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?

@TheYearOfSmallThings I do agree re oestrogen but there are women who have problems for months and sometimes years in spite of being on both topical and systemic and for those women (I am one and I know many others) it's a real battle finding a resolution. So I can understand the OP's frustration, although it is fairly likely her problems will resolve given either more time on topical oestrogen or adding full HRT in.

The thing is if you’ve been deficient in oestrogen for a long time it’s going to take a long time for things to get back to any normality too. Oestrogen plays a part in practically any part of our bodies. I became oestrogen deficient at 35 ish but I wasn’t diagnosed with it (or the menopause, same difference) until 37. I had
an on off start with HRT where I had some issues where I wasn’t sure if I should take it or not and I wasn’t convinced it was doing much. I went all in taking HRT at 40 and it’s only now at 42 that I really feel the full benefits of it. Some women feel the benefits of it a lot sooner but I think I was so deficient for so long it’s taken me
ages to pull it back. (I don’t produce / make any oestrogen at all, I have very complex pituitary issues - I basically don’t produce any of my own hormones).

I had exactly the same as OP. I’ve posted on here before about being prescribed Ovestin. I was reluctant to use it nightly for 14 days so just dabbed a bit on two nights a week. I then had a good read of reviews and a rethink. Last night was my 12th consecutive application: outside, on urethra opening and poking some up inside and at the risk of jinxing it I feel reborn. No stinging. No busting for a wee feeling. No bladder pain. It’s truly been miraculous

there are women who have problems for months and sometimes years in spite of being on both topical and systemic and for those women (I am one and I know many others) it's a real battle finding a resolution

Totally true, even with an expert gynae clinic. But with any luck the OP isn't in this relatively small group - she has only tried one topical oestrogen after some years of menopause and quite advanced skin problems, so there is every chance she can be helped by existing treatments.

I'm one of those that cannot get va under control, don't think I ever will. On patches, vagifem and ovestin and no end to the soreness. Hope you can get sorted Op.

@mutterphore someone on the Velo vixen fb group had this issue and has posted to say two weeks after starting full hrt her symptoms are gone and no more saddle soreness.

Thought I'd post an update - which is very mixed - and see if anyone has further advice. It's now about 6 months since I was able to go cycling or exercise with any regularity or for any distance -without pain/ discomfort - and I'm struggling to know what to do to get my old life back.

About 4 weeks ago, I thought I'd started to get better. I think this began after I'd done another week of nightly Ovestin, following all the great advice on here from so many of you like @JinglingSpringbells , @Nixer, @Xrays and others. I then cut this down to about 3 times a week.

It also coincided with the last few days of being on one of the prophylactic antiobiotics (Nitrofurantoin) and then into the first few days of being on the new one (Cefalexin). So I don't know if the one I was coming off had done a good job or the one I was going onto was starting to help.

Anyway, I've recently in the last week or so, had an exacerbation of the two main symptoms - UTI-type sense of needing to pee/ tenderness and soreness at entrance to ureter - and - burning soreness inside vagina and labia. Both wake me up at night and distract me all day long.

I used dipstick urine tests to check for infection but didn't pick up anything (although tests might be faulty and unreliable) but Cefalexin can show a false negative result. However, it doesn't exactly 'feel' like an infection. It just feels like hypersensitive cystitis type of thing alongside sore/raw vagina.

I'm now totally conflicted wondering if I overused Ovestin which then made me sore? Or - should I use even more Ovestin again??

I've got very sensitive skin and every other product such as Sylk, YesVM and Replens has made vaginal soreness worse.

Did I do too much cycling when I started to feel better - but this was only about 5 short cycle rides (12 to 15 miles) across 2 weeks - nothing compared to the 80+ miles a week I used to cycle?

Why did I start to have a relief from symptoms? Was it using more Ovestin or less? Was it a specific one of the three prophylactic antibiotics and if so which one - or don't I even need any?

I really have no idea what to do or think next. I'm finally seeing the consultant for the second time next week and need to know what to ask/ tell her. I'll need to disclose that I've used more Ovestin than she told me to use and I'm not sure how she'll respond. I can't work out what aspect of treatment so far has helped and what hasn't.

Do I need a proper further course of antibiotics or to continue prophylcatic antibiotics indefinitely or come off them altogether?

In July, I've got my one holiday of the year - a cycling/ sea swimming holiday where we usually cycle about 200 miles in a week, out on bikes for around 6 hours a day. This is usually my best thing in the year. I thought that 6 months down the line, I'd have recovered by now as I'd never had any problems at all with these symptoms until last November. This is probably my last ever holiday with my DCs who are grown and almost gone.

Do I just persist with the Ovestin (and I also use a tiny drop of olive oil on labia in daytime to help with dry/soreness) for a lot longer, as many people have suggested here - and do nothing different?

Personally I would go onto full HRT, which would likely resolve or at least greatly help the issue.

I'm so sorry to read your update OP. You have lots of sympathy from me. It's horrendous when a health issue gets in the way of something that is so much part of us.

I've just done a quick search of all your posts and the one thing I don't think has been mentioned is clothing. What do you wear for cycling?

When I got into cycling I invested in two pairs of shorts for cycling. One of them was a standard pair of lycra cycling shorts and the other was an inner short with padding with baggy polyester shorts to go over the top. Both sets of shorts gave me a horrendously sore vulva (which took weeks on end to recover). I just don't seem to be able to wear lycra, polyester, nylon etc.

I ended up doing the C2C ride wearing cotton leggings from M&S and now this is the only thing I will cycle in.

Have you had a cytoscopy?

TBH it's probably the cycling.

I think a few of us have mentioned it can take a while for this to sort itself out.
You haven't consistently used Ovestin for 6 months. If your bladder lining needs to heal and regrow it can take months. (the estrogen gets through to the bladder via the front vaginal wall.)

I really wouldn't suggest more antibiotics. They will wreck your gut health and you will get all other kinds of issues.
The ones you have had are already very strong.

I know it's hard to determine exactly what is going on but I'd say carry on with Ovestin 3-4 times a week, stop the ABs and stop cycling for a while.

If it carries on and on you are possibly going to have to think about full HRT.
The other option is swapping Ovestin for Vagifem which is a tiny tablet you insert and it's a slightly stronger form of estrogen. You can buy this OTC and it's called Gina.

You can use Ovestin externally too- are you doing that instead of olive oil? A pea-sized blob a couple of times a day where it's sore.

TBH I'd not bother to see your consultant. Everything she's told you so far has been a bit 'iffy' compared to other consultants. I can't actually believe she said using Ovestin more often was wrong- that is simply incorrect.

(I see a private menopause specialist and 16 years ago when I started Ovestin I was told it causes no build up of the lining, but if necessary/ concerned a short course of progestogen could be tried to see if any lining came away. This guidance has now been changed to 'never needing'.)

I doubt this is your bladder - it's really a hormonal issue and needs time. And no cycling. You've had this brewing for 10 years almost and it' s going to take longer than a few months.

Oh- and you might like to test yourself for thrush by taking an oral thrush treatment. The burning etc could very well be caused by thrush after so many ABs. It doesn't always show as the curdy discharge - it can be watery and make you sore.

Yep. If you are super dry you won’t produce the discharge. Just soreness. And you won’t be able to dissolve the pessaries either. I have to use canestan internal cream pre filled applicator once a month every single month otherwise the thrush just creeps back. (It’s a 10% pre filled applicator you insert, it’s not the same thing as the 2% external cream but you can use this as well externally at the same time).

op I’m saying this kindly but you sound exactly like me. You need a cystoscopy to check for inflammation/ intercystinal cystitis which will open up other treatment options - including amitriptyline which has been game changing for me. No more bladder discomfort. It doesn’t sound like you actually have any infection left.

And you sound try full HRT. What have you got to lose except feeling absolutely miserable about how much your life has changed??

*should

@Xrays I had issues like yours for decades. I refused a cystoscopy (having followed posts on a bladder forum for years) as so many women found they had more pain afterwards and their urethras took ages to recover from the procedure. Mine is a very long tale (which included drugs) and I won't bore you with it, but diet, HRT and Ovestin have helped hugely.

I do believe that this is not a bladder issue per se but a hormonal problem.

Maybe. I get what you’re saying. Mine is definitely a mixture of the two. I chose to have the cystoscopy because I have lupus and also needed to see whether that was affecting my bladder (it wasn’t).

I had cystitis type symptoms on and off for 3 years, with my doctor insisting it was "age" or "hormones" and not even offering a cystoscopy. Last Christmas I had an emergency appointment with another doctor while away from home who said I should definitely have one. Discovered in January I have advanced bladder cancer.

Hello OP, I haven not read the entire thread but you mentioned having used a hydrocortisone creme . That is definitely not a good thing to overuse because it fragilizes the skin. It should be used as sparingly as possible for the shortest time and certainly avoided as a biker! Good luck and hope you're back on the bike soon!

So sorry to read this 💐😞❤️

Thanks very much for all the further help and support.

@ReallyShouldBeDoingSomethingElse I only wear cotton leggings for cycling, even though some people on here have recommended padded cycling shorts, which I've not got round to looking into yet. I also change underwear after cycling and never had any problems up until 6 months ago.

@TheYearOfSmallThings at this stage, I'd no longer rule out full HRT completely. I've just never had any other symptoms to merit going onto HRT and was always very wary of anything that had any contraindications. But given there's been such a drastic change in my quality of life, very recently and the less exercise I can do because of it, the more unfit and overweight I get and the more frustrated I become, if HRT could solve this, without causing additional problems, then I'd now consider this.

@Snowontheroof no, I've not had a cystospcopy and as@JinglingSpringbells points out, I too have heard negative consequences of this but I'll see what the consultant says when I see her next week.

@JinglingSpringbells I always appreciate your wisdom and I know my consultant might be less than optimal. I've only seen her once and will see how the next appointment goes. I wish i knew whether I was over-using Ovestin, which I have been spreading on labia/ vaginal entrance and a dab on ureter entrance when I 'inject' it at night but then wondered if I'd exacerbated soreness because of the non active ingredients in the product. I's also tried smearing a bit on in the mornings too but then thought that a small amount of olive oil was actually better.

All seemed to be going well until about 2 weeks ago when I got progressively worse again. However (touch wood) this morning it's not quite so bad - either then cystitis type sensations or the soreness. I applied Ovestin last night but then I've also applied it on and off across the worse time recently and the less bad time too. So I can't discern a specific pattern.

Yes, it might have got worse through starting a bit of gentle cycling again but initially, when I restarted, it didn't seem to be exacerbating symptoms. It was after a longer two weeks of cycling - but only every few days and not for far, that I then had an exacerbation of symptoms again. This coincided both with coming off one antibiotic and starting the next. But again, I can't see a direct correlation with antibiotics either. I'll only know if I've needed them when I come off them and if I then get further UTIs.

If Ovestin is helpful for local soreness (unless it's actually causing soreness of course) then Vagifem won't have that additional help but could also be the answer if Ovestin is exacerbating soreness I guess. It's just so difficult to know exactly what's helping and what isn't.

I guess I might have thrush without the usual symptoms. I actually have a three tablet 'shot' of thrush medication to take orally (from the GP) but never took this as the side effects sounded horrendous and would interfere with my work and daily life. Maybe I'm too wary of course and should try taking it but maybe I ought to wait until I've seen the consultant. How easy is it to test for thrush without an invasive smear test? I'd happily treat for thrush if I knew I had this.

@Whataretalkingabout , yes, I agree about the hydrocortisone cream that the GP originally prescribed within a strong treatment cream for possible thrush. I think this aggravated all the soreness in the first place and made it take much longer to heal. This is why I'm reluctant to do 'treatments' without actual evidence that I've got the particular problem.

@Snowontheroof I'm so sorry to hear about your diagnosis of advanced bladder cancer. You poor thing! I don't think I really have symptoms of this myself and have never had blood in my urine and other than the sporadic worsening of cystitis-type pain and ongoing vaginal soreness, I feel fit and healthy and desperate to get out on my bike again - and also walk and so sea swimming too - all the things I enjoy in life that I've now not been able to do for the last 6 months.

@JinglingSpringbells you may well be right that I just need to keep going with Ovestin and stop cycling for even longer. The latter is so massively upsetting, as the weather improves and losing another 6 months of active life, at my age (I'm now 60) feels like a huge proportion of what's probably left of my active years!

You should get the internal thrush cream i mentioned and use it regardless of whether you’ve had a positive test for thrush or not, it won’t do any harm at all and if you do have thrush it will get rid of it - and the cream itself is pretty soothing.

You can get it prescribed or you can order it through this link -

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/6Cx4gb9

I think you have to stop overthinking everything re side effects. Yes medication can have side effects but not everyone gets them and even if they do they’re usually mild and if whatever you have is making your life miserable then how can it not be worth trying something to treat it?!

@Xrays thanks for this recommendation. Very kind of you to send this link.

I can see though that the info. accompanying it says not for use for women over the age of 60, presumably related to menopause. If I know something is absolutely necessary and treatment for something for which there's evidence I've got, I can happily tolerate side effects. I guess I'm just naturally hesitant to use something with side effects if I don't even know I've got the actual issue.

So sorry to read this.

I hope you will be okay.

I don't know what @mutterphore has had done so far, but she's had a lot of urine tests and if there is even a hint of blood or anything odd, they usually want to look a bit further in recurrent 'infections'.

Sending you good wishes.

@mutterphore TBH I think that 'not for women over 60' is not really that applicable. IMO it' s there in case women post-meno may be using it for other reasons without having had medical checks. In fact, I'd not be surprised if they say 'not over 60' in case women are trying to treat VA as thrush! Whereas in your case it's almost the opposite. Evidently over 30% of women get thrush after antibiotic use and you have had 3 types of very strong ABs.