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?

@Xrays I see what you're getting at about self sabotage and thanks for your input. I have actually taken on board what everyone is saying about using Ovestin more liberally and have done a complete turnaround on this from believing I'd never ever even try this to now using more than my consultant has told me.

However, my starting point in all this has been a lifelong trust in my own body to repair itself and that body's often reach their one equilibrium again if you've got the patience to wait it out. This used always to be the case for me and I've felt healthy and strong......but now it's different. I though post-menopause was when you've got through menopause and out the other side and was feeling great and very energetic and had easily passed through menopause and out the other side, ready to seize the day...and then just over 4 months ago, I presume my body did another dramatic hormonal shift. At first I was aware of feeling particularly energetic and fit and strong and then the UTI hit and then VA has loomed like a spectre across my life!

A medic in my wider family had warned me off using that drug that stops you wanting to wee so much because of various side effects. So that's why i didn't try out that drug but I might not rule it out completely now just to regain a small amount of quality of life. I'm sorry you've had such a really rough time yourself. Thanks also for the heads up about D-Mannose. To be honest, I'm not that keen on the idea of yet another substance too and will research it more thoroughly. Do you have any internet links indicating adverse effects?

I'm taking on board everyone's advice and personal experience. Thanks again for so much useful support.

I'm sorry you are still not sure of the way forward @mutterphore and do understand the stress of a long journey. No chance your son can take a train from uni, home this once?

now to the issue of the consultant. Her next free appointment booked for me is in May. Do you mean she is fully booked for the next 2 months, or she's requested you don't see her till then? There's a difference.

It's not acceptable to do all this to-ing and fro-ing by email. You're not getting a proper discussion with her. Most consultants would ask you to make another appt sooner if you need to ask them questions.

I've lost track a bit of the history but I keep wondering now why your own GP isn't dealing with this and you are running a private GP alongside the consultant.

I also don't understand why the consultant won't oversee a urine test and is passing you over to another dr. Is she expecting your private GP to do this? If you see the consultant at a hospital or clinic, there should be facilities for doing tests, especially if she has prescribed drugs that warrant 'proof' they are needed.

A couple of posters have expressed their frustration with you and the consultant. This would normally be a very simple problem- but that's not diminishing your pain etc.

You'd just use more Ovestin and keep going- it might take 3- 6 months to reverse the atrophy. You've only started treatment when it's very severe (unable to insert the applicator.) Many women start this in their late 40s/early 50s when sex is painful (which is the sign something's not right there!) but if it's left unnoticed for 10 years it takes longer to reverse.

One thing I'd say is that you shouldn't put your faith in one consultant. I've had some issues where I've seen 2 or 3 different consultants and they all had different ideas.

You also don't need a GP referral to most consultants now. Their PAs make the appts.

There's a book called My Menopausal Vagina written by Jane Lewis who had a very long journey with her VA. The book was sent to many GPs and she's appeared an TV etc. It might be worth reading.

If you want a different consultant, the BMS has a list on their website. thebms.org.uk/find-a-menopause-specialist/ I know you don't want to give your location on the forum but other posters may be able to help if you ask them by PM.

@JinglingSpringbells thanks very much indeed for further very helpful advice and support. Much appreciated! I did manage the 7+ hour round trip to pick up my son from uni. He has an enormous amount of 'stuff' and can't leave this in his college room during vacations or manage it on the train by himself.

The book recommendation looks great and I'll see if I can get hold of a copy. The list of recommended menopause specialists is also really helpful too. Interestingly, my current consultant isn't mentioned at the hospital I see her but I think she's more a specialist gynaecology and urology medic rather than specifically menopause. The one mentioned on the list is a male consultant for that hospital and I'm slightly reluctant to see someone who isn't female.

My current consultant may, I suppose, have other available appointments but seemed to want only to see me after I'd tried things out, as she's recommended, for three months before either of us could say whether or not it was working and to give it time. She works at a hospital about an hour's drive away. So it's not even that easy to access her. In the meantime, I've got an appointment with my private GP on Wednesday and will ask her some of my questions then.

I haven't been to my NHS GP for about 5 or 6 years now and they're based about 50 minutes drive away. Since even before the pandemic, it was difficult to get through to them even to find out if there was an appointment available and now on their website they say only contact us if you are seriously ill etc etc, as I think they're hugely understaffed and far too busy. So I've used a private GP recently, which is based only about 15 minutes away and which provides a much much better service too. The quickest and easiest way for me to get a urine sample is to see her.

Meanwhile, I've been using Ovestin 4 times a week, which is double what the consultant recommended. Even so, I'm still having some days or parts of days with the 'urgency to wee/ ureter pain' feeling and all the time, local dryness and soreness. Yesterday, I had a lovely longer walk with DS for about 3 hours and then suffered for this later and today - feeling more sore. It's so frustrating as I'm desperate to exercise more and get fitter again even if I can't cycle.

The product called Sylk doesn't seem to help with the soreness and dryness but just makes me feel wet - yet not 'lubricated'. The consultant suggested something called 'YesVM' which I've not yet been able to get hold of but don't know if that's all that different than Sylk. I've also tried applying, locally, a small amount of Ovestin but that hasn't really helped either.

Once again, I really appreciate your input and expertise! Thanks very much.

Well, it's good you managed the trip with your son!

Most experts on meno suggest YES a moisturiser (there are research papers out there on the most effective ones as they all work in a slightly different way.) You can buy it online.

This is from the BMS and it may put your mind at rest regarding any side effects

(what it also confirms is that your specialist appears out of date as it was in 2015 that NICE guidance said no limit to how long treatment is used and no risk of estrogen being absorbed. Yours said have a break after a few months didn't she?)

journals.sagepub.com/doi/full/10.1177/2053369120957514
Vulvovaginal atrophy/Genitourinary syndrome of the menopause

Traditionally referred to as vulvovaginal atrophy (VVA), the North American Menopause Society and International Society for the Study of Women's Sexual Health have proposed the new terminology “Genitourinary syndrome of the menopause” to indicate that both the urinary and genital areas can be affected by this condition (Portman et al., 2014), This terminology has not yet been widely adopted, except in North America.

Symptoms related to urogenital atrophy have been reported to be experienced by approximately 50% of postmenopausal women. Topical vaginal estrogen treatment has been shown to be effective in improving symptoms related to vaginal atrophy, such as vaginal dryness and superficial dyspareunia.
Estrogen also has a proliferative effect on bladder and urethral epithelium and may help relieve symptoms of urinary frequency, urgency and possibly reduce the incidence of recurrent urinary tract infections in women with urogenital atrophy.

Low-dose vaginal estrogen preparations can be used by symptomatic women and continued for as long as required. This was also supported by the NICE 2015 guideline on the diagnosis and management of the menopause, which recommended that vaginal estrogen treatment should be offered to women with VVA and that treatment can be continued long-term to relieve symptoms.

All topical estrogen preparations have been shown to be effective in this context. There is no requirement to combine vaginal estrogens with systemic progestogen treatment for endometrial protection, as low-dose vaginal estrogen preparations do not result in significant systemic absorption or endometrial hyperplasia.
**

I wouldn't be too concerned about a gynae being male or female. Mine is male (and I've seen him for 16 years, one of the best in UK) and he's great. I also have scans etc done by male consultants and find them extremely caring.

You don't need to have a dr on your doorstep either- since the pandemic, many are working remotely and will do video consultations.

I know you feel frustrated with no instant improvement, but look at it this way- it's taken ten years for you to get to this point and you aren't going to turn the clock back in a few weeks. Even though your symptoms have become very noticeable recently, you've been losing estrogen for a decade or more.

I can’t help much from a medical pov but have you thought about getting a recumbent? I have one and love it.

@JinglingSpringbells You are SO helpful! Thanks very much! I thought I'd give an update as I've recently seen my GP. She totally endorsed everything you and others here are saying that Ovestin can be used as and when and no worries about overriding the consultant's advice to use it only twice a week.

So I'm back to using it every second night for now and will see how it goes. Already, I feel a bit better and currently don't have the 'urgency' to wee symptoms. She also did another urine sample test which was negative but this might be because I've now started on the next type of antibiotic, although given it's a prophylactic dose, she thought it was unlikely I'd actually had a recent infection. Symptoms must have been related either to less Ovestin or interstitial cystitis.

However, the vaginal soreness/rawness continues. I've now tried Replens, Sylk and then most recently YES VM. I was really hoping the latter would work but it definitely made me sting more, as did the other two. I see on the ingredients that it contains Citric Acid. Could it be this component that exacerbates stinging and soreness after application?

My GP has suggested a different approach if YES VM didn't work and to use a barrier cream usually used for bed sores called Medi Derma-S Barrier Cream. Has anyone ever used this for vaginal dryness and soreness?

Obviously it'd stop absorption of Ovestin but she said it washes off, so I'd shower and then use Ovestin at night afterwards.

My common sense tells me that what I really need is some type of oil....olive oil maybe - but is that going to cause unknown problems locally?

If anyone here has found products like Sylk, Replens and YES VM make you sting and more sore, have you discovered anything else that helps? I'm currently applying a small amount of Ovestin but I think this also stings too.

@QuintanaRoo thanks for your cycling related suggestion of using a recumbent. I don't think I could use one happily as I'd not feel safe that low down and it doesn't feel the same as ordinary cycling either. I used to do a lot of off road cycling along narrow muddy tracks and that's what I yearn to get back to.

I miss so much being able to jump on my bike and do a quick 22 mile cycle ride after work. I also miss being able to drink coffee and have a long hot bath and go open water swimming without fear of a UTI! Has anyone been able to return to these things once VA and UTIs kick in or is this it now for life?

Hi OP,
ive read the thread and just wanted to chime in with my experience in case it helps.
I’m 51, post menopausal, and about 3 years ago started noticing vaginal soreness combined with tenderness and v small “paper cuts” after bike riding. I had used HRT for two years but then stopped and most symptoms were manageable, sleep is much better, etc. I am fit and healthy. But this lingered and worried me. It was during lockdown but I managed to get an in person appt with my NHS GP who was young, female and very clued up. She examined me internally and said it was probably VA but she was a bit worrried about lichen sclerosis so she put me on Ovestin and said to take it every day for SIX weeks, then 2/3 times a week for another six weeks and then come back. I did, and the irritating/ painful symptoms went away, and everything felt plumper and smoother. She examined again and said it all looked much healthier and she was pretty confident it was just VA, advised me to stay on Ovestin twice a week. I now have a permanent prescription.
Now and again I can start to feel a bit more irritation coming on and then I increase to 3x a week and that does the trick, then drop to 2x week if it’s OK. Go by feel.
My point is, I agree with @JinglingSpringbells that you probably need to use it every day for quite a while, then drop down gradually to a level than maintains you where you need to be.

Also agree to get rid of the antibiotics- it’s like nuking your gut biome, esp if you don’t actually have an infection. Don’t bother with commercial probiotics but eat prebiotic foods - broccoli stalks, kale, fibre etc as well as the stuff people often recommend like fermented foods (if your stomach problems allow). Avoid sugar. Coffee is good for you!

I also avoid as much artificial stuff on my body as possible although I admit I am a bit arbitrary about it - for example, I don’t use shampoo or body wash, just warm water - you get just as clean! - and we don’t use a fabric conditioner. However I do use a moisturiser/ sunscreen and we use Ecover washing powder. But overall, less total “burden” of products and chemicals. Sometimes for the bike I use coconut cream as an anti-chafe - I have a pot bought in the food aisle… non toxic and washes off easily.

hope that helps!

PS I swim as well, never had a problem with rivers or sea (luckily considering pollution sometimes). Usual rules I’m sure you know already - don’t swallow, cover cuts, don’t swim after heavy rain, shower thoroughly afterwards. I would expect to get a stomach upset far more readily than a UTI from swimming.

@MotherOfCatBoy thanks very much for sharing this. What a difference between my consultant and everyone else's doctors plus my own GP too, all of whom agree that as much Ovestin as needed is completely fine and would actually help too. Given I'm almost 10 years older than you, @MotherOfCatBoy , my VA is presumably far worse and gone on for many years yet the consultant didn't even examine me at all before she prescribed very low level Ovestin.

I honestly don't know what to do with the antibiotics as the consultant did say this was important to ward off more infections. I've rarely taken antibiotics at all across my life and although this is low dose daily, I agree that it can't be helping my biome. I don't feel particularly ill though just mild headaches and slightly weird tummy issues but I've had digestive problems for years anyway.

My GP said I could drink coffee but that it was an irritant but wouldn't do any harm. My consultant said just drink water and no coffee. I'm having a couple of very weak coffees per day and when I'm on more regular Ovestin, it seems to cause fewer issues than when I drop the Ovestin use.

Can I ask you about coconut cream? Are we talking about coconut cream that you can buy in a supermarket in the food oil rather than health/beauty? I don't think I've seen this is a supermarket food aisle. Why coconut cream rather than olive oil? Any contraindications of using this? Is it completely pure with no additives?

I've also not been using scented shower gel and/or just water to wash down there. I too like to be as natural as possible with products.

Thanks for the reassurance about open water swimming too. My GP said this should be OK but I've worried I'll get another UTI and the consultant said no baths even so I've avoided all immersion in water.

Hi again It's great to see your GP approving Mumsnet advice!

The soreness - it's inside or outside?

I am assuming it's external on your labia or vaginal entrance?

It can take a while for Ovestin to work- and maybe you have not applied it externally for long enough?

A pea-sized blob once or twice day might help.

Also, using some water after peeing can help to rinse the skin - either from a bottle or just wet cotton wool.
A barrier layer of plain Vaseline might also help.

Don't get too disheartened and be patient.

(And maybe give the antiBs a rest- they can wreck your immune system.) The way to improve that is really healthy eating, including food with live bacteria like plain yoghurt, kimchi, kefir, but go carefully as they are quite acidic.

Ex nurse here with gynae experience. 100pc the answer is topical vaginal oestrogen and try it for at LEAST 12 weeks before making any judgement on its efficacy. Having seen 100s of vaginas/vulvas I have seen first hand so many times the damage that vaginal atrophy causes, including miserable utis. As a result at the first hint of discomfort I started vagirux and will remain on it for the rest of my life. One year of vagirux = 1 day of hrt. The dose is tiny.

Yes the coconut cream is from the food aisle, no additives etc, like you would use in curries etc. Solid at room temp (except in hot weather), you can put some on your fingers and put it where it needs to go - just a little helps avoid irritation from knickers or whatever. Not internally.
I haven’t used olive oil - suppose I thought it’s runnier therefore messier.

If you want to use something oily/greasy to help with the general external discomfort and soreness then try Epaderm. It’s a greasy emollient and you can buy it in any pharmacy, no prescription needed.
This would be in addition to the topical oestrogen, not instead of it.

I'm now in the fifth month of pain/soreness, still am nowhere near being able to cycle or do much exercise without things feeling worse and have put on over half a stone in weight! I'm about 7 to 8 weeks into using Ovestin. So thought I'd update here again.

I've been using Ovestin internally, more regularly, about once every 3 days. I've also been applying it externally morning and evening most days. However, external use (on labia/ vaginal entrance and ureter entrance) seems to be causing more irritation but, kind of at the same time, possibly helping with the 'urgency to pee' symptoms. It's difficult to work it out actually but it seems that I'm either getting more of the soreness but less of the 'urgency to pee' feeling, if I use more Ovestin or vice versa if I don't apply Ovestin twice a day externally.

I'm never NOT sore. I do have some days that are better than others but there's no pattern to it and it doesn't seem to correlate with what I drink, eat, do. I feel like Ovestin sort of provides some kind of 'barrier cream' to the whole area along with the hormonal component but that maybe I'm using it too much as I'm stinging. Absolutely every other product like YES VM, Sylk, Replens makes the soreness a lot worse. Olive oil might help a tiny bit but then seems to make the 'urgency to pee/ ureter pain' worse, so I've stopped using this.

I've been to wary to try other things like barrier creams, coconut cream but I'm not ruling these out.

There just seems no gradual and consistent improvement but more like some parts of some days are better than others and some days are still pretty bad with the ureter entrance pain and 'urgency to pee' sensations.

I can't believe how much my entire lifestyle has changed for the worse because of this. I feel much less fit and much older. Not being able to move around so easily or even go for a long walk without exacerbating the soreness or needing to pee when there's nowhere to pee, is so awful and not being able to cycle at all is just miserable.

Tomorrow, I'll be starting on the 3rd different prophylactic antibiotic prescribed by the consultant for another month and I'm now even worried that when I stop the antibiotics, I'll get another full-blown UTI and will be back where I started.

How come something that seems so trivial and only affects one part of the body has so dramatically changed my life? Why am I not gradually getting better and better?

I know people on here are saying that I need to wait and keep going longer but shouldn't there be some sense of upward trajectory towards consistent recovery, however bumpy that path?

Maybe drop down to once a day with the external application?

And using it once every 3rd day is still only twice a week on average.
A lot of posters have advised you to increase this to daily, or 4 x a week. IMO you are not using enough internally and possibly a bit too much outside.

You could try taking (orally) a tablet for thrush in case all the ABs have given you that.

Not washing undies in bio products? Only unperfumed non-bio?

I know you don't want to even think about this but you might need to use full HRT to help settle this down. 1:4 women who use full HRT also have to use topical creams/ pessary.

Yep. All of this. And especially the full HRT.

I have had horrendous uti / bladder issues from the menopause and the only thing that’s really sorted it for me (and even now it’s not totally sorted) is the combination of systemic HRT (oestrogel, utrogestan) and Ovestin (which I use externally most days and 4 times a week internally) and amitriptyline at night - to help with the bladder discomfort.

Yes I think twice a day on the urethra is too much, and it probably wouldn't hurt to decrease the frequency you apply to rest of vulva. But it could also be the antibiotics irritating urethra. Or just the VA.

Assume you are having no caffeine (not even decaff - it's got caffeine in)? If there is no infection it might be worth reading up on bladder retraining - essentially you try not to go as often and the bladder learns to stop sending so many "need to go" signals and gets used to holding more urine. Also drink lots of water as more concentrated urine irritates the bladder more.

I don't know what you're using on the moisturiser front but might be worth stopping everything and using Epaderm or similar to wash with, to moisturise externally, and as a barrier both before and after loo visits if your urine is irritating your skin.

Regarding your final few paras about an upwards trajectory, not really IME. Some lucky people hit on the right meds straight off and get better within a few months. The rest of us just clang around trying things and eventually find the right things. I've just started amitriptyline and have had a few hours without pain on the last 2 days (have been in constant pain for 9 months) but am in a lot of pain again this evening. And I think that's quite common. Lot of nerve endings down there and not enough is known about it all.

Thanks so much for your thoughts and advice everyone. Much appreciated.

@JinglingSpringbells I was using Ovestin internally more frequently but recently only about once every 3 days as I thought it might be causing the soreness. I'll reduce the use externally but continue every two to three days internally and see how that goes. I don't have any symptoms of thrush (ie no discharge or itching at all) just ongoing soreness/ dryness and abrasion when I move around I guess.

I've not used just non-bio laundry liquid as I've never had any issues with this in the past but can give it a go now.

The very last thing I want to consider is full blown HRT! It seems like overkill for one single problem that I've ever had through menopause and beyond. I literally never had any other menopause related problems and not even this problem until mid November, despite cycling about 80 miles a week and leading a fairly active lifestyle. I guess I may need to consider HRT now though but I really don't like the idea of systemic hormones when every other part of me feels healthy and well and in balance!

@Xrays I'm so sorry to hear about all your issues too. It's awful being a woman sometimes! I do mostly manage to sleep OK even if I need to be up in the night to pee and hope this doesn't change for the worse.

@Nixer, I do still have one or two very weak cups of coffee a day. I've found that if I don't, then I'm a bit dozy for work and can also get a mild headache. However, when I did trial no caffeine at all, there didn't seem to be a direct correlation between UTI-type/urgency symptoms and caffeine and even with one of two weak cups per day, some days are OK and some days are not. The rest of the time I just drink water. I guess I could increase how much water I drink, although this would probably increase the need to pee in the night.

I have tried peeing less often to train my bladder and will continue as the consultant had also mentioned doing this and pelvic floor exercises.

I'm sort of OK enduring pain and would rather do this than take even more meds like amitryptiline. It's more the worry that I might get more UTIs if I try cycling or don't get to grips with the whole VA thing. I just think it's so frustrating that modern medicine still hasn't solved this issue for all women who suffer and we have to try this and that and then something else and then that stops working and so on.

Might Epaderm cause more irritation as it contains paraffin? I've found that I'm hypersensitive to anything that contains citric acid like Sylk and YesVM and worry that just about anything might further irritate the skin.

My GP suggested MediDerma-S and I sent off for some but it arrive without the cap sealed, so may have been used before. So I didn't dare give it a go and wasn't sure anyway that it'd be suitable.

Can anyone think of any contraindications to using olive oil down there?

@mutterphore I'd definitely swap your laundry stuff. Some supermarkets do their own brands called 'Sensitive' which is without perfume or bios.

I'd also consider a thrush (oral) tablet. In the past (decades ago) I was diagnosed with thrush as part of swabs for something and I had no symptoms other than some slight burning.

Another tip someone gave me is that after weeing, you can gently wash yourself with cool water, still sitting on the loo (from a bottle or jug) as this stops the urine (acidic) inflaming already sore tissue.

It's your call, but personally I'd be wary of taking another lot of antibiotics. They do so much damage in other ways and you could in time develop AB resistance (I appreciate they are different types) but at the moment am I right thinking you don't have an infection?

The other thing to consider is swapping from Ovestin to Vagifem (it's a tiny pill to insert) and is a slightly different (stronger) type of estrogen- it's estradiol and Ovestin is estriol. You could still use ovestin externally. You can buy the OTC version of Vagifem- called Gina.

re the Epaderm (ointment, I should have said, not cream). Yes you might be sensitive to it, but it/similar are recommended to and used by women with vulval eczema, dermatitis, lichen sclerosus and other conditions. It's more likely that everything stings because the nerve endings have become fired up than that you are sensitive to/allergic to absolutely everything. That said, if this irritation continues it might be worth finding a vulva dermatologist.

Just putting this out there- if you have vaginal dryness / atrophy it’s unlikely you’d produce the typical discharge associated with thrush so don’t let that - the lack of discharge- rule out thrush. I have Sjögren’s syndrome and all the vaginal issues you have and I also have persistent thrush (that’s how all my issues started off) and not once have I ever had any sort of discharge with it. Ever. Just redness, itching. It’s been diagnosed by positive swabs. I have had to use the canestan internal cream pre filled applicator (10% strength) - not the pessaries as I can’t dissolve them, you won’t if you aren’t wet / moisturised enough- I get them on prescription but you can buy them from Amazon too. I use this once a month, every month and I also take a Fluconazole 150mg capsule once a month too. (Under the direction of my specialists). If you are dry down there you will be very prone to thrush.

This is what I mean - I get this on prescription-

Canesten Thrush Combi Internal & External Creams for Thrush Treatment | Clotrimazole | Two-Step Complete Relief Thrush Treatment,2 Count (Pack of 1) https://amzn.eu/d/bXpFJ9F

(apologies I’ve I’m repeating myself - I’ve posted very similarly on several threads and I can’t remember what I’ve said and what I haven’t)!

I just think it's so frustrating that modern medicine still hasn't solved this issue for all women who suffer and we have to try this and that and then something else and then that stops working and so on.

In fairness modern medicine has done a great deal to solve this issue - namely lack of oestrogen in a female body. The solution is to replace the oestrogen. Other solutions are never going to be fully effective because they are not addressing the actual problem. I think the solution is better understanding of HRT and better communication by GPs especially, because that is the point at which many women are not given the information they need.

I have gone on very reluctantly to full HRT because of these very issues....and they are way, way better. I feel like a different person I have to say......

I have gone on very reluctantly to full HRT because of these very issues....and they are way, way better. I feel like a different person I have to say......

No need to be reluctant. Your body used to provide its own systemic oestrogen, and now it doesn't and you are replacing it. This protects not only the sore external bits, but also the internal bits you can't see.