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?

You should be able to get topical oestrogen from your GP, and you don't need to wait until you have seen a urologist. Your GP is treating everything except the one thing that needs treatment - oestrogen deficiency. Please don't keep waiting patiently - it is easier to prevent permanent damage than to repair it once atrophy is advanced.

I still heard nothing back from the GP about the referral letter, @Dogsgottabone , so I've now booked another expensive appointment with her in the next few days to discuss topical HRT, suggesting Ovestin, as someone upthread said this can be used across the whole area as well as a pessary. Whether or not she'll think this is a good idea I don't know and she may want me to see the consultant first....if I ever get the referral for this. At least I feel I'm spurred on to be more proactive, thanks to all the support here.

Meanwhile, I looked up Ovestin cream and was really concerned about the potential side effects listed, including migraines, breast and ovarian cancer, thrombosis/ blood clots, vaginal irritation and itching, feeling sick and flu like, skin problems etc etc. I presume these are rare?

Can those of you who've been on topical oestrogen tell me what your experiences are, especially if you've been on them a long time? Are the potential benefits likely to outweigh the risks/ side effects? Also, how long after you start using the topical HRT do you start to get benefit - eg reduced UTIs and vaginal soreness and, in my case, being able to cycle again and wild water swim without fear of infections?

@Anyonebut thanks for the suggestion of cranberry extract tablets. I've got some powers that you dissolve in water but not yet tried these.

@JinglingSpringbells I didn't know that cranberry juice had fallen out of favour. My GP highly recommended it and said there was evidence that it helped produce better chemical conditions in the bladder/ kidney that made infection less likely. If it's too acidic, then that could explain why I've had even worse problems in the last few day with the burning sensations. I've been 'medicating' myself with it although it tastes disgusting but was trying to find natural remedy.

I'm nervous to try Gina cream until further discussion with the GP.

The consultant's secretary by the way said that they couldn't arrange an appointment for me without the GP referral letter.

@LoveMyPiano , thanks very much for the bike saddle recommendation. I'll look into this. My worry now if that I'll have to cancel my bike trips (in March and April) and my cycling holiday in July, as I'll not be OK enough in time to cycle even if I do get to start topical HRT.

@Lovemydaxie thanks for letting me know that dipstick tests for UITs are available from Amazon. I'd prefer to have more autonomy over checking than having to arrange yet another expensive appointment with the GP.

@Sharereportbookmark I actually mentioned to the GP that I'd heard dipstick tests and even lab cultures weren't always accurate and she disagreed and said they were very accurate! Thanks for the clinic recommendation. I'll see what happens with the next GP appointment and referral to the local consultant but it's good to have personal recommendations too.

You're all being so helpful and I just wish things could improve quickly enough for me to get back on my bike and into the sea!

Hi OP, I found that within the first two weeks of using ovestin internally, I felt plumper and better. I hadn't realised I had started to atrophy until GP did an internal and said I was very red and sore looking.

I then also used it to make it more comfortable to sit on my chair at work. I'd noticed I felt chafing just sitting still.

So I would say I noticed the benefits v quickly.

I think the side effects are v rare and I pretty sure Louise Newsome is doing work on getting those side effects in leaflets revised as she thinks they are very out of date.

*I'm pretty sure

BTW OP why can't you go in the sea? Does that make it sore?

Sorry if I missed a bit upthread

Meanwhile, I looked up Ovestin cream and was really concerned about the potential side effects listed, including migraines, breast and ovarian cancer, thrombosis/ blood clots, vaginal irritation and itching, feeling sick and flu like, skin problems etc etc. I presume these are rare?

Meno consultants have been campaigning for years to get that leaflet removed from the products.

The leaflet is the same as the one is all systemic HRT.
It does not apply to vaginal estrogen.

The dose of vaginal estrogen if you use it for one year is the same as 1 day of systemic HRT. It is not absorbed anywhere except the vagina.

You can buy Ovestin online- think it's Superdrug. It's a bit of a rip off at £28 or whatever, as the retail price if you buy it is about £8 ( I pay for it as mine is on a private prescription from my gynae.)

You could order it now or buy Gina in Boots (or any other pharmacy) today.

I'm not sure why you are hesitating TBH as it's harmless, cheaper than seeing a private dr for this, and the sooner you start on it the better. It may take a good few weeks to completely reverse the atrophy.

This is a really, really, common problem.

The treatment is used by very elderly women too- not just for sex but for comfort and reducing infections.

I'm nervous to try Gina cream until further discussion with the GP

Your GP has shown they don't know about this issue so why are you placing your faith in them now?

Gina was 'released' onto the market in Sept 2022, and it's a huge step forward.
It was given the go-ahead after years of consultation by menopause experts.
www.balance-menopause.com/news/gina-vaginal-estrogen-available-over-the-counter-what-you-need-to-know/

It's been cleared for OTC use because so many women are suffering as you are, and it's wasting GPs' time prescribing something that is so simple to buy.

Your GP has shown they don't know about this issue so why are you placing your faith in them now?

Yes! You know the solution here! Why are you hesitating?

Everything JinglingSpringBells said, with bells on. What have you got to lose?
Also the first thing any urogynae worth their salt will ask is why you haven't tried topical oestro, so by trying it beforehand you aren't wasting your money (if private) or their time. It will likely resolve your UTI symptoms within a few days or a couple of weeks if they are due to atrophy but you will need to take it for life.

Hallo again mutterphore. I've been using Vagifem for more than 5 years now and have had NO side effects, only very positive ones. I seem to remember my lovely female doctor telling me that the leaflet didn't really apply to topical oestrogen and that it was very safe, (also the urologist who I was referred to - I had already started using it before my appointment came through). I hesitate to criticise the medical profession as they are dealing with such a huge range of issues, but it does sound as if the private GP you are seeing is not very experienced in this area and I wondered if you have an alternative who you could see rather than bashing your head against this particular brick wall.

Just to add, I think I felt the benefits after the first couple of weeks of the "pre-loading", ie using it every day, and have since been using it every 3 days.

And just to say again, I completely understand your concerns about HRT which I share, but the topical oestrogen has been fantastic - I have not had a UTI since using it and have not needed to go on to full HRT - and I'm back to cycling 4 or 5 days a week (on a Brooks leather saddle!).

I've used it for about 16 years, from late peri.

It made a huge difference to my bladder issues that were very serious.

I've been using Vagifem for over a year and the benefits were obvious within about 2 weeks. The only side effect for me is that after about 3 months on it, I do seem to get more migraines. However I stop for a while until it settles down and the restart. The benefits outweigh the inconvenience. Most people don't have this problem but I am obviously sensitive. The other thing you can try for urine infections is D mannose. Much more effective than cranberry juice. I take 1 capsule every day and really helps prevent problems.

I found that vaginal oestrogen helped. I also used to use bubble bath and stopping that is what seems to have made a big difference. The chemicals even when heavily diluted could have been an irritant.

I'm not a cyclist and can't comment on whether lycra/friction etc would aggravate difficulties caused by menopause. (I'm a runner and wear lycra sports wear but probaby not for as long.

@Dogsgottabone that's really helpful to know the topical HRT worked quite quickly for you.

Is there any real difference between Ovestin and Vagifem by the way, except that someone up thread said with Ovestin you can smother the whole area in the cream? Is one type better than another?

The GP told me that I should avoid baths as even tap water can carry microbes so I assumed all my wild water swimming pursuits weren't possible either. I wonder if anyone on this thread has issues with open water swimming and getting lots of UTIs post menopause and whether topical HRT also stopped that happening too?

@JinglingSpringbells, @Boiledeggandtoast , @Nixer and others, what you say is very reassuring about topical HRT. My hesitation has been because I've just never needed or taken any hormone or in fact any medications really other than antibiotics or paracetamol very occasionally, lifelong and it feels strange and scary to start on something I may then need for the rest of my life. On the other, I'm not getting any younger and I do want to be able to enjoy my main activities before i get far too old to move around at all.

I finally got a copy of an email sent from my GP to the consultant's secretary with a copy of the referral letter that was apparently sent a few weeks ago but clearly never passed on to the right consultant. So clearly it's not the GP's fault that there's been a delay. In her referral letter, she also says that I'd 'declined topical oestrogen' . I don't remember this only that she referred to it in passing and I thought we'd both agreed that HRT was a step too far but maybe I misinterpreted what she was saying and she misinterpreted me too.

I intend to discuss topical HRT with her shortly at the appointment I've just booked but am now thinking she may no longer feel she should prescribe it until after I've seen the consultant to explore causes of my symptoms and there's still no sign of an appointment offer from the consultant.

I think you've all 'sold me' on the idea of topical HRT and so once I've seen the GP again, will now pursue this. I think I'll wait rather than try Gina as it's not long anyway until I see her.

By the way, is topical HRT expensive on prescription and if it readily available? My local pharmacy often needs to order things in and it can take ages. So what happens if you run out between prescriptions and can't get any straightaway?

I intend to discuss topical HRT with her shortly at the appointment I've just booked but am now thinking she may no longer feel she should prescribe it until after I've seen the consultant to explore causes of my symptoms and there's still no sign of an appointment offer from the consultant.

How can I put this without sounding bossy?
🙂
It's a little bit the wrong way round. Try the most likely and easiest treatment first and save the consultant for if nothing improves.

The first step with post meno urinary problems is to treat vaginal atrophy- actually now called 'uro-genital syndrome' - as it affects all the pelvic organs and tissues not just the vagina. GPs should offer this.

Have you actually had bacteria found or is all done on the symptoms you have which 'feel like' a UTI?

TBH you need to grasp the nettle and demand Ovestin or Vagifem from your GP or whoever you are seeing first.

Using vaginal estrogen is not a 'big thing'. It's not much different to using handcream on dry hands or moisturiser on your face- it's just a different part of your body that needs a bit of help.

Cost- the cost is the same as any prescription - so £9 and a bit. A tube of Ovestin is supposed to last 7 weeks if you use a 2 x a week dose.

I would actually ask for both vagifem/vagirux and ovestin. You can put ovestin in the urethral opening which can help. Pharmacy is pretty likely to have both in stock btw the only thing I have had trouble with lately is Blissel and they got it within a few days. As to what you do when you run out, well you aim not to. But at least with vagifem you can buy Gina OTC and I think someone upthread said you can get Ovestin from Superdrug.

I've not used Ovestin, but Vagifem is a pessary tablet, very easy to insert although the first couple of times it felt a bit odd because I think I was very dry. I still use a pessary but it's now Vagirux which I insert with my finger as each Vagifem tablet had its own applicator, which was a terrible waste of plastic. (It was the pharmacist who changed brands because of the plastic waste, but it's just as easy to insert without an applicator.) My pharmacist has always had them in stock (I don't think there has been the same problems with supply as for systemic HRT), but I usually renew my prescription with a couple of weeks in hand so I don't run out. And best of all, I'm not sure how old you are, but if you are over 60 (I'm 61) NHS prescriptions are free!

Sorry, I've just seen that you said you are nearly 60, so hopefully not long until you can get it free.

I intend to discuss topical HRT with her shortly at the appointment I've just booked but am now thinking she may no longer feel she should prescribe it until after I've seen the consultant to explore causes of my symptoms.

My doctor prescribed my first lot of Vagifem to take while I was waiting for the consultant appointment to come through. When I did get to see the consultant, she was quite happy that I was taking it and that she didn't find any other cause for concern (I had a few tests to rule out other problems).

You can just use a prepay until 60 which makes it cheaper if you need more than one sort of medication in a month. There was something about only having to pay once a year for HRT but I assume that was systemic rather than topical and I think it's probably going to get postponed again, already postponed once.

@JinglingSpringbells the dip stick test found infection on two of my appointments with the GP - once the first time and once again even after treating with antibiotics. However when I last went - and am still getting symptoms (burning, barbed wire sensations, urgency to wee even if just been etc) - the dip stick test found no sign of infection and nor did the lab test on that sample either. What I don't know though is whether I keep getting different infections or whether its now post-UTI interstitial cystitis or whether an underlying infection is still there but hard to detect. The GP has assured me though that the dip stick test is very accurate.

It does actually feel like a'big thing' to me to try topical HRT because even though it's tiny quantities of oestrogen, it's still an artificial source of hormone. However, I think all the really helpful information on this thread is convincing me to ask for topical HRT as I figure that if it works and I can carry on cycling, wild water swimming, drinking coffee and having baths - all the things that give me pleasure but can't now do - even if it does increase the risk of HRT related problems, it'd be worth it for another 10 years of active and happy life. Not that I'm suggesting I'd only have 10 years of life per se of course!

@Nixer I think I will ask the GP for both vagifem/vagirux and ovestin so I can insert one and use the cream too but I'll see what she thinks.

@Boiledeggandtoast thanks for letting me know that prescriptions are free after age 60! I had no idea as I've rarely ever taken any medications at all across the lifespan. I'll be 60 fairly soon this year, so I suppose that's one good thing.

I've now found out that the GP did send off the referral letter straightaway over two weeks ago but it never reached the consultant and must have gone to some central hospital appointments system who never passed it on! Anyway, it's now going to be another 3 weeks until I can actually get to see the consultant.

You're all being so incredibly helpful on this thread and I really appreciate it. Thanks.

Op, I can’t help with the medical issues, but I do know a little bit about cycling.

first, don’t go buying a saddle (yet)

find a shop that does a proper BikeFit. it will cost (about £80 when I last looked) bit will help optimise your position. They will also be able to advise on saddles. The bigger shops mighthave a lending library of saddles. Or there is one here
www.lbk.org.uk/saddle-library

the other option is to look at a different bike…

a recumbent will take all the pressure off said area. They aren’t for everyone, and aren’t cheap, but might be worth consideration. You can definitely hire them to try.

don’t know where you are in the county, but these guys are amazing
www.getcycling.org.uk/

i went their showroom a couple of years ago, as an assistant to a friend who had been a keen cyclist but had had to give up due to injury They were so helpful, my friend had a surgically reconstructed knee joint, and they let them try loads of different bikes to see which they would be able to manage.

now the next bit I am absolutely no expert, but I can’t see that you should have to stop wild swimming entirely. I have suffered a lot with recurrent thrush and UTI, and AFAIK it’s the heat of a bath, and the chlorine in the pool that have the detrimental effects, not the immersion per.se. I’d have thought sea swimming would be beneficial, as long as water quality is ok.

@mutterphore

You appear to have vaginal/bladder atrophy.

Did you read the links left or have you done any reading on this? There is loads online. www.bladdermatters.co.uk/content.php?id=155g=0/Influence-of-menopause Written by Dr Heather Currie, consultant gynae.

VA makes women more likely to get infections because the protective layer of mucous membranes in the bladder are thinner and in the urethra.

But now you are not showing any infection, you have soreness and the acidic urine stings and makes you want to wee a lot.

Vaginal estrogen will gradually help your bladder heal and the lining become thicker. (The estrogen goes through vaginal walls into the bladder as it's directly behind the vagina.)

The hormones in topical HRT are not 'artificial' they are made from plants (yams mainly.)

even if it does increase the risk of HRT related problems
There are no related problems with vaginal estrogen.

You are overthinking it. Just try the treatment everyone here suggests and see if it helps - might take a few weeks but keep going.

If you ignore it, it's likely to get worse and then harder to improve. Some women use systemic HRT and topical HRT to manage the problem.