Hi Maryjane
I have been more comfortable since having both systemic HRT with Vagifem twice a week.
I can still get some burning and my theory is that my urethra has permanently collapsed or atrophied so that I may not be emptying my bladder properly every time and this may lead to mild infection or inflammation building up in the urethra. I am quite disciplined about making sure I empty my bladder properly these days - I will lean forward and backwards to help this. I try to make sure I drink enough, though I have to limit the amount I drink in the evenings or I will still get up several times at night. At least on systemic HRT I fall back to sleep ok having got up to pee.
When my burning was at it's worst, there wasn't any sign of infection, only blood in my urine and the urologist said it was likely to be interstitial cystitis (i don't get bladder pain, only a burning urethra) - a diagnosis which is very frustrating as there seems so little they can do about it! I've tried avoiding certain foods and drinks but the only things that do make it worse are very acidic drinks like fruit juices.
I have to say I dread to think what it will be like as I get older and have to stop the systemic HRT as the local stuff only helps intermittently. DG x