Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: alibeau on February 13, 2025, 10:15:46 PM
-
So I’ve been able to ‘manage’ my bladder leaks up until the weekend.
I avoid caffeine and fizzy drinks, especially when I am out and about. I wear the smallest Tena lady pads, they are way more than adequate.
I do my pelvic floor exercises daily.
I felt as though I had the situation under control.
Fast forward to Sunday. I arranged to meet a pal for a walk. Luckily due to the cold weather I had a pair of thick leggings on with joggers over the top. I did not have a lot to drink beforehand and didn’t feel like I needed the loo but I have never leaked so badly. Pad was sodden, my leggings were wet and my joggers were damp but luckily it didn’t show. It was a really horrible experience.
I’m now trying to figure out why things have got so bad so quick.
I feel as though I have been suffering with some vaginal dryness which is new.
I am 52 and have been quite settled on 3 pumps of Oestrogel and 2 Utrogestan tablets at night for 12 nights out of 28.
I’m not sure where to go from here?
Perhaps increase my Oestrogel slightly?
Or contact GP for some help with my vaginal dryness? Is it connected?
What should I be asking for?
Any advice really would be appreciated.
Thanks.
Ps Having read my post back I should add that I have been out shopping since and although I was worried things seemed more like my normal. Plus the walk I went on was hours long and with no toilets along the way so I guess the circumstances were a little extreme but I still feel something has changed for the worse.
-
Your vaginal dryness may be the start of vaginal atrophy, which estrogen pessaries will help with, and the pessaries can also help with the leaks if they're down to lack of estrogen.
The leak you experienced when out for the walk could have been caused by any number of things, and is hard and long drawn to find out why (your triggers).
It could simply be down to not being able to use a toilet when needed and the cold weather, as this can make you wee more.
It could be something you've drunk or eaten, there are lots of triggers, chocolate, tomatoes, sweeteners, citrus, etc.....
If you want to help reduce or eliminate leaks and bladder problems, you could try pumpkin seed oil extract, though as it's a supplement it can take at least 3 months to see any results.
-
I would:
Get Vagifem and Ovestin from your GP (really they should prescribe both but if they refuse, go for Vagifem) and use it every night for many weeks. The info will say to use it twice a week after a building dose of every night for 3 weeks, but ignore that if you need to - it is perfectly safe to use every night.
Also investigate increasing your systemic HRT. You should be able to go up to 4 pumps easily via your GP, which is the max licensed dose (but many women need much much more). When you are on 4 pumps, get your blood levels checked. If they are not 400+, consider seeing a private menopause clinic to increase your E dose further.
I had bladder leakage when on lower doses of HRT. It really got me down. I was using local E and also systemic E, but the systemic was pretty low dose. Due to other debilitating night time symptoms (inner tremors, hypnic jerks, insomnia) I had to increase E dosage via a private menopause clinic (Newson Health) to see if that worked. Not only did it eventually improve those symptoms but all my bladder leakage stuff totally stopped and I feel like a 20 year old again. My E level varies between 660-880pmol. To achieve that, I am on 200mcg of patches PLUS 6 pumps of Oestrogel. I get the meds for free on the NHS from my GP, but I see NEwson Health annually who write to my GP and tell her what to prescribe....
-
Agree with both treatments needed, Vagifem & Estriol but you need to put up a good case because most don't know how local treatment works and what's needed to control symptoms. You will need to explain yourself well because they will say, its unusual to need both, be assertive in getting your point over.
Believe me its taken a year of explaining to the world and his wife why I am using both Vagifem & Estriol on a daily basis but after my latest review I think I have finally got the message over.
-
Yes and just to add - Vagifem and Ovestin are INCREDIBLY low dose. Like 1 oral HRT tablet is the equivalent of a year's worth of Vagifem (or something similar, someone correct me if wrong).... It's perfectly safe to slather this local E on you....
-
Brilliant, thanks so much to you all.
I will complete an E-Consult for my GP on Monday with all the info you have shared and see what they come back with.
What is it they say, knowledge is power!!! I feel more positive already, thank you.
-
A quote from the Position Statement For Management of Genitourinary Syndrome of the Menopause (GSM)
“Using 10mcg oestrogen pessaries regularly for one year is an equivalent dose to just one 1mg of oestradiol HRT tablet.
And they dare to give us grief with dosage when using topical oestrogen with figures like this!
-
Wow, interesting, many thanks.
I've got a GP appointment for 5th March.
Thanks again.
-
Something else to consider, your oestrogen could be over relaxing your muscles. When I have tried oestrogen, it has caused some hypermobility in my muscles, including the pelvic floor. It almost feels as if I cannot engage the muscles at all. Once I stop, the muscles go back to normal. The vaginal oestrogen made it even worse for the same reason.
-
Oh lord dangermouse....
I guess it will be yet another case of trial and error then ::)
Take care x
-
alibeau -- you shouldn't have to 'manage' bladder leaks >:(
Please ask your GP for estradiol pessaries and Estriol cream. Use daily for at least 4 weeks then reassess. You may be able to reduce so you don't have to use them daily, or you may find a reduction causes symptoms to reappear. It's definitely trial and error until you find what works best for you.
Don't put yourself through this for another 3 weeks waiting for a face to face appointment. Could you email a request to the surgery? Or a phone call?
-
You can actually buy over the counter estrogen pessaries from any pharmacy. They are called GINA. You'll have to pay for them, but it would let you get started now (and then hopefully you can tell your GP they are really helping and get them to prescribe...).
-
You can actually buy over the counter estrogen pessaries from any pharmacy. They are called GINA. You'll have to pay for them, but it would let you get started now (and then hopefully you can tell your GP they are really helping and get them to prescribe...).
I’m really tempted try this…
Any reason why I shouldn’t?
-
Only that they are expensive to buy, the reason the majority of us are reliant on our surgeries to supply, particularly if needed on a daily basis.
No reason why you can't get ahead of the game by buying the pessaries. You can also buy Estriol cream, Boots do their own version called Ovesse, you will just need a smear of this for the outside, my tube lasts me three months. Also bear in mind that the treatment can take months to take effect but we are all so individual when it comes to symptoms of GSM and it's treatments.
-
:thankyou:
-
Hi Ladies,
So I started on the vaginal oestrogen pessaries.
I bought some myself and then when I saw the GP she was happy to prescribe.
So I did the initial dose of every night for two weeks and then dropped down to twice a week.
This was at the end of March. This initially worked well.
However this week I have noticed a return in my symptoms ie some dryness/soreness but mainly bladder leaks again.
I completed an e-consult for my GP on Thursday but no response yet…..
Any advice for me? Should I go back to nightly for a spell? And then perhaps drop to every other night?
Will my GP be happy to prescribe this dose?
Any feedback would be great.
Thank you xx
-
I need a daily dose of both pessaries and cream, we are all different, use as much as is needed to relieve your GSM symptoms.
If you have to fight for extra treatment then fight, that's all we can do.
I gave my new GP a lecture on why I needed daily pessaries and he understood completely when I told him my regime is equivalent to one systemic HRT tablet a year, he gave me the impression that he had better things to be getting on with and agreed with my daily use of pessaries and cream.
-
Thank you :)
I have received an email this morning directly from the practice pharmacist stating not to use the pessaries more frequently than twice a week.
They have said that they will prescribe a cream to try instead, to be inserted with syringe every night for a fortnight and then twice weekly. They say this may work better for me and if not to let them know....
Worth a try?
-
It's very unlikely to work any better because it's the same frequency. You need to change doctors and find one which is more menopause aware and prepared to prescribe daily use, whether the pessaries or the cream. You can even use BOTH of these TOGETHER, EVERY DAY!!
-
Thank you Joziel. I appreciate your input.
I had already made a decision to go back to using the pessary every night to get things back on track, so I guess I could try the cream for a fortnight and see if things pan out any differently when I drop to twice weekly....
In cases like this where I may end up looking to go against the recommended dose, is there any material I can reference to as 'back up' if I need to? Can I simply 'demand' to go against the dose?
I know if push comes to shove I can buy the products myself but really don't see why I should have to.....
I will do some investigations locally to see if anyone can recommend a GP who is more clued up on these things...
Thanks again.
-
Pages 4, 5 and 6 of this document is your ammunition, its been mine when confronted with how much of the treatment I use, that and the fact my previous GP is a gynaecologist and uses daily treatment herself.
You have to be very assertive and know what you are talking about if you go over the recommended dose and are challenged when you do, I've been confronted three times so far and I have come back fighting, this document is there to be used to your advantage.
https://bssm.org.uk/wp-content/uploads/2023/02/GSM-BSSM.pdf