Vaginal atrophy and prolapse

[AlisonMargaretBrand]

Why don't doctors as a matter of course invite women in for a menopause education session and physical review when we're in say our 40s? I had a symptom free menopause (or so I thought). I even bragged! No hot flushes or anything like that. I had my daughter when I was 40 and now 19 years later suddenly I'm in a mess - constant burning, terror of UTIs, prolapse etc. I wish I had known about the devastating effects of oestrogen drop. I'm now trying to stabilise the problems I've got and am hoping that starting nightly vagifem, plus pelvic floor exercises will do something for these awful urinary and vaginal discomforts. If men had the menopause there's be so much more funding and interest in treating it!

Couldn’t agree more. I suppose we will cost the NHS money. Vagifem is more important than Viagra, imo.

Agreed! Thank goodness that at least it's being openly spoken about now and there are resources such as Dr Louise Newson and Dr Marion Gluck that women can access. There's also over the counter vaginal hormone therapy available from pharmacists and Wellsprings. It's improving but women tend to have to know what they want and need to get it.

such an interesting point - so much attention given to viagra in terms of different delivery systems (it was injectable initially I think).

Very interesting point about the lag in time, accessibility and safety research in HRT treatments for women and Errectile Dysfunction treatments for men. Misogyny?

I agree totally. It's almost an accepted norm that it's just how it is for women.

It's not good enough. There should be at the very least some easily readable information from your doctor on the subject.

People know about hot flushes in menopause but many are clueless about the long term effects of oestrogen depletion and that it starts much earlier, in
peri-menopause.

So much misery could be avoided with micro dosing of oestrogen. Which is minimal almost insignificant risk compared with full HRT.

Even full HRT is safer now than it ever was.

The NHS is on its knees, I couldn't get a GP appointment at all last year. I had a couple of phone nurse appointments which I waited 5 weeks plus for each time. I can't see the resourcing being available to give women in their 40s education on the menopause. There is plenty of documentation to read online regarding peri and actual to trawl through. I actually went through the menopause at 42, just after having a baby, which is very unusual. Ended up taking both hrt and the contraceptive pill till I was 50. Now 73, when we moved new gp wouldn't prescribe the hrt. This was in the period it was decided it was dangerous. I have never suffered from vaginal dryness, and I believe that as I continued to have a sex life,it helped enormously. The majority of my friends (who didn't have early menopause) had given up sex in their 40s. I am of the "Physician Heal Thyself" school of thought. I have done the PC excercises daily for donkeys years,you should continue for ever. Blokes should also be protecting their pelvic floors.

What I have learned is that you can be unaware that vaginal atrophy is happening. I have not experienced dryness in relation to sex and it was a colossal shock to be told that my horrible UTI type symptoms were due to VA. Totally agree about taking responsibility for one's own health but this is a public health problem. There should be more proactive education in schools perhaps too about the female trajectory and the known impacts of oestrogen drop off. I had no idea how oestrogen drop affects so much!

I'm certain it's misogyny - deeply entrenched in our society. And in my experience women can be the worst! BTW I hated Little Britain because of that old lady peeing sketch they did. Awful. Not effing funny!

It’s a myth that regular sex will prevent pain. I have an active sex life with my DH but have to throw everything at it so I don’t feel discomfort.
The changes down below are not the ones talked about enough. I have always done pelvic floor exercises so that’s fine

I don’t want regular sex. I’d rather take HRT.

I have prolapse and VA and did not really know about either until it happened.
I was told about pelvic floor exercises when I had my children years ago but thought they were just for the first few weeks post childbirth.
Hot flushes and other menopausal symptoms are well publicised and I took HRT for a few years.
I became single in my mid 50s. When I hit 60 I had a couple of episodes of thrush which I self medicated with Canestan. I ignored the advice to go to a GP if over 60 as saw no reason for it. I had a very painful smear and the nurse said a lot of women find it uncomfortable when getting older but did not say why.

I then developed a prolapse and was referred to Urogynae for a hysterectomy, plus bladder and bowel prolapse repair. A lot of the women there were young with prolapse caused by complicated childbirth.
They also diagnosed me with VA and prescribed Ovestin oestriol cream. I now have a very weak pelvic floor, despite doing the exercises. My VA presents as incontinence if I don't take the Ovestin. Incontinence is such an embarrassing condition which I had previously thought was mostly an issue for very elderly, frail people in nursing homes.

I'm not suggesting everyone should have sex,or that it's a cure all..I had really dreadful painful periods from the age of 11,was really positive about the menopause. It floored me. I went from incredibly fit, active (42 remember,) to an old woman overnight. Hot flushes, terrible joint pain,thin hair, couldn't even remember to feed the animals (the call it "the list syndrome") requiring a couple of operations,had to come off the hrt beforehand, the symptoms were back with a vengeance! I always said it was completely natural I wasn't taking her. My GP said early menopause, slight build, couple of fractures, you must take hrt ,he was young and male. I suppose you could argue it's the same with men being unaware of prostate problems and low testosterone, and that they should also do PC excercises (sorry ladies, regular sex helps prevent prostate problems)

I have just typed out a long reply and deleted it because it was perhaps too personal. I digress...

I have attempted to obtain vaginal oestrogen from female GPs. I am single. The impression I have been left with is that my vagina is unimportant because I do not have a man to service sexually.

There is a male GP who is much nicer but I avoid seeing him for examinations because then I have to have the receptionist as a chaperone which is unpleasant too.

As an aside they need to stop using dryness as a catch-all term. I didn't think anything was amiss for ages because I wouldn't describe what I was experiencing as dryness.

Couldn't agree more. When you say micro dosing oestrogen do you mean topically? Or am I missing something else?

I was a fool who thought I’d sailed through the menopause just feeling a bit warm now and then. Then I started with a urine infection which was treated with antibiotics. Seemed to clear that up but something wasn’t right. Back and forth to different GPs at the practice. More wee infections. Vaginal atrophy was never mentioned. Did my own research and asked for Ovestin and I’ve never looked back. All in all that took six years. Not one GP realised that could be the reason for the wee infections, burning, stinging and constant need to wee which all resulted in an overactive bladder. Ovestin has now stopped all that and my bladder is now back to normal and “trained”. It was so debilitating I rarely left the house. Turned down invitations and dreaded having to go anywhere. So easily treated. GPS need to be more aware x

Gosh, that's a lot I didn't know

I believe that we have to shout loudly for what we need to keep us well. No one offers. You have to seek it out but some people for whatever reason simply don't so yes, information should be easily available from GP though I suspect there's still a cohort of GPs who are still going on old research. The drug companies need to up their game and meet with GPs and NICE needs to update GPs or maybe even themselves! On the plus side, it is probably easier to go to a pharmacy and speak to a pharmacist and they can assess and prescribe directly. It's just a conversation.

I'm a lucky exception - my menopause was relatively low symptoms, but my GP told me that I'd need something for vaginal dryness/itching/possible UTIs (didn't mention VA as such) at some point. So as soon as I started to get some of these symptoms I went and asked and was prescribed vagifem.

You probably won't be surprised that this GP is a woman of very much my own age. The one I saw to get the prescription was a young man so either he had the sense to not argue or she'd educated her colleagues.

I was astonished by this article in the Guardian. I had no idea all of these issues could be a factor. I am not uneducated about menopause but it was blooming news to me.

https://amp.theguardian.com/society/2023/dec/17/millions-of-women-are-suffering-who-dont-have-to-why-its-time-to-end-the-misery-of-utis

Please also ask for referrals to pelvic health physios - managing the oestrogen drop whilst also strengthening the muscles is so important and would urge anyone struggling to seek a referral x

I don't know where you are in the world but in UK it is simple to get vaginal HRT through a questionnaire at a chemist. You can even do it online. No physical examination required.

It is the oestrogen pesseries. A whole year of pesseries is the same overall dose as a few days of HRT. It's a tiny dose that works on a few inches of tissue around the pessary. It's useful to get it positioned just right for your needs.

I don't know where you are in the world but in UK it is simple to get vaginal HRT through a questionnaire at a chemist. You can even do it online. No physical examination required.

You shouldn't need a physical examination at the GPs either.

I don't know where you are in the world but in UK it is simple to get vaginal HRT through a questionnaire at a chemist. You can even do it online. No physical examination required

I didn’t know this. Are women just expected to ask at the counter? Or what?

Gosh I am realising there's so much I don't know. I opened the thread as I have a prolapsed uterus but I don't know anything about atrophy, can someone explain what that is please?