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[nothappybun]

Hi!
It's been weeks since I discovered this site and find it wonderful all the information you provide and it is lovely to be able to exchange tips and information with others going through this change! 
A bit about me and my process:
I'm 51 and had regular periods till August 2015 where I skipped my first one and a month later started having several hot flashes every 5 minutes, severe sweating vaginal discomfort and scary palpitations. Before that I had only suffered from insomnia when premenstrual and mood swings.
My gyno put me on Qlaira pill for 6 to 10 months and that worked wonders. No symptoms at all and felt my self. I was so happy! I took Maca root which helped with the vaginal dryness in my case, all the other herbal remedies I took before the pill didn't do anything, I took vitaestro, red clover and black cohosh for 2 months, while having tests and the ok from beast consultant (I have lumpy beasts)
As I turned 51 my Gp sent me to the meno clinic as they cannot prescribe Qlaira any more and here starts my burden.
They saw me on the 18 of August and gave me Evorel Sequi 50 and vagifem. I stopped the Qlaira on the 2nd tablet of the cycle and straight on the patches the day after. The vaginal discomfort started straight away, on the 3rd of 4th day after stopping the pill even thought I was using the vagifem daily that week. I tried to stick it out to see if I need time for the new prescription to kick in but when I started the patches with progesterone, I started having the hot flashes back and sweating like mad. I had a period before I was suppose to have the bleed at the time it would have been due with the pill and it was a full period, not a breakthrough bleed I went back to the meno clinic and basically she is telling me she won't give me a full hrt as I have an undetermined autoimmune disease and there is more risk of clotting. My rheumatologist has tested me for clotting and I am negative, he wrote me a letter months ago saying not to worry about this, no clotting problems. I healthy, a bit underweight 44kg 1.62cm and good blood pressure so I don't understand. She has given me 1mg Sandrena and told me to apply it always on my arms and Ultrogestan progesterone tablets from the 1st to the 12th every month.
The hot flashes are mild but still get a few a day and feel hot all the time, permanently hot with the gel but the vaginal discomfort and an urge to pee all the time and can't, I sit on the loo and have to concentrate a long time. I have no infection as they tested me, twice. Even my urethra hurts so I believe it is the drastic drop from the 3mg/2mg to 1mg daily. I went to my GP desperate and she has given me Ovestin cream for only a week as it doubles my hrt. She won't prescribe for longer. It is helping a lot and I apply it outside too so don't use the full dose internally as it is more external discomfort and pain, like a wringing pain, urge to pee and can't and bloating. I told my doc, I'm going on holiday on Wed and it's our first holiday this year so don't want to spoil it for my hubby being miserable and feeling.
I tried getting another appointment at the meno clinic and they've given me one at the end of this month so really don't know what to do and feeling so low. In one month my life is upside down again.
Also, I have a stupid question but concerns me, as I apply it to my arms is it safe for other people to touch the area? my other half likes sleeping cuddled up holding my arm and I've been pulling away worrying It might transfer.
Thanks for all the help you all give here and any tips, advice is so much appreciated.

[Justjules]

Hi Nothappybun, welcome to the forum. Sorry to hear of the dreadful time you're having. The forum is quiet at the moment but someone will be along soon to advise you. I've never taken HRT and am post meno but there's loads of ladies on here going through the same thing. Have a good browse round while you're waiting and do some similar searches, there's lots of info and experiences. People are at work sometimes so tonight will be busier. Good luck. X

[Dancinggirl]

Hi and welcome to MM Nothappybun

I'm not sure where to start.  You've given us lots of info.  The HRT regime you have been given  - the Sandrena with Utrogestan - is a good regime to try but you must give it at least 3 months to work it's magic.  Finding a HRT regime that works for you is the key - it's trial and error I'm afraid.  The lowish dose of oestrogen is probably a good idea - I always believe it is good to start low and if your flushes and nights sweats are not under control then up the dose in small steps over several weeks till you find the right balance.
The gel can be applied to inner thighs which can be better but it dries within about 10 mins so you can dress once it's dry, it absorbs within a couple of hours - I'd read the instructions but you should normally avoid direct skin to skin contact with the area for about 2 hours.

Something I do have experience with is this horrid pain in the urethra and vaginal area and this urge to pee.
This is quite common when meno hits and local oestrogen is the answer.  Using Systemic and local oestrogen is often necessary to get this under control.
 When meno hits, the vaginal secretions reduce, everything becomes dry and delicate and more prone to mild infections and irritations. The urethra and bladder will also become more delicate - the skin becomes atrophied and sore.
If you are using Vagifem alongside Ovestin - Ovestin DOES NOT DOUBLE YOUR OESTROGEN DOSE!!! Not sure whether your GP told you this or not but Ovestin is a very, very low dose of oestrogen designed to deliver a tiny amount of oestrogen to the local area and many women find they need to use extra mounts of local oestrogen because it is not strong enough.  Keep using the Vagifem.
However, oestrogen treatment alone is not enough. Strategies for helping this:

Drink lots of water - at least 1.2 litres per day - if your urine becomes too strong this will make you burn - drink more not less. Gradually build up the time between toilet visits - so try to wait one hour, then 2 hours and then 3 but it's a good idea to empty your bladder every 3-4 hours anyway. Make sure you empty your bladder properly each time.

Avoid coffee, tea, alcohol and acidic drinks like orange juice - these will make your urethra burn.

Wash with unscented soaps, wear cotton pants, loose trousers - preferably skirts.

Try using vaginal moisturisers like Sylk and/or Multi Gyn Actigel - these help to keep things lubricated and also keep the flora balance in the vaginal area - this will help to stop any bacteria taking hold and causing problems.
Whenever you get this burning urethra, try drinking a glass of water with half a teaspoon of bicarbonate of soda stirred into it, morning and evening to neutralise acid.

I have suffered with VA and burning urethra on and off for many years and it's horrid - it has to managed and I know I will need local oestrogen for the rest of my life - Vagifem 2-3 times a week.  I use Sylk every day and Multi Gyn Actigel whenever I feel itchy.
Dg x

[Hurdity]

Hi nothappybun

  from me too!

Dancinggirl has already given you an excellent reply so I've nothing much to add.

Just to say that as far as I remember almost all transdermal HRT - including Sandrena - is supposed to be applied to the lower part of the body (although estrogel instruction also say arms - not sure why this one differs).

Also I am wondering if they (the meno clinic perhaps?) can prescribe Qlaira off licence for longer - I have no experience of this and I can't recall anyone on here having success. However it does seem ridiculous (to have to stop at 50) since it is bio-identical oestrogen rather than the stronger synthetic types that are in the usual CCP. I am sure you will be noticing the reduction in oestrogen from Qlaira to Sandrena as that is quite a low dose. I would suggest that after the oestrogen dose you've been having you need a higher dose.

lso agree re the local oestrogen - many women need this as well as systemic HRT and I am on both  50 mcg patch ( well 62.5 now) + Vagifem twice a week and I'm 63.

If you look at some of the other threads you will see where NICE Guidelines have been quoted re local oestrogen - and the fact that it can be used indefinitely see eg on the main MM website:

http://www.menopausematters.co.uk/local.php

Local estrogen can be used for vaginal and bladder symptoms, when systemic treatment is not desired or appropriate. For some women, vaginal estrogen may be required along with systemic HRT.

http://www.menopausematters.co.uk/dryness.php

Low dose vaginal estrogen preparations can be used long term without causing any known systemic effect, and without needing any progestogenic protection of the lining of the womb.

Link to NICE Guidelines:
https://www.nice.org.uk/guidance/ng23/chapter/Recommendations#managing-short-term-menopausal-symptoms

Hope the vaginal discomfort eases soon - but defo get some more local oestrogen - long term - print off as much info as you can to direct your GP and you will have to insist - or try to find someone else in the practice who will do so!

Hurdity x

[matildamouse]

Apparently the 2 sex hormones, estrogen and testosterone are potential problems when other people and pets are exposed. My cat became very ill due to laying in my arms often while I was still on oestrogel. The vet said small kids can even go into premature puberty if regularly exposed to hormones eg. Grandmother in skin to skin contact with grandkid. 

[CLKD]

 

[nothappybun]

Thanks so much for the replies and such a warm welcome!   
I had my mother-in-law staying over for the weekend and couldn't get on here.
It does feel better knowing that some of you have reached a balance and there is hope.
Dancinggirl, thanks for all the info, tips and advice, I will start using your strategies, I had tried holding on between and making sure I empty properly. I have realized I don't empty and if I try hard I continue peeing.
My problem is the meno consultant has taken me off the vagifem when moved me on to Sandrena Gel and the locum at my GP gave me the Ovestin for only a week and said she cannot prescribe for longer when I went round desperate last week. They won't see me at the meno clinic till the end of October so I've made an appointment on Tuesday at my GPs and I'll try to get another prescription.  Basically in the menoclinic I am told the vaginal and bladder symptoms I have described and Dancinggirl understood immediately and also suffers are not related to my meno!!!! Strange they started when she lowered my dose to less than half coming off the Qlaira pill.
Hurdity, it seems they are not allowed to prescribe it in the uk as hrt in women over 50  I wish I could have continued another year at least and surely I would be through meno and be post.
Matildamaouse, that is scary, it does worry me, I think I should start using it on my thighs instead of my arms as she said.
Another embarrassing question, anyone have terrible bloating and wind with hrt, it didn't happen with the Qlaira pill but since started with evorel and sandrena, my lower bowel is a round balloon and I'm passing wind like mad  I've gone through three packs of windsettlers in no time
Thanks again xxx

              nothappybun

PS:(2 hot flashes while typing this and my dose isn't due till tonight  )

[nothappybun]

Something I do have experience with is this horrid pain in the urethra and vaginal area and this urge to pee.
This is quite common when meno hits and local oestrogen is the answer.  Using Systemic and local oestrogen is often necessary to get this under control.
 When meno hits, the vaginal secretions reduce, everything becomes dry and delicate and more prone to mild infections and irritations. The urethra and bladder will also become more delicate - the skin becomes atrophied and sore.
If you are using Vagifem alongside Ovestin - Ovestin DOES NOT DOUBLE YOUR OESTROGEN DOSE!!! Not sure whether your GP told you this or not but Ovestin is a very, very low dose of oestrogen designed to deliver a tiny amount of oestrogen to the local area and many women find they need to use extra mounts of local oestrogen because it is not strong enough.  Keep using the Vagifem.
However, oestrogen treatment alone is not enough.

The doctor who saw me on the day was a young locum, she did say she had done gynaecology and strange enough told me she could only give me a weeks supply as it was doubling my hrt    I believed it and reading what you say and post on here that is not true. How can I get the doctor I see this week to prescribe it, it does feel much better even using half the dose as don't want to run out and I do spread some externally as she said.
Another question is do you feel your pelvic lower area is hard and bloated? does that have to do with the hormones?
Sorry I am asking so many questions.
         nothappybun xxx

[Dancinggirl]

OK - here goes.  Here are the links that will give your the evidence you need when you go to the GP about getting Vagifem again.  This first link is directly copied from the NICE guidelines on the treatment of meno symptoms -  Urogenital problems are recognised symptoms of the menopause and your GP needs to know this!!!!! If you don't already know; the ‘Uro' bit of ‘Urogenital' means your bladder, urethra and whole urinary tract which. along with your vagina, becomes atrophied due to the lack of oestrogen:


Urogenital atrophy

1.4.9 Offer vaginal oestrogen to women with urogenital atrophy (including those on systemic HRT) and continue treatment for as long as needed to relieve symptoms.

1.4.10 Consider vaginal oestrogen for women with urogenital atrophy in whom systemic HRT is contraindicated, after seeking advice from a healthcare professional with expertise in menopause.

1.4.11 If vaginal oestrogen does not relieve symptoms of urogenital atrophy, consider increasing the dose after seeking advice from a healthcare professional with expertise in menopause.

1.4.12 Explain to women with urogenital atrophy that:

symptoms often come back when treatment is stopped

adverse effects from vaginal oestrogen are very rare

they should report unscheduled vaginal bleeding to their GP.

1.4.13 Advise women with vaginal dryness that moisturisers and lubricants can be used alone or in addition to vaginal oestrogen.

1.4.14 Do not offer routine monitoring of endometrial thickness during treatment for urogenital atrophy.


Please not that the first paragraph actually says (including those on systemic HRT) so is clearly telling doctors to give local oestrogen in addition to systemic HRT for ‘as long as needed'.

Here are the whole NICE guidelines that were published at the end of last year - you could print this out to give to the GP (highlighting the section you need them to read) suggesting all the GPs in the practise have a look at this??? 
https://www.nice.org.uk/guidance/ng23

Here is the link to the NHS website that also gives advice on treating Urogenital meno symptoms:   http://www.nhs.uk/Conditions/dry-vagina/Pages/Introduction.aspx#oestrogen

It is soooo frustrating that we have to spoon feed our GPs.  I do stress you need to approach this with your GP in a tactful way as they often get upset when told things by their patients - makes them feel stupid.
Hope this helps. Good luck  DG x

[nothappybun]

Thanks a lot Dancinggirl, I shall print it out and take it with me on Tuesday. I checked and I'm going to be seen by unknown/locum again  I did get a routine appointment to see if I could get hold of one of the three female doctors and my practice who specialize in woman's health but no luck, would have to wait three more weeks!
I hope my update on Tuesday is good news
Thanks again you are helping me so much
   nhb xxx

[CLKD]

The GP Trainee? may have 'done' Obs and Gynae but that doesn't cover menopause  and she is badly informed.  Using Ovestin1mg no way increases over-all HRT! because it is localised, also the GP was completely wrong as the initial load for VA treatment is 2 weeks every night!!!!  You need to point this out when you go to the Surgery again and ask that the Locum is informed because she will continue with this myth!!! 

Take a list of symptoms with you and ask for advice on each one.  Let us know how you get on

I am spitting BRICKS about the bad advice you have been given  which was totally negligent, both from the Locum and the supposed meno-clinic  .  Sounds like there is a lack of knowledge there.  I would be inclined to send details to Dr Currie for her information!!!

[Maryjane]

Just to say , I am 50 awful
Va/ bladder.

I require sandrena , vagifem 5 xs a week AND ovestin as and when needed.

HP says she has lots of ladies who need the lot for VA , and she said its all about quality of life NOW.

Even with all that , I still have to follow the same protacol as Dancing girl.

[Maryjane]

I am afraid we have to put our brave pants on , and say I want per the guidelines not can I have. End of.

Can you take someone with you ?

Yes can/did feel swollen down below I think it's all coming alive again , when it was going into Autumn it's been sent back to spring.

[nothappybun]

The GP Trainee? may have 'done' Obs and Gynae but that doesn't cover menopause  and she is badly informed.  Using Ovestin1mg no way increases over-all HRT! because it is localised, also the GP was completely wrong as the initial load for VA treatment is 2 weeks every night!!!!  You need to point this out when you go to the Surgery again and ask that the Locum is informed because she will continue with this myth!!! 

Take a list of symptoms with you and ask for advice on each one.  Let us know how you get on

I am spitting BRICKS about the bad advice you have been given  which was totally negligent, both from the Locum and the supposed meno-clinic  .  Sounds like there is a lack of knowledge there.  I would be inclined to send details to Dr Currie for her information!!!

I'm shocked too, I really believed them and thought it might be something else. I've been reading all the links Dancinggirl posted for me and printed them out to take them with me! You are so right and I'm so grateful I came across this forum to get the right info!

Just to say , I am 50 awful
Va/ bladder.

I require sandrena , vagifem 5 xs a week AND ovestin as and when needed.

HP says she has lots of ladies who need the lot for VA , and she said its all about quality of life NOW.

Even with all that , I still have to follow the same protacol as Dancing girl.

I am afraid we have to put our brave pants on , and say I want per the guidelines not can I have. End of.

Can you take someone with you ?

Yes can/did feel swollen down below I think it's all coming alive again , when it was going into Autumn it's been sent back to spring.

How long did it take for it to kick in with you? started with Dancinggil's protocol today

I can't go with anyone Maryjane, I moved here last December and don't know anyone that much to ask them something so personal
Maybe I was so stressed with the hot flushes every five minutes and the Vaginal/bladder killing me I didn't explain myself properly at the doctors that's why now with it written down and the other info printed out it will be easier, when I told them my symptoms, the locum told me they were related but the meno clinic consultant said they had nothing to do. Tested me for urine infection (negative) asked me if I thought I had chlamydia (didn't even know what it was) and asked how many partners I had. I told her my ex for 18 years and my actual husband 8 years and no one else so she didn't test me. Maybe I should be offended now I've read about it and surely with regular smears and other test I've had before her I would have known.
The vaginal symptoms started when I stopped the pill which contained:
 2 days 3 mg estradiol valerate
 5 days 2 mg estradiol valerate and 2 mg dienogest
 17 days 2 mg estradiol valerate and 3 mg dienogest
 2 days 1 mg estradiol valerate
 2 white tablets do not contain active substances
She put me on Everol sequi 50 and vagifem on the second day after the pill so went from 3mg estradiol valerate to 50 micrograms of estradiol per 24 hours on the second day the hot flashes were every hour, the sweats continous and my parts felt as if someone was wringing them, a week after even my underwear was uncomfortable and made me sore, then I started feeling the urge to pee all the time but couldn't like when I was young and was nervous doing an exam or had to take a plane, I'd go to the loo and just pee a small concentrated drops, then my urethra started hurting too and felt swollen. My belly and lower abdomen was very hard and swollen too. Since I started the Ovestin the peeing issue is resolving and the urethra pain, still have the wringing sensation inside and dryness. So she changed me to only 1mg Sandrena on my arms everyday  and Urogestan from the 1st to the 12th every month and said that the problems mentioned above have nothing to do and to stop using the Vagifem which I was using twice a week with the patch. The first week was every day, the second alternate days and the third twice a week. I started the Sandrena on Thursday and by Monday it was so bad I went to my GP on a walk in basis and got the Ovestin off the locum who would only prescribe it for a week as it was doubling my HRT she said and couldn't prescribe it for longer!  now I know that is not true thanks to you girls and this forum!
After reading on here I am sure it is hormonal and the drop from the peri treatment (qlaira pill) and the new HRT which is a much lower dose.  Before the pill 10 months ago, I had regular periods till August when I skipped one and the hot flashes/sweating/palpitations started in September but continued having a period so I started the pill in October as they considered me still peri now I must be right in the middle or end of meno.

Sorry for the long post, I feel so lost and I'm really grateful to have found someone I can share with and I'm getting lots of information which is helping me understand and makes me feel better already.
Thanks again
hugssssssssss xxx

[CLKD]

Keep adding to that list ;-).

Browse round.  Make notes.   My VA presented with bladder irritation which seemed like urine 'infections' but my GP realised that it was VA.  For me it felt like razor blades up there  ! but after 2 weeks load of local oestrogen symptoms went away.  If it is getting a nuisance it starts under my belly button with 'heaviness' and an extra need to pee …… so I up the loading again.

Chlamydia is a 'hidden' condition which gives no symptoms.  It can cause problems with fertility and both partners need treating once it's been diagnosed.

Sounds more like a 'special clinic' than one knowledgeable about menopause.  So now you know a lot more than the medics you have seen, if you look on your Surgery web-site it should give details of any of the GPs interested in female problems.  Maybe there's a Prescribing Nurse who would be more knowledgeable?  Perhaps send an e-mail to the Surgery and ask? 

At the very least, have a look-see at your local Hospital Gynaecological Dept. and see if there is information about special menopause clinics?  Some Hospital web-sites are more detailed than others so it can be a bit of hunt!

Now you are here, you are less alone  :for you:


Ask, ask, ask!!