Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Anabelle31 on November 25, 2024, 05:44:33 PM
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I’m 41 and have been suffering from feelings of a uti for 6 months (burning, frequency etc) but all cultures show is microscopic red blood cells. As a result I’ve had kidney and bladder ultrasound and a cystoscopy and all looked fine. My gp said I have signs of mild atrophy but kept saying I was very young for it. My mum went through meno in her 40s but I keep being told this is more common in older ladies. Does anyone have advice or experience?
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No one is 'too young' :bang: put his head down the loo and pull the flush. Several times. Blood can be shown in urine samples due to thinning of the vaginal walls due to a loss of oestrogen = causing dryness: inside and out; deep in the ears, eyes, nostrils, vagina .........
:welcomemm: If any results have come back 'within normal limits' then there is no reason why your GP can't prescribe VA treatment. Have U read the 'bladder issues' and various threads about VA on the Forum? There is also a book: Me and My Menopausal Vagina: which is a good read.
One can buy 'gina' over the counter but is probably for ladies over 55. U could have alookC at BOOTS web-site.
Is there a Nurse Practitioner to talk with at your Surgery? MayB ring her and ask for a prescription.
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I’m 41 and have been suffering from feelings of a uti for 6 months (burning, frequency etc) but all cultures show is microscopic red blood cells. As a result I’ve had kidney and bladder ultrasound and a cystoscopy and all looked fine. My gp said I have signs of mild atrophy but kept saying I was very young for it. My mum went through meno in her 40s but I keep being told this is more common in older ladies. Does anyone have advice or experience?
I had a similar experience to you but in my mid 40s - pain & frequency. Had two cystoscopys with biopsy and apart from a bit of inflammation in one area of the bladder, nothing abnormal found. When I did later have a UTI, the horrific pain just never went away but no bacteria were found once the antibiotics had done their thing.
I even asked the gynaecologist if it could be related to menopause and he said no, you 'look fine'. Their solution was to put me on a long term antibiotic, which I wasn't happy to do as my urine was clear and they would wipe out the good bacteria.
I did my own research and found an article on how vaginal oestrogen can help with bladder symptoms, took that to the GP and to my surprise, was allowed to try it. I continue on it today, later adding systemic HRT. It definitely helps a lot. I also take high quality aloe vera capsules orally, which contain glycosaminoglycan, which can be soothing - expensive though.
If I were you, I would try and get some vaginal oestrogen and see how you get on. You are certainly not too young - if he has said there are signs of mild atrophy, I can't see why they aren't willing to prescribe some for you. They are very out of date!
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You aren't too young at all, and vaginal estrogen should have been tried first before invasive investigations.
Even if someone who didn't need vaginal estrogen used it, so what? There's no harm from using it.
The one thing I would say though is that if your genital tissues are suffering from lack of estrogen, there are implications for other areas of your body too such as bone and cardiovascular health, so don't overlook the rest of your body if you are potentially heading into early menopause.
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No one is 'too young' :bang: put his head down the loo and pull the flush. Several times. Blood can be shown in urine samples due to thinning of the vaginal walls due to a loss of oestrogen = causing dryness: inside and out; deep in the ears, eyes, nostrils, vagina .........
:welcomemm: If any results have come back 'within normal limits' then there is no reason why your GP can't prescribe VA treatment. Have U read the 'bladder issues' and various threads about VA on the Forum? There is also a book: Me and My Menopausal Vagina: which is a good read.
One can buy 'gina' over the counter but is probably for ladies over 55. U could have alookC at BOOTS web-site.
Is there a Nurse Practitioner to talk with at your Surgery? MayB ring her and ask for a prescription.
Thank you for this. I’ve read lots of posts here but since I actually had microscopic blood in urine I wasn’t sure if I fit the criteria or not. I’ll push for another appointment. My last period was 17 days late, there’s clearly some evidence of menopause happening!
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You aren't too young at all, and vaginal estrogen should have been tried first before invasive investigations.
Even if someone who didn't need vaginal estrogen used it, so what? There's no harm from using it.
The one thing I would say though is that if your genital tissues are suffering from lack of estrogen, there are implications for other areas of your body too such as bone and cardiovascular health, so don't overlook the rest of your body if you are potentially heading into early menopause.
Thanks I will be sure to speak to doctor again. I don’t know why the medical establishment is so set on insisting this only happens to post menopausal women!
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I had a similar experience to you but in my mid 40s - pain & frequency. Had two cystoscopys with biopsy and apart from a bit of inflammation in one area of the bladder, nothing abnormal found. When I did later have a UTI, the horrific pain just never went away but no bacteria were found once the antibiotics had done their thing.
I even asked the gynaecologist if it could be related to menopause and he said no, you 'look fine'. Their solution was to put me on a long term antibiotic, which I wasn't happy to do as my urine was clear and they would wipe out the good bacteria.
I did my own research and found an article on how vaginal oestrogen can help with bladder symptoms, took that to the GP and to my surprise, was allowed to try it. I continue on it today, later adding systemic HRT. It definitely helps a lot. I also take high quality aloe vera capsules orally, which contain glycosaminoglycan, which can be soothing - expensive though.
If I were you, I would try and get some vaginal oestrogen and see how you get on. You are certainly not too young - if he has said there are signs of mild atrophy, I can't see why they aren't willing to prescribe some for you. They are very out of date!
Thank you! It’s so frustrating that not one doctor raised the possibility of perimenopause.
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One can buy 'gina' over the counter but is probably for ladies over 55. U could have alookC at BOOTS web-site.
Just to be clear Gina is available over the counter for women over 50
Annabelle31, there are posts here from women in their early forties suffering with VA, therefore definitely not too young and the sooner you start treatment the better.
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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.
Later when I was 39 I started having short spells of having a painful bladder (it felt very full and sore even after going to the toilet). I mentioned the earlier blood in the urine and was retested. It was found again, so I was sent first for a CT scan (to check for bladder/kidney stones) which was clear and then onto a Urologist who was very reassuring and not particularly concerned about the blood. He asked me to provide a urine samples for 3 consecutive days to check for signs of cancer. This was clear and I coincidentally didn't get the symptoms again after that.
Earlier this year I was getting up during the night to go to the toilet and went fairly frequently during the day.
Now I have been successfully treated with vaginal estrogen (Ovestin) I now assume the microscopic blood was the very early days of VA working on me. I have read online (somewhere, cannot remember) that blood in the urine can be a symptom of VA / low estrogen down there but it doesn't seem to get much of a mention. I was therefore very interested to see your post!
Incidentally the daytime frequency has greatly improved and nighttime toilet runs are non existent since using the vaginal estrogen.
Like your doctor, mine did not think my vulva symptoms were related to the menopause (asked her 1st visit >:( ) Similarly, my mum became menopausal in her late 30s too.
You're not alone. Ask for vaginal estrogen. Good luck.
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:thankyou: Elissa.
Morning: If a urine sample is dip sticked in the surgery it is likely to show signs of blood if VA is present due to thinning of the vaginal walls. If a GP suspects a urine infection then a sample should be sent to a lab..
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One if my friends is 44 and is suffering from VA - she spoke to her Doctor, who finally agreed to give her the vaginal pessary, Vagifem - So it might be worth speaking to the practice nurse, who often seem a little more sympathetic.
I was prescribed the pessary about four years ago, and although it’s not a miracle cure, using those combined with Yes Vaginal Moisturiser, does make life a lot more bearable!
I’ve always found the practice nurses in invaluable, so might be worth booking in for a check up!
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After my last experience with the Practice Nurse at my new surgery I would ask for an appointment not with my GP but with her on anything to do with GSM (VA).
As I walked out from my appointment with her I told her she was an absolute star, this reaction coming from the horrendous stories from women on this forum suffering needlessly and not being able to get the right medication.
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I am really concerned about the numbers of women in their 40s with signs of hypoestrogenism who are just begging for crumbs rather than advocating for systemic treatment.
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.
Definitely you should pursue vaginal estrogen, but it is the absolute least you deserve, not the ceiling of treatment.
It may also help if you can afford it to buy one tube or pack of pessaries, try it and then present it to your GP as a fait accompli - you can then say "I have tried this and it works, give me a good reason why it can't be continued on prescription".
This bypasses the old "I don't think X will help you" because you already have evidence it does.
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I am really concerned about the numbers of women in their 40s with signs of hypoestrogenism who are just begging for crumbs rather than advocating for systemic treatment.
A very condescending comment as not everyone wants to use systemtic HRT.
I am neither pro nor anti HRT. What I do care about is a woman's right to choose exactly what course of action she wishes to take regarding her own bdy.
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I am really concerned about the numbers of women in their 40s with signs of hypoestrogenism who are just begging for crumbs rather than advocating for systemic treatment.
Asking for systemic HRT at such a young age is not the best way to approach GSM symptoms, its entering a whole new complicated world when a simple topical treatment is available. Further on down the line then yes, think about systemic HRT but while it’s the minefield it is, and always has been, I feel best to leave well alone.
I would not have wanted to start on systemic HRT so young and I waited until other menopause symptoms occurred like hot flushes which began at age 50, I used it for five years then had enough and just to add I have not had major health problems from not being on systemic HRT, I just lead a healthy lifestyle which is important as we age.
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I've not required systemic replacement but the VA treatment works 4 me.
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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 ;)
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CLKD and Ayesha - well said.
👏👏
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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.
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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.
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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.
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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).
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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 ;D 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.
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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?
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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 ::)
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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.
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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!!
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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 :)
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bombsh3ll, is vaginal atrophy always a sign that the systemic estrogen levels are low?
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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.
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bombsh3ll, is vaginal atrophy always a sign that the systemic estrogen levels are low?
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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.
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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 :)