UTI, soreness - are my bike riding days over?

[mutterphore]

I'm nearly 60 and post-menopausal for 5 years (luckily sailed through that process with no difficulties). Unfortunately, I've had my first UTI for the last 8 weeks+ with incredibly and unremitting soreness too and am on my third set of antibiotics.

As a regular bike-rider - usually around 80 miles a week - I can't even imagine the possibility now of getting back on my bike as the soreness is so awful, all the time. Will I ever cycle again? It's my main source of exercise and one of my greatest pleasures.

All the creams the GP has prescribed so far haven't worked and in fact I'm slightly worried they may have made things worse. I've tried Canestan Hydrocortisone (although I don't actually have any of the usual thrush symptoms - eg no itchiness and no discharge) which I think exacerbated the soreness, Replens - which definitely made it worse and Sylk, which sort of relieves it a tiny bit for a few seconds but doesn't go anywhere near relieving the soreness.

As I had no problems at all before all this, I'm reluctant to try topical HRT.

Wise women, can you suggest something for immediate relief from the soreness - ideally a safe, natural product, as I think all these creams have just made it worse?

Has anyone suffered similarly but then the UTI and the soreness gone away completely without further more drastic interventions. Finally, if there are any other post-menopausal cyclists on here, can you give me hope for future bike rides?

Has the doctor done proper urine tests - not the dip test but microculture and sensitivity i.e. sent off to a lab? Have they ruled out diabetes?

The fact that three lots of antibiotics haven't cleared it makes me wonder if this is lack of oestrogen and possible vaginal atrophy. For which you'll need topical oestrogen I'm afraid. It might be worth also trying a vaginal moisturiser but if the "soreness" is external you might have just upset things with too many creams (this happened to me) so may be better to leave that for now. A vaginal moisturiser is unlikely to solve the urinary problems though.

If I were you I would probably try the topical oestro and then if the UTI symptoms don't stop or reduce after a few weeks ask for a bladder ultrasound and further investigations/referral. In my experience you have to be quite pushy and keep going back if things haven't worked.

I replied on your other thread in the Cycling topic. I totally agree with the poster above. Topical oestrogen is a very, very low dose and if that's the cause of your issues it will help enormously.

I am postmenopausal myself, on HRT, and still enjoy regular cycling with no issues.

By the way, I thought I had treatment resistant thrush at first until I eventually had a lightbulb moment and realised it was menopause related. Topical oestrogen helped a lot, but I did eventually decide to go for full HRT which works better for me.

Vaginal oestrogen like Vagifem will really help. I also highly recommend normal HRT too. Nothing to be scared of and it protects nether regions, Jones, cardiovascular health and against dementia. Patches, gel or spray is gold standard.

I agree with both the above posters. I'm a keen lifelong cyclist but a couple of years after my periods stopped (at 54) I kept getting recurrent UTIs and soreness and was very worried that the cycling was making it worse. The final straw came when I had 3 UTIs within the space of 2 months. I was also very reluctant to go down the HRT route, but an older female doctor recommended oestrogen pessaries (Vagifem) which deliver a very localised tiny amount of oestrogen. I started with 1 a day for 10 days and then one every 3 days. I'm now 61, have been using them for about 5 years, haven't had a UTI since and am back cycling comfortably!

Good luck mutterphore, you have my sympathy; it seems interminable at the time but hopefully you will be able to get a successful resolution.

Thanks for all the advice. @Nixer I'm waiting for the results of a lab test on my latest urine sample. The GP did say that if I keep on getting UTIs, even after the third does of antibiotics, that I could have an ultrasound.

The unanimous advice from all of you seems to be topical HRT and I'm really reluctant to try this as I've heard so many 'horror stories' like hair loss etc. However, if it's a choice between no more cycling and topical HRT, I'd rather get back on my bike.

@Boiledeggandtoast it's good to hear that you're back to cycling and thanks also for your input @DramaAlpaca and @SophiaLarsen . I really am hesitant to try full HRT but might consider the topical type.

I fear this is going to be a very long, protracted saga, as it'll take a while still to get back the lab results and then presumably I'll also have to wait after I finish the latest antibiotics to see if these clear things up and then return to the GP for further advice and referral - all of which I can envisage could take months.

In the meantime, I just really don't know whether to avoid all topical creams and trust that things will heal naturally or keep trying regular use of one of them. Do I just grin and bear it?

I thought that once you were post-menopausal that things would stay consistent but is it the case that for the rest of the lifespan, oestrogen levels continue to fall and problems get worse?

@mutterphore My lovely lady doctor also referred me to a urologist for a bladder scan which took a while to come through but in the meantime prescribed the Vagifem, which I started straight away so by the time my urology appointment came through I had had no more problems. (The urologist was very understanding and it was reassuring to find there was nothing fundamentally wrong.) I completely understand your reluctance to go down the HRT route - I also didn't want to (and have not needed to) go full HRT - but I have had no adverse effects at all with the Vagifem, only huge relief of what was becoming an increasing problem.

Vagisil wipes will soothe the discomfort very quickly although I haven't been on a bike for a decade so I don't know if it will help with that.

Vagisil wipes will do diddly squat for lack of estrogen.

My advice is to stop putting this and that on. Give it a few days clear. I would start on Vagifem as soon as, because it can take time to get atrophy under control.

There is no such thing as through menopause then you're fine. Symptoms can develop at any time thereafter periods ending.

"I thought that once you were post-menopausal that things would stay consistent but is it the case that for the rest of the lifespan, oestrogen levels continue to fall and problems get worse?"

I presume oestrogen levels bottom out at some point and I believe some symptoms like flushes etc settle eventually for most without needing HRT. But vaginal atrophy is slightly different in that it does not get better by itself.

I should say, internal plus external topical oestrogen initially seemed to be
resolving my bladder problems, but they came back and I am now being investigated for other stuff (and doubting the diagnosis of atrophy a bit). But for most women topical oestrogen will resolve it.

Ask for a urologist referral.

If your problems are being caused by lack of oestrogen then the only way to halt/reverse vaginal atrophy is through topical oestrogen. Maybe do some reading around vaginal atrophy.

The dose in vaginal oestrogen is super low and much lower than in oral/topical oestrogen.

I've been using topical cream (Ovestin) & it's totally sorted out itching & soreness. I haven't heard of major side effects associated with just using the cream?

Sorry, confused terminology. Ovestin vaginal cream (rather than regular topical HRT which I guess means patches etc)

I'm really reluctant to try this as I've heard so many 'horror stories' like hair loss etc.

Who is saying this?

It does not cause hair loss. (Loss of estrogen does cause hair loss in many women)

To put the dose in context @mutterphore

If you use vaginal estrogen as prescribed ( 2 x a week) for a year, that is the same amount of estrogen you would get with ONE day of systemic hrt.

So, in other words, 104 ( 52 weeks x 2) applications of Vagifem or Ovestin is the same as a 1mgs tablet of HRT. (which is a low daily dose.)

If you don't treat this, it will get worse as the years go by.

Left untreated you can get bleeding from the vagina as the walls get very thin and fragile.

Very worst cases are elderly women whose vaginal walls have fused together due to thinning skin and lack of moisture.

I have known women in their 80s and 90s being prescribed vaginal estrogen.
Don't be afraid of it.

Topical oestrogen is the answer. It's very very low dose - I was told a whole year's worth (even if you use it every day) is the same amount of oestrogen as a day of HRT.

It's so low a dose that you can even have it after you have had breast cancer.

Interesting you mention diabetes, is this a common symptom?

Where on earth have you heard topical oestrogen causes hair loss?? Never ever heard that before!

As others have said the oestrogen creams are extremely low dose - so low infact that when I have to stop my systemic HRT for specific blood tests related to my rare autoimmune issues (cortisol related - HRT falsely elevates cortisol levels, very complex) I can continue to use the Ovestin cream as it makes no impact on blood tests at all. I hope that helps to put your mind at rest. I am under a specialist at the Newson Health Clinic and also a specialist gynaecologist in the nhs.

If you are going to try topical oestrogen make sure you get Ovestin rather than Vagifem as you can use the Ovestin externally, rubbing it around the vulva, rather than and in addition to just using it inside. Vagifem is a pessary type thing usually.

Also - google Sjorgens syndrome. I have this and it’s one of the reasons I suffer so much with these things. It’s hugely under diagnosed amongst post menopausal women because they’re very quick to write off their symptoms as just getting older etc.

I don't know. I also had a rash/suspected thrush during one of the (many) UTIs so they tested for thrush and diabetes (it was neither).

Topical oestrogen immediately stopped the recurrent UTIs and thrush-like symptons for me.
It hasn't stopped the external soreness, though. Or made any difference to the vaginal atrophy that made sex unbearably painful, (not that I felt like having sex any more anyway by the time i had fully gone through the menopause) .

If I could turn back the clock, I would definitely go on HRT as soon as the very first problems had arisen.

That's unusual and horrible for you @Oldnproud

Are you using ovestin or Vagifem?

You can use Ovestin outside (it's cream) as well as internally.

Have you continued to use whatever you are using?

It has to be used for life. Not just for a few weeks or months.

And you can go above the 2 x a week if you need more.

I wonder if you know all about hrt?

You are probably not too old to use it.

You can start over 60, so maybe you have misunderstood how it can be given to older women?

Why did you go off sex after the menopause?
Now, women with libido issues can have testosterone alongside their HRT to sort that out.

Do you think it's worth seeing a dr about it now?

Thrush is a common symptom of diabetes.
It's because urine contains high glucose levels and this irritates the genitals- vagina, vulva, etc, causing thrush.

Just re-read your first post @mutterphore

You are still 59- there is no reason why you can't use HRT!

The benefits to your heart are best if hrt is started within 10 years of your last period.

You are well within that window.

Considering your issues with vaginal atrophy, no libido etc, maybe go and talk to your GP (if they know about HRT!) and discuss.

I assumed from your other posts that you were much older- late 60s or 70s.

Many women are just starting HRT at 59.

There is this misunderstanding that meno symptoms disappear after a few years, but the sad fact is they just keep on coming, but in different ways.

@mutterphore so much good advice (I am taking heed myself) i just wanted to mention I'm a little younger than you at 48 but found myself picking up UTI after UTI the past year and it was always brought on after a long day in the saddle. I do similar miles weekly to you. I may be totally wrong but I changed my saddle to a Specialized Mimic and it helped, I stopped getting them.

I've since got a second bike second hand for the indoor turbo and lo and behold the UTIs are back. I find it very hard to get on top of once the cycle starts.

I'm interested in the topical advice here too. I'm on HRT patches as I am peri-menopausal.

What knowledgeable women you all all! Thanks for all this advice. I don't have any other symptoms, post-menopause, than this first ever UTI and soreness and otherwise feel very fit and healthy - though a bit overweight. So I was hoping not to have HRT ever, as no other women in my family have ever gone this route. However, I am now seriously thinking about something like Ovestin and depending on how things go with this round of antibiotics, will discuss further with the GP.

Awful to think that after 5 years since my last period and no difficulties, there's possible been a falling off the cliff edge of hormones. How on earth did women cope back in the day when there was no such thing as HRT and topical HRT?

The last time I paid any attention to HRT info. was in the era when breast cancer rates were increased and I'd always assumed that I'd never go on it and didn't need it in any case, as menopause was very straightforward for me.

@Anyfeckinusername many thanks for the suggestion about a Specialised Mimic saddle for my bike. I'll look into this too.

Xrays that is very interesting as I was recently diagnosed with Sjogrens (although now know I have had it for many years...) and have had the same problem but didn't connect the two. Can I ask how you manage it?