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[dap5645]

Hi everyone not posted for some time. But would just like some advise please.

Been post menopausal for 7 years. First 4 years great then I got vaginal atrophy and have really suffered for 3 years. Its now getting me down badly. Over Christmas and New year had a kidney infection given antibiotics finished them yesterday and then today had a bad cystitis attack.

I am taking oral hrt Premique normal dose and I have estriol cream. I have been on these tablets now about 6 months all okay but I still get sore inside vagina at times and have burning urination the majority of the time at night.

I have used estriol cream today and that eased it immensely. but the last time I did this I bled after using the cream and the tablets together. Touch wood havnt bled.
I have no idea what direction I'm going in with taking this lot. I don't know if the tablets are doing me any good. I have only used cream when sore. Really I think I should be using the cream twice a week no Doctor has ever informed me or given me any direction on how to manage this vaginal atrophy and believe you me I have been for 3 years.
Also could anyone advise pleas e on good lubricants for sex I have used YES but I can get an attack day after when using this. Thanks so much. Any help will be appreciated.

[CLKD]

Vaginal atrophy can drag on a bit  -  the usual regime is every night application for 2 weeks followed by every 4th and every 5/6th night.  So begin the treatment, it won't impact on any other HRT as it really is very localised.  I use KY jelly or Savlon on the outer 'lips' to stop them itching. 

Up your liquid intake.  Your urine should be straw coloured all day, any lighter and you are drinking too much.   

The only way to see if you are benefitting from the tablets is to stop taking them.  But if you feel well I wouldn't, I would continue feeling 'well' 

[dap5645]

Thanks for posting CLKD. Sorry I havn't got back sooner just not been too well. To be honest this is getting me down. I can be okay one day and really uncomfortable the next. I will do as you advise and keep on the hrt tablets. Hope you are well and take care xxx

[Mary G]

dap5645, sorry you are having these problems, I had this for years (since 1988) after using a contraceptive cap and it has never entirely gone away and became worse again around the menopause.  After extensive investigations over a number of years, I cannot do anything about it but take Pirifur after sex which is the only medication that works for me.

Is there any particular reason why you chose Premique normal dose?  Is it because you don't want to have periods?  From my personal experience, oral continuous combined HRT has never worked properly at relieving symptoms, it did nothing for my constant vaginal irritation, burning and constant urination (arguably made worse by the menopause) and I am also intolerant to synthetic progestins which leads to other complications like silent migraines, breast pain and low mood.

Having been on lots of different types of HRT, the only regime that has got rid of my problems is the oestrogen gel which is bio identical and transdermal which is thought to be far more effective.  Frankly, nothing else even came close to being as good as the oestrogen gel and it has got rid of the vaginal irritation and I don't need anything else apart from the Pirifur.  I also take 100mg of Utrogestan for 7 days each month.  I tried Ovestin but it gave me cramps and bleeding and then I developed an infection.   

The symptoms you are having can really get you down and I would suggest you look at changing to medication similar to mine.  What dose are you on, I could only find the low dose figures?
 

[CLKD]

Some ladies find that Vagifem gives cramps, so far on the Ovestin1mg I've been OK.  How have you both been 2-day?

[Taz2]

Hi dap - sorry to hear that you have had a kidney infection. Just want to say that if you have finished your antibiotics and had an attack of cystitis then you do need to get this checked out. It can mean that the antibiotics haven't cleared all of the infection - a common occurrence - and you may need either some more of the same one or a different one.

Taz x

[Hurdity]

Hi dap5645

Sorry to hear about your soreness and vaginal atrophy - this is just to correct the info in CLKD's post. The usual application for vaginal oestrogen (including the cream) is once a night for 14 nights (the "loading period") and then twice a week thereafter ie every 3rd/4th night (the maintenance dose") which is slightly more frequently than she said. I see the product info says 2-3 weeks for the initial loading.

I suggest you start  straight away with the 14 days and see how you get on. Some women find also that they have to "re-load" periodically ie do the whole 14 day thing again. I presume you have an applicator?

Hurdity x

[Worrywart]

If no one has taken a swab and your urine is clear, you might ask them to test for thrush. It's not always obvious and can cause burning and stinging rather than itching. Just a thought.

Mary, is estrogel even better than patches as a transdermal approach? I tried it after my hysterectomy, but at the time it didn't seem to keep things under control as continuously and I went back to patches. Do you have experience of one vs another?

[Mary G]

Worrywart, for some reason, the patches just didn't do it for me.  They do offer an even dose of oestrogen but I could never get enough into my system!  Much of it is down to the individual and how well you absorb each product.  We are all different, and I find I soak up the Oestrogel like a sponge and it works much better than the patches but I do split the dose by 12 hours to keep the levels up.

What dose of Oestrogel were you taking?  Could it be that the dose was too low?  From trial and error, I have found that splitting the dose is the best way to use the gel. 

[CLKD]

Hurdity - I was advised by a GP and a Pharmacist to use the product twice a week after the initial load of 2 weeks.  So for me it works out every 3rd and every 5/6th night …… currently, my vagina is symptom free [phew] so I haven't needed it for 3 weeks.

[Suzi Q]

Hurdity - I was advised by a GP and a Pharmacist to use the product twice a week after the initial load of 2 weeks.  So for me it works out every 3rd and every 5/6th night …… currently, my vagina is symptom free [phew] so I haven't needed it for 3 weeks.

GP said to me every night for 2 weeks the 25mg tablets then I chose sunday and Thursday
For the twice week regime of 50mg
Now im ahhhhh cos I need to do it 5 days a week to get the same dosage

[CLKD]

Nuisance ain't it  and so time consuming - trying to plan when we use medication and how often  [that's stamping my feet by the way  ]

[Hurdity]

Hurdity - I was advised by a GP and a Pharmacist to use the product twice a week after the initial load of 2 weeks.  So for me it works out every 3rd and every 5/6th night …… currently, my vagina is symptom free [phew] so I haven't needed it for 3 weeks.

Not sure I quite understand your nights! If you mean every 3rd night and then every 5th or 6th night following the third night then that is less often than twice a week - or do you mean you take it twice every 6 days ie slightly more often than twice a week?

In any case - I know we have discussed before CLKD that stopping for 3 weeks is not how it should be used!!!!!!!!!! It's not a question of not needing it! VA is a permanent condition caused by oestrogen deficiency. When you stop the local oestrogen it comes back. The whole point of the maintenance dose is so that it doesn't come back! If it gets to the point where you feel you need it again then you've gone too long and ideally you should start the loading dose again!! I know you are using cream but it's not like ointment or a lubricant - although it helps perform this function too.

If you use it the same nights of the week then it's not that difficult to remember....

Hurdity x