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[beaniegirl]

Hello

I have awful trembling and sensitivity in lower middle abdomen. Don't know if it's uterus or bladder. No urine infection. Have had scans of bladder and other organs - all OK. Am going for internal scan tomorrow. Had all same tests 4 years ago - all negative. Was given HRT pills then - on them for 10 months, then everything perfect until 2 months ago when same feeling came back. Started with what I thought was urine infection - given antibiotics, then vaginal oestregen/progesterone pessaries - not working. Doctor doesn't want to prescibe HRT pills again as it is "too long after start of menopause for them". I am 59 and started menopause about 5 years ago. Does anyone have this feeling? Not pain, just feeling of "live" tremors and extreme sensitivity like when you have flu and everywhere feels open and raw and fragile. I feel my nerves are alive in there and it affects my whole being. What to do?

Thanks

[CLKD]

Your GP is out of date!

[Hurdity]

Sorry to hear about your symptoms beaniegirl. I can't quite imagine what you mean by abdominal trembling and sensitivity though? In terms of the HRT - CLKD is right that your GP is out of date re HRT and the menopause - if s/he is dismissing it completely, but s/he is probably right re the actual tablets - at your age/stage now. When was your last natural period and had you been 12 months without a natural period before starting HRT? What do you mean by starting menopause 5 years ago - symptoms? Periods? Flushes? Blood tests?

Anyway the good news is that if you are within 5 years of menopause and aged under 60 - this is within the time-frame for being OK to start HRT, and especially transdermal ( ie through the skin - patches or gel and separate progesterone) rather than tablets which are associated with higher risks.

Have a look at the risks here:
http://www.menopausematters.co.uk/risks.php

and balancing risks and benefits here:

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

Under 50 the risks are thought to be less than the benefits and especially within the window of opportunity mentioned in the cardio-vascular part of the risks page:

"HRT should not currently be taken for presumed cardiovascular benefit [Ref 4] but HRT used in the early menopausal years for control of menopausal symptoms is very unlikely to be harmful to the heart and may yet prove to be beneficial. It is very likely that there is a “window of opportunity” whereby, if HRT is commenced early, it may be beneficial not only for control of symptoms and prevention of osteoporosis, but also prevention of heart disease but if commenced later when disease of the blood vessels has developed, further damage may occur."

The window of opportunity is given as  within 10 years of menopause  "We strongly believe that the first 10 years of the menopause is an important time in a woman's life to improve her health and reduce the risk of long term disease, the so-called ‘window of opportunity'." https://thebms.org.uk/_wprs/wp-content/uploads/2015/10/BMS-Response-to-Cochrane-review.pdf

I presume you are still using the Vagifem or estriol/Ovestin and did a two week daily use followed by at least twice a week thereafter - for ever? Some women need systemic HRT as well as local oestrogen to keep vaginal/bladder symptoms at bay. Have a look at Maryjane's posts on this (to view someone's posts you just click on their name and then "show posts" and they will come up with the latest first (or the oldest first!).

Do read as much as you can about this and especially looking at Treatments/HRT preparations (top tabs pale green banner) and if you would like further advice do ask. If necessary ask for a referral - not sure whether to urologist or gyane and others will hopefully be able to advise this?

Above all - get a move on (!) - as there can be a psychological barrier with some docs to prescribing HRT at around or over 60 but looks like you have encountered this already! DO NOT BE FOBBED OFF if this is the route you want to go down - and we are with you all the way

Hope this helps....

Good luck with your quest for the right treatment and keep us updated.

Hurdity x

[beaniegirl]

I must apologise to you, Hurdity, for not thanking you sooner for having taken the time to reply. That first comment from CLKD (which although perhaps true, wasn't exactly constructive) set me back a bit and I felt rather foolish for having written, so I didn't look at this site for a while. However, I feel better now after reading what you, Hurdity, had to say. It has helped a lot. Thank you.

[Taz2]

Hi beaniegirl - nice to see that you are posting again. I hope that you will find some useful advice from our posts. Quite a few of us have had to change our GP's because their knowledge of menopause and HRT risks is somewhat lacking.

As for the bladder feelings. I have fibromyalgia and the first symptoms were as you describe. Everything felt raw and as if all of my nerves were on the outside somehow. Do you have any other symptoms?

Taz x

[beaniegirl]

Hi Taz2
Thanks for your reply.
When the raw pulling, tugging feeling is at its worst (generally in the afternoons and evenings and when I lie on my sides in bed) I feel anxious, sometimes distraught, and driven to fidget and pace. I have some sweats but I can cope with them.
Also I seem to have lost normal sensation before, during and after peeing. There is no pain or burning and I don't need to go any more than usual, but it just feels "wrong" (there is not the usual "urgency" to go or "relief" afterwards) and my pee feels "thick". My pee looks normal and has tested normal. I am not dehydrated and am drinking the same amount as usual.
I am nearly finished the 20-day part of using vaginal pessaries before going onto one every second day (estriol 0.2 mg/progesterone 2.0 mg) but they're not having any effect just yet. Perhaps it's too soon? Are there different strengths available?
Painkillers don't have any effect on the sensitivity.
By the way, my GP is female, in her 50's and says she is having a bad time with her own menopause, so you'd think she'd be on the ball, but maybe not!

[Hurdity]

Hi beaniegirl

I don't know where you are getting the estriol/progesterone pessaries from but these are not what are recommended on NHS so this could be why your symptoms are not improving. You do not need progesterone pessaries for VA (the only ones available are Cyclogest and these are given for fertility and off licence for HRT). Maybe you are not in UK?

The estriol preparations recommended for VA are at a higher dose than this - from my notes previously researched it is 0.5 mg for one dose of Ovestin for example.

Have a look at the preparations on the list here - these are the ones that are licensed for helping VA:
http://www.menopausematters.co.uk/local.php

Hurdity x

[beaniegirl]

Thank you.
I am in France and got these on prescription from GP here.
I think I will have to go back to see her and ask about this. I am loathe to though, in case she thinks up some other tests for me to have. Have had practically everything but a brain scan - and maybe that wouldn't be such a bad idea.
So I should be having estriol-only pessaries? Is progesterone dangerous for me?
Thanks again.

[Hurdity]

Sorry beaniegirl I think you might have mentioned you were in France before? Progesterone is not dangerous it just won't do anything for your bits and the estriol dose is too low. Not sure why you've been given this? You either need pure estriol pessaries - they may still do them in France - we used to have Orthogynest pessaries which were 0.5 mg, or you could use vagifem if they do that too. This is a 10 mcg estradiol tablet with applicator. I don't know where the HRT types available in France are listed. I had a quick look but didn't come up with anything.

Sorry I can't help but if you can find a list of HRT including vaginal products available in France and send me the link we can suggest what you might like to try?

Hurdity x

[WANDERER2]

Ha beaniegirl! Don't know if you have read my new topic? Vaginal atrophy giving me weird sensations/spasms going right up inside! Yes, it is a sort of trembling! Like a shaking in the pelvic floor, I know EXACTLY what you mean!!! All the clinicians I have seen must have thought I was mad! (Well, probably a bit!).

I wonder if it is the tightness of the pelvic floor muscles being irritated by the thin vaginal walls? I have yet to find a really good product that works, after 5 years! It even makes the tops of my thighs tingle and feel weak. It also affects my digestion badly, causing grumbling after food, and VERY bad constipation! I liken it to being like a dufflebag that has had all the strings pulled up tight!!!

So I really do know what you mean, and, although it doesn't help, I am relieved it's just not my imagination!

ps. Got a Whippet called Beanie!!

xxxx

[WANDERER2]

Hi again beaniegirl. Forgot to say, I am ALSO 59 and started my "horribleness" 5 years ago! Something in the air that year?!!!! Do you also find that it affects your mental awareness, it does me!

xxx

[beaniegirl]

Hi Wanderer

Thanks for your reply. Sorry you are suffering this - it is HORRIBLE - though, like you, I have sort of come to terms mentally with it now. When it first happened, I was convinced I had cancer of everything down there.
I have had so many doctors/"specialists" look at me as if I was completely mad when I have tried to describe my symptoms - even one female gynaecologist, who I thought would be the answer to my prayers, pooh-poohed it, but she was only about 30 - just you wait, madam! I really felt foolish and was beginning to believe I was making it up!
I had this for a year, 4 years ago, before I was prescribed Duova tablets (I am in France) - first 1mg estradiol/2.5 progesterone, then when that wasn't really working, 1mg estradiol/5mg progesterone. I took this for 10 months, then stopped and everything was perfect for 2 years. I couldn't believe it when it started up again this August. Why? My GP said my body had been storing the oestrogen from the tablets even after I stopped - but for 2 years?
As I mentioned, I have been using vaginal pessaries this time, but they are not working. Apparently, there are no stronger pessaries available in France, so my GP has (reluctantly it seems) prescribed the Duova tablets again (same lower dosage as before to start, then up it if that doesn't work). I have the tablets in my hot little hand, but I am swithering about taking them. The risks worry me and also I had a fair bit of bleeding after a couple of months on the higher dose, which I didn't like.
Hurdity, please could you tell me why you said at my age/stage the GP might be right not to prescibe
tablets.

Thanks again.
Love to Beanie!

[Taz2]

Hi beaniegirl - I think that Hurdity probably meant that it is safer to use either HRT in gel or patch form once you get older - especially after 60. I believe it is the stroke risk which rises as we get older.

Taz x

[beaniegirl]

Hi again

I am in a mess and don't know what to do for the best.

I have been prescibed the Duova tablet 1mg estradiol/2.5mg progesterone (or 1mg estradiol/5mg progesterone if I feel I need a stronger dose) but I haven't taken any at all because I am scared of the risks. I took this successfully 3 years ago for the same symptoms until I started to bleed because of it, which I hated. But now I am 59 and I believe the risks are higher? Does anyone have any opinions on whether this is an acceptable dose (risks versus potential relief) at my age/stage.

I told my gp that I was scared to take the Duova and now she has prescribed a pessary Pysiogine 0.5mg estriol. She says I have to use this every second day, though the leaflet in the pack says use for 3 weeks then twice a week. Is this the same drug as Vagifem? How does the dose compare? It seems to be for dryness (which I don't really suffer from) and other problems of the vulva and vagina. Will it work on my symptons which are primarily tremors and discomfort in the uterus/bladder (I'm not sure which) or do I need the stronger Duova tablet, even with the risks and the bleeding?

What about magnesium supplements? Would they help "relax" things inside?

Sorry for so many questions, but I am losing confidence in my gp (and she is the best of the bunch here) and there is so much conflicting information everywhere. I feel I am being forced into self-diagnosis and am leaping from one thing to another without giving one thing a chance to work.

Please share your thoughts
Thank you.

[Hurdity]

Please don't worry too much about the risks - as I said earlier in the thread you are within 5 years of menopause and still under 60. The problems arise more if women start HRT very late and longer than 10 years since menopause - because of the changes in the cardio-vascular system that have occurred, so oral HRT can lead to increased risk of stroke. This is not the case with you and especially if you are not in any risk category and are generally healthy - ie healthy BMI, non-smoker, low alcohol healthy diet with lots of fresh food etc.

Here is some info about risks:
http://www.menopausematters.co.uk/risks.php  ..and balancing risks and benefits:
http://www.menopausematters.co.uk/balance.php

You will see that under 60 the benefits outweigh the risks and over 60 they are about equal - but depends  on other fatcors too like body weight etc  as I mentioned above.

If you get breakthrough bleeding on the oral HRT - then you can take the stronger one with the higher prog in it ie the 1/5. If you still get sporadic bleeding then you could go onto a cycle like many of us ( including me in my 60's!) where the bleed is predictable. I am on a long cycle though ( with doc approval).

Yes the protocol for vaginal oestrogen is daily for at least 2 weeks ( as you say - 3 weeks if severe) and at least twice a week thereafter. I would be doing this as well as the systemic hRT. If you are really concerned about tablets then why not try a transdermal one - I am sure there are preparations available in France? Estriol is not the same as Vagifem ( which contains estradiol) but it does the same job at the same dose - ie plumps up vaginal tissues to alleviate VA

I don't know about Magnesium - you should get enough in your diet without needing to supplement - but I don't have info on its use high dose for medicinal purposes (eg like Milk of Mag for stomach complaints etc!).

Hurdity x