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?

Thanks very much for all this helpful feedback again.

So, the amount of Ovestin I've been told to use if 0.5mg per night for one week only and then for two weeks, only every second night. So it does sound like a lot less than some of you have been prescribed.

The Consultant is a dual urologist/gynaecologist by the way and I think does start off very conservatively. So she was even careful to say if I used some of the Ovestin dose on the ureter entrance, it should only be from the 0.5mg dose and not extra, if you see what I mean.

I guess I ought to follow what she's told me to do even if it's a lot less than most people use, ie not even two weeks worth of nightly Ovestin? It's the same with taking the antibiotic. I feel i should do what she's prescribed really, especially if there's an undetectable infection still going on. The last dip stick test by the GP was clear though.

@JinglingSpringbells by 'lubrication' I just mean for comfort as I feel completely dry and sore at the moment and I wasn't told by the consultant that it'd be OK to use any extra Ovestin just on the inner and outer vaginal labia.

@Xrays the consultant is being very cautious I expect and presumably trying to see what's the lowest does of Ovestin that works for me. So it's not even 1mg, it's 0.5mg and I'm a bit concerned that 0.5mg only twice a week, once I've finished the second week of only every second day, will make any difference at all.

I won't be having any contact with the consultant for another 3 months now but can pay to see the private GP but I expect she also won't want to go against what the consultant has prescribed. The GP (as opposed to the consultant) did take a look at my vaginal area - although not with a speculum - and did say it looked like I had the ordinary level of VA for a woman of my age.

No one has mentioned a prolapse so I've no idea if this might be part of the problem. The GP had thought the consultant might want me to have an ultrasound but at the consultant didn't mention any tests at all, the GP said just see how you are in 3 months.

@Wolfout , the consultant did talk about pelvic floor exercises and thought I urinated too frequently for what I tend to drink in a day. She warned me that I could become incontinent, which I've never suffered from so far.

So from what most of you are saying, it sounds like I shouldn't be too cautious about the exact amount of Ovestin I apply and at least use a tiny bit more to apply as well as the 0.5mg in the applicator.

If I wanted to ask the consultant about doing more than just one week of nightly 0.5mg Ovestin, I think I'd have to book another very expensive appointment and I also think the GP would say just do what the consultant suggests.

I was also told a while back by a different GP and a different gastro consultant, that probiotics don't work at all and not to bother with these, despite the antibiotics. So I'm again not sure what to do about this either.

@brooksghost I did try to get a bike fit appointment locally but they didn't do the kind of thing I needed and nowhere local to me does. I may just have to try a different saddle but right now, cycling seems a very long way off as it's even sore sitting down and walking around.

The dose as per the leaflet is 1 application daily for 14 days.
You need this loading dose.
Thereafter the dose is 2 x a week but some women use it daily if they are very sore.

Not sure why your dr is suggesting daily for one week as that is not the correct dose and will only make it harder and take longer for you to get improvement.

Also (just a tiny note in case you discuss with a dr and it causes confusion) it's your urethra not your ureter (that's a long tube from your kidney to the bladder.)

Hope the treatment helps.

If I wanted to ask the consultant about doing more than just one week of nightly 0.5mg Ovestin, I think I'd have to book another very expensive appointment

You don't need permission from anyone.
It's your body. And the patient leaflet says 14 days to start with.

I think you find from posts here that your dr's advice goes against what everyone else's drs are telling them, so take matters into your own hands.

Did the GP do an internal examination, or just look at your outer labia?

My GP diagnosed vaginal atrophy from the internal examination, because she could tell by how the vaginal walls felt.

Regarding my own issues with urinating too frequently and not being able to hang on - the GP told me to try the Ovestin and the pelvic floor exercises - and then if that didn’t help she could refer me to the urology clinic.

TBH most drs will avoid internal examinations if women present with signs of atrophy, as it's painful.

It's not something pleasant to have done and it needs a very expert eye, usually with a speculum to inspect the vaginal walls.

Yes she did use a speculum as well. She was very gentle and it wasn’t painful. However I did mention I thought I had a prolapse too.

However that’s only my experience, I have no idea what is ‘normal’ in these circumstances.

You're all so very helpful! Thanks!

@JinglingSpringbells - you give me confidence! I've now emailed the Consultant's secretary to express confusion about only using Ovestin once a day for one rather than two weeks and hope this will elicit clarification. It does clearly say on the patient leaflet that the usual does is once a day for TWO weeks but then the pharmacist label on the box says only for ONE week.

Thanks also for picking up on my mistake between ureter ad urethra! It's several decades since I did Biology O Level!

@Wolfout , the GP just looked at the outer labia, looking using a torch to light the area but didn't attempt using a speculum, as even the thought of this at present makes me grit my teeth! Maybe after 3 months on Ovestin, the consultant might then suggest an internal examination. I've not had a smear test for about 8 years and the last ones across the years were very painful and needed use of the smallest possible speculum.

@mutterphore The pharmacist is following dr's orders as on the prescription.

You can make up your own mind about all of this, you know.

I've not had a smear test for about 8 years and the last ones across the years were very painful and needed use of the smallest possible speculum.

Did you stop having smears at 51 because of the discomfort (which must have happened from your 40s if you stopped 8 years ago.)

If so, your GP ought to have prescribed vaginal estrogen then.

Sadly, so many women are suffering in silence (still) and not talking about this stuff or getting really simple and safe treatment, early on.

Exactly.

So many women just not getting the treatment they deserve. It’s a real scandal. Just so sad for women. I think a lot of very elderly women in particular (not the case here but thinking hypothetically) have had so much suffering because of the lack of knowledge of these things.

Have you considered a physio check for hypertonic pelvic floor. Worth looking up as the symptoms mimic a water infection and also cause the soreness. The cycling can irritate things.

You may be able to see your prolapse. I was incredibly sore and squatted over a mirror to see if I had some kind of wound which is how I discovered mine, went to GP who confirmed it.

Ovestin was my absolute saviour! I thought I was suffering with UTI, thrush and bladder pain for ages, but nothing seemed to stop it. I ended up seeing another gp by chance and he gave me Ovestin, I used it once a day (at nighttime) for two weeks, and I now use it every other day, and have done for months. The only time I've had a relapse was when I went away for a few days and forgot to take it.

@JinglingSpringbells - yes, smear tests just got increasingly painful especially when the nurse was rushed/ busy. I have to say that Ovestin is already starting to make a difference. I'm barely getting any of the UTI/ urgency symptoms.

I am still however feeling very tender and sore and still can't imagine cycling. Long walks also make me feel sore. I have tried using a bit of Sylk, in the mornings but am not sure this is making any difference and also don't want to apply anything that might interfere with the Ovestin. I also feel like it's not so much a water-based 'moisturiser' I need but something more oil based. I don't know what to use though and as I say, don't want to compromise the effects of Ovestin being absorbed.

Once slightly 'scary' aspect is that it's taken about 4 days of applying Ovestin to realise that I couldn't actually get the applicator all the way in. I only realised this when I suddenly did! So the first few days I've not been able to apply Ovestin deep enough. That really indicates to me that I probably had worse VA than I'd thought.

@JT69 and @CherryogDog I'd not thought about either hypertonic pelvic floor or prolapse. I rarely if ever see a doctor and so have never had any advice on 'women's issues' across the time of peri-menopause and menopause.

I've got a follow up appointment with the urogynae consultant in May and will talk to her then about how things are going and if I need further checks. I've also emailed her about whether to continue another full week with Ovestin or start only once every two days and will see what she says.

@CleaningOutMyCloset the consultant's prescription is only one week of nightly Ovestin, one subsequent week of every other night but thereafter only twice a week for three months. Again, this feels much less than many of you have had prescribed.

On the Ovestin patient info. it does say that if you accidentally apply more than prescribed, you can experience vaginal bleeding a few days later. So I am reluctant to go against what the consultant has prescribed. Maybe she'll get back to me and clarify things. I'm also worried I'd run out of Ovestin before I next see the consultant in May and then would go back to where I started.

You need to be patient. If you are so tight you can't get the applicator fully in, it could take many weeks for this to improve. It will take even longer if you do what the dr said which is daily for a week- NO IDEA why she says that when the instructions say otherwise.

I also think you need to be a bit more confident about this and not rely on the consultant 'telling you what to do'.

Over the years I've found as many opinions on some aspects of health as there are drs! Thankfully, I now trust mine 100%.

You do seem very apprehensive of using it and even using the prescribed amount even though everyone here is trying their very best to reassure you.

And- the leaflet info about bleeding- the 'prescribed amount' is in fact 1 dose daily for 14 days. (I must admit I've never read that bit so I will look. )

I will say it again- using it as prescribed (on leaflet) for 1 year is the same amount of estrogen as 1 day on a low dose HRT.

I'm delighted to hear that you are getting some relief, even if it is early days. It's a very hopeful sign that you are now - at last! - on the right path. Did you mention to the consultant when you emailed that the Ovestin is helping? I would have thought that if you run out of Ovestin you would be able to ask for a new prescription. I have never had a problem asking for a repeat prescription and it was only this year, after some 5 years of using Vagifem/Vagirux, that I had a brief phone discussion with my doctor (at their request) to check that I was getting on alright with it. She said it is very safe and to continue with it as required, including 2 weeks preloading again if I felt I needed to.

OP, Yes do a good range of moisturisers which are excellent. Take a look at their website www.yesyesyes.org/products/yes-vm-natural-vaginal-moisturiser

@JinglingSpringbells I really appreciate your experience and input with all this! I think because of you and some others on this thread, I don't now feel apprehensive about 'hormonal' topical cream and am relaxed about using Ovestin.

The consultant has now got back to me and said if I want to, I could continue to use Ovestin once a day for one more week but she sometimes finds that this can lead to soreness. So I feel more confident now about making that choice but am definitely experience soreness. I'm not sure if this is related therefore to Ovestin or would get worse if I reduce the dose to once every two days. I've emailed her again to ask about recommendations for counteracting the soreness and will wait to see what she says.

@Boiledeggandtoast , I didn't really mention that Ovestinw as starting to help as I thought I should keep my email to her - via her PA - short a succinct in case she doesn't have time to reply. Now I've emailed again with the further question about soreness, she may respond to say don't keep using the Ovestin daily for another week because this is what is exacerbating the soreness and/or she may suggest what to apply locally to help soreness. If I run out of Ovestin, I can email and ask her to prescribe more.

@Lovemydaxie thanks for the recommendation of this product, which i also think someone else suggested too. I have tried Sylk but that doesn't help to take away soreness. I sort of feel like I need some kind of oil really but wondered whether that would then prevent absorption of Ovestin by creating a skin barrier.

@MiddleAgedLurker thanks for your input and clear guidance about bike saddles. I have tried sitting on corrugated cardboard to get a measurement of my sit bones but either I'm too well-padded in that area for this to show indentations properly or the corrugated cardboard was too firm! So I couldn't see anything on the cardboard to measure up. I'll try again when I can get hold of more corrugated cardboard and I've also heard that a Selle saddle with a cut out is a good plan. Right now, I still feel a long way off from being able to cycle at all however as it's all just so sore.

Until mid November, I'd never had a single problem before, during or after menopause with UTIs, cycling, soreness etc so this is all very annoying and frustrating and I'd never had a single GP discuss any of this kind of thing with me at all - but then I never really went to a GP either.

The consultant has now got back to me and said if I want to, I could continue to use Ovestin once a day for one more week but she sometimes finds that this can lead to soreness. So I feel more confident now about making that choice but am definitely experience soreness. I'm not sure if this is related therefore to Ovestin or would get worse if I reduce the dose to once every two days. I've emailed her again to ask about recommendations for counteracting the soreness and will wait to see what she says

TBH I think you are expecting too much from the consultant!
It's all very much trial and error and she can't really predict how you will feel or if reducing would help. I don't think TBH you should keep going backwards and forwards to her (partly as if it's privately, you paid for an appt, not continuous ongoing contact - unless she has said that's ok. Usually one email after an appt is ok, but not ongoing.)

To combat VA you really do need to do the 14 days first. Otherwise it will take even longer.

It's quite normal to get some stinging from the cream at first but as your skin thickens up and you get used to the cream, that soreness will go.

If you want to change anything, it's possibly better to reduce the amount, rather than the number of days. Just don't fill the applicator right to the end.

You need to be patient! It's taken many years for you to reach this state and it won't all miraculously change in 4 days. Yes, there will be some teething troubles to begin with but you have to be patient and push on with it.

If you feel really sore, just wipe away the excess cream that's come down from your vagina. Wear cotton pants (you probably do anyway) and a bio-free laundry product.

Hi. What bladder issues did you experience before using the topical oestrogen and have they resolved?

I'm coming back on to my thread with an update and a question. Ovestin cream helped and the consultant agreed that I could use it daily for two weeks, every second day for one week and I'm now on the "twice a week" regime indefinitely.

However, on my first Day 3 without Ovestin, due to apply Ovestin again tonight, I'm aware that things down there are not as good as they were - ie more dryness, soreness, possibly slightly more 'urgent' need to wee. I'm looking forward to being able to apply Ovestin tonight but worried that the next 4 days afterwards will be without Ovestin, then it'll be every 3 days/ every 4 days - to match the twice a week regime.

My consultant was very clear not to overuse Ovestin, so I feel I can't really go against medical advice. However, from this thread, I know that some of you have been suggesting more leeway in Ovestin use. What are your thoughts about applying it even maybe every 3 days rather than every 3 and then every 4 days? Will it eventually lead to oestrogen 'overload' over time?

No other non-hormonal creams seem to have worked for me and feel not 'oily' enough - just wet.

My consultant told me not to try cycling again for 6 weeks, so I've got about 2 to 3 weeks to go until then but don't at all feel I'm going to be able to cycle much as I'm still pretty sore and dry. I was cycling around 80 miles a week and it's now nearly 4 months off my bike and even walking long distances can also exacerbate soreness/ dryness.

As a result, I've put on almost half a stone in weight and was already overweight at the start. It's incredibly annoying getting 'old' and my body no longer allowing me to do what I want! Being even more overweight is only going to make cycling more 'pressured' on the soft tissues. (Am of course trying to eat less but so far, no weight loss at all and when I tried 16:8 I actually put on more weight!).

But, back to Ovestin, what are your thoughts - you very wise women?

I just shove it on whenever I remember. But I've grown up (to age 45!) with excema and asthma so I have a v relaxed approach to things like this.

Sore hand? Shove on some hydrocortisone cream for few days until the itching stops. Patch of excema comes back? Reapply. I have been using it for so long I've no idea what the regimen is.

Same with ovestin. Sometimes I'm sore and itchy. Shove some on and in.

It's such a benign cream.

Maybe your consultant is super careful because you had UTIs too, I didn't have that problem.

Did they say why they were being so cautious?

As your symptoms were so severe, you probably need more for longer.

There are women using it every other day or even every day for more than 2 weeks.

I don't really understand why your dr is so wary. It doesn't fill me with confidence on her knowledge, especially as it goes against what other consultants would advise.

Using it as prescribed- 14 days then 2 x a week is the same amount of estrogen IN ONE YEAR as a 1mg daily dose of systemic HRT.

So if you carried on as she's said it would be the same as using HRT for one day out of 365.

Years ago, there used to be the idea that to counteract any stimulation of the uterine lining, women could be given a very short course of progestin, and this would cause a bleed if there was any lining to come away.
(This was mentioned to me 16 years ago.)

However, this has been changed and no one does this now as it's considered safe to use it long term.

If your dr was very worried about endometrial build-up, all she has to do is give you 10 days of Norethisterone (or arrange a scan) and that would put her mind at rest.

I think you have to take matters into your own hands.