be a push on it, but I still don't think those particular GPs take it as seriously as they should.
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Honey-moon cystitis ::). Not quite the same as it usually resolved itself.
4 me the importance of managing the symptoms is important as well as recognising when I require a 'boost'. Plus using 'nurofen' when there is a nip as the urine flow shuts off.
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I am of the opinion now that if any woman is suffering with Vaginal Atrophy (GSM) and not with any other horrid condition that vagina's are prone to, then we can be completely in charge of the condition.
For instance if a GP said I was to try and reduce my use of Vagifem and Estriol it would be a firm no because I alone know what dose I need from my experience of using the treatment for nearly three years, I alone know my body and I know what is required to control the symptoms, as we have mentioned here many times, we all react in a different way when suffering with GSM.
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Honey-moon cystitis ::). Not quite the same as it usually resolved itself.
4 me the importance of managing the symptoms is important as well as recognising when I require a 'boost'. Plus using 'nurofen' when there is a nip as the urine flow shuts off.
I was referring to the UTIs that many women of all ages get with sex but was common on honeymoon in the days people refrained till after marriage.
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The tests are an ultrasound of bladder and blood tests. Not sure what they’re looking for, possibly checking that ovaries and bladder are clear of anything ‘nasty’ or serious?? The whole of this started two years ago when I had some recurrent UTIs and eventually I found out about VA/GSM and local oestrogen! It’s been a journey - loading dose was great but then I started systemic and had a bleed so had to stop as they investigated and that lead to another return of symptoms and UTI. Then had to reload - they changed HRT and that also had an impact. So many little things can change the balance. Speaking to my menopause specialist tomorrow and will see what she says. Have returned to daily internal ovestin (estriol) and now added it in externally too. May even ask about using it twice a day while in this flare up. Antibiotics have worked - all of the UTIs tested positive for leukocytes- so hoping I can get back on track. My worry is if the do a transvaginal ultrasound it’ll set off VA again and I don’t need that.
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I've had TV scan and hysteroscopy recently and worried about that. I took one of my ABs after the hysteroscopy. The TV scan was very gentle. I think you'll be ok. I'm paranoid about UTIs, I had such a bad run of them, hospitalised once because it wasn't diagnosed so I don't take any chances
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Jules I don’t have any prophylactic ABs but my specialist has suggested Hiprex to help with recurrent UTIs to ensure all bacteria gone. Will continue with vaginal oestrogen just need to persuade GP to issue it for daily use.
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There is of course good and bad bacteria. VA treatment will help get rid of any urine infection-type symptoms. When I get the need2P feelings I take 2 nurofen 3 times a day to ease the hip feelings as urine flow shuts off.
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Thanks CLKD I’m just trying to learn how to live with this - been two years now and mostly ok it’s just when things flare up it feels like you’re back to square 1 but I know I’m not. Just trying to manage it so I can live the ‘best’ life possible despite VA
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Use treatment every night if necessary.
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Jules I don’t have any prophylactic ABs but my specialist has suggested Hiprex to help with recurrent UTIs to ensure all bacteria gone. Will continue with vaginal oestrogen just need to persuade GP to issue it for daily use.
I think I need it more often but last time I increased I got side effects.
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Which may well happen - if I stop for a week then restart, I get bounce back symptoms for 24 hours; until the vagina soaks up what it requires.
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I know your pain, literally! I've suffered from severe dryness for 3/4yrs now.
It was also causing cystitis, so ended up having an internal bladder scan just to make sure there was nothing sinister going on, all clear (apart from a fibroid pushing in to my bladder!).
The lovely Pratice Nurse said that being so dry can cause bladder issues, everything needs moisturising! She prescribed 2 x week Vagifem pessary, which has helped 'puff me' up, if you get what I mean! And the bladder issues have resolved.
But I don't find Vagifem brilliant, it works, but I still need something more, tried a few other vaginal moisturisers, but the best one I've discovered is the YES YES vaginal moisturiser - it's non sticky and is supposed to help your body moisturise when it needs it - it is well worth a try, it's the best so far I've found!
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Bermuda Queen, how do you use that? On days you don't use vagifem?
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As mentioned in your thread BermudaQueen, U need to use the 'vagifem' every night! 2 simply doesn't help and some require 'ovestin' as well or a moisturiser every night. 'yes' or 'sylc' products get good Press on here ;-)
Your Nurse isn't keeping up!
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Well I am going with the prescribed dosage they gave me, one pessary 2 x a week!
I had a Hysteorscopy yesterday with biopsies for post-menopausal bleeding, waiting on the results now - my womb is now also 'atrophic' so once I get the results (fingers crossed no abnormal cells), I'll ask them to review my treatment.
But finding the YES products really helpful.
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Where do you buy Yes ftom? I use vagisil prohydrate but now wondering if I need to try something different
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I’m looking for a good moisturiser- I use Vaseline to help with soreness and protection during the day. I’ve used Yes VM which can sometimes sting a little - depending on if I’m in a flare. Sudocrem also helps for healing. It’s a management thing!
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Yes, its all about managing things and eventually finding what suits. Zinc & Caster oil cream is also very good, not as thick as Sudocrem and Vaseline but I find it very effective.
Yes products are worth a look at, various types and easily available on Amazon.
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Where do you buy Yes ftom? I use vagisil prohydrate but now wondering if I need to try something different
Hi Jules,
I'll pop a link here, I'm not associated with them, but it really works for me
https://www.yesyesyes.org/products/yes-vm-natural-vaginal-moisturiser
I've tried other products, but often they sting and cause irritation, never had a problem with YES, it does work for me!
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I’m looking for a good moisturiser- I use Vaseline to help with soreness and protection during the day. I’ve used Yes VM which can sometimes sting a little - depending on if I’m in a flare. Sudocrem also helps for healing. It’s a management thing!
I know how painful and uncomfortable it is - the Pratice Nurse told me not to use Vaseline as she said it can hold bacteria as it's so thick.
I suppose it's a case of finding what works 'for you', but I've tried various moisturisers, Vagisil, own brands, but the only one that works for me is YES - worth a try!
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Where do you buy Yes ftom? I use vagisil prohydrate but now wondering if I need to try something different
Hi Jules,
I'll pop a link here, I'm not associated with them, but it really works for me
https://www.yesyesyes.org/products/yes-vm-natural-vaginal-moisturiser
I've tried other products, but often they sting and cause irritation, never had a problem with YES, it does work for me!
Thankyou
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Where do you buy Yes ftom? I use vagisil prohydrate but now wondering if I need to try something different
Hi Jules,
I'll pop a link here, I'm not associated with them, but it really works for me
https://www.yesyesyes.org/products/yes-vm-natural-vaginal-moisturiser
I've tried other products, but often they sting and cause irritation, never had a problem with YES, it does work for me!
Thankyou
It’s not cheap but if you sign up you get offers sent to you, I was a bit sceptical at first because everything else I’ve tried has stung and irritated, I was pleasantly surprised with YES, I do feel for me it does help - best of luck and let me know how you get on!
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I've ordered some and will try initially to see. As I've said I use vagisil externally but haven't been using anything inside which won't have helped
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I've ordered some and will try initially to see. As I've said I use vagisil externally but haven't been using anything inside which won't have helped
Let me know how you get on Jules, hope it gives some relief!
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I tried the Yes last night and this morning and found it soothing, easy to apply so I'll carry on.