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[donnacrichton]

Would the cream be more effective as can make sure the urethra is covered?

[Ayesha]

We can only answer from our own experiences and you will have to find out for yourself through trial an error what will eventually work for you.
I use Vagifem pessary and Estriol cream which covers all areas, I have to have both treatments to keep my VA under control.

All these UTI symptoms could be easily resolved by using topical oestrogen, it can be as simple as that.

[DottyD68]

This maybe controversial, having read the other posts, but personally I would try gradually reducing the oestrogen a bit to see if your symptoms change/improve.

I only say this as I was of the "more must be better" mindset and got up to 4 pumps for sometime. Some of my symptoms reduced but I gained others including weight gain right around my middle from my armpits down to my hips. I was still exercising daily (cycling/walking/pilates) so couldn't put it down to that and had a healthy diet. My anxiety went through the roof and palpitations unbearable so I reduced down to 2 pumps and felt a whole lot better. I also lost quite a lot of my blubber in the process. I am now on the equivalent of 1 pump (on patches) and generally feel (relatively) ok.

I have come to the conclusion that there is not a one size fits all for HRT and you have to tweak it to find your own sweet spot. I hope you manage to find the right doseage and start to feel better.

[donnacrichton]

Thank you so much for all the replies. I’ve decided to keep the dose I am on and treat the UTI with cream or pessaries and address the weight and exercise. I also had issues with high estrogen on gel which is why I was asking. If it is high for me I usually can not sleep and the anxiety is unbearable. If I don’t get any relief I will take a different approach. I can’t tell you how helpful it is to have people who just understand 😁

[joziel]

Donna, there are loads of threads about vaginal atrophy etc on the forum, so do check those out.

The gist is that you should feel free to liberally use as much local estrogen as necessary to feel better. You can use both Vagifem pessaries or similar PLUS Ovestin cream if you want something internal and external. I do think if your issues are UTIs that getting something internal is going to help get the estrogen closer to the bladder.

You should feel free to use local estrogen every day forevermore if necessary and any doctor who insists you should reduce to twice a week is simply wrong. Many women need it daily. It is local and won't go systemic.

And for the weight situation, I can highly recommend (been on my own journey here) eating a very high protein diet (like 1g of protein per lb of desired body weight, per day - for me that is 145-150g of protein a day) PLUS strength training. You can do this at home using dumb bells, you don't need to go to a gym. There is a great app for iPad or laptop called CGX (Caroline Girvan) which has an Ultimate Beginner programme on it and is really excellent. I'm on my 3rd programme with Caroline and with the high protein as well, my body has changed beyond belief.

There is also a great podcast called Metabolism and Menopause by Stephanie Crassweller which has loads of info on the best nutrition (high protein) and strength training for fat loss in menopause.

[Dr. Heather Currie]

I am very concerned about previous posts encouraging use of very high doses of estrogen. Regarding the first question about when to reduce estrogen, it is very reasonable to reduce at this stage Donna. Having been stable with no ovaries for a number of years, there would be no reason to increase the dose as has been suggested, and gradually decreasing is the right option for many women. Whatever dose of HRT is taken, many women still have vaginal and bladder symptoms and  benefit from taking vaginal estrogen in addition.
I am aware that this doesn't always happen but once settled on HRT, ideally an annual review should discuss if what you are taking is best for you for:
-symptom control
-side effects
-dose
-type
-route
-duration
-need for vaginal estrogen

Regarding very high doses, this is a serious concern. It would be worthwhile reading the following--
https://vajenda.substack.com/p/a-master-class-in-hormone-levels

Best wishes
Heather

[joziel]

Surely the best advice would be for Donna to get her estradiol levels tested, so she can actually see how much she is absorbing? And then make a decision accordingly.

If she has been stable for a number of years without ovaries and now has developed new symptoms, she may have stopped absorbing her patches.

High doses are irrelevant if someone is not absorbing them. There are women (I'm one of them) with serum estradiol levels on 3x the licensed dose which are the same as women on 3 pumps of gel or 75mcg patch. What sense does it even make to talk about dosages?

[CLKD]

tnx. Heather.

Donna: if you have supposedly repeated urine infections what has your GP/Nurse Practitioner suggested, have U been referred to an appropriate urinary consultant for a diagnosis?  There are situations were infections become embedded which need exploration at Hospital under the care of a urologist.

Use the VA treatment nightly and when I have symptoms I take 2 Nurofen 3 times a day to ease that nip as the urine flow stop.  4 me it acts to relax the spincter = less urgency. 

Hormones rise and fall so to me it stands to reason that a woman may not need the same dose of HRT throughout the 'month', hence it's a bit Trial and Error to find a regime that eases symptoms.   .  I have mentioned elsewhere that I had/have no idea which hormone causes which part of my cycle, 4 a period arrived every 32 days ....... with excruciating pain and flooding  .  Then it went that I had a bleed every 10 days ......

[bombsh3ll]

Surely the best advice would be for Donna to get her estradiol levels tested, so she can actually see how much she is absorbing? And then make a decision accordingly.

I agree.

Formulations can change over the years, in particular people have been reporting certain brands of patches sticking less well than they used to.

Also someone's weight may have changed or they may have developed another condition, started taking other medication or changed aspects of their lifestyle that affects absorption.

Additionally there is no evidence to support the idea that women should try to taper down their hormones because they have reached a certain age or duration of use.

[donnacrichton]

Thank you for everyone’s replies. I have been referred for a scan but a mass was ruled out earlier in the year with an embedded coil scan. My urine infection did become embedded and it took four courses of antibiotics to clear it only when I got private tests done 🤷‍♀️. I have joined the gym for strength training and addressed the diet and on high protein. I am taking a preventative DManos to help the bladder. I will contact my nurse practitioner on Monday for some VA treatment. If all this fails I will consider adjusting the dose very slowly as it took years to get it right which is why I am hesitant. I have no intention of every coming off hrt but as I age I would take the lowest effective dose but hoping I don’t need to adjust something that has worked so well🤞