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 can but OTC swab tests for thrush. Not sure how good they are and reviews say don't use the Canetest one as it is for BV.

You really ought to use a single oral treatment for thrush. It's harmless and will do some good if you have it.

Vagifem is used internally, Ovestin externally. You can be prescribed both. At this point, it would be good to try Vagifem as it might work better and use ovestin outside.

It's all about trial and error.

You're going to have to experiment. If using it twice daily externally irritates, drop down to once or not at all for a couple of days.

Please appreciate that you do not have to do what this consultant says. They are not 'God' and yours has some odd ideas.

You are allowed to say you want to think about whatever she suggests and never go back if you feel unsure with her approach.

I am a nurse in my 50s and a keen runner/cyclist and recognise all the above
what I have found helps is replacing oestrogen by every way possible, I am on oestrogel with a mirena coil, vagifem most days and Oestrin which I often use twice a day. Plus I make sure I get out of gym leggings quickly, wear loose cotton knickers/yoga pants, not wearing jeans all day/ avoid shower gels/ soaps as much as possible and not too much tea/coffee. Feels like a full time job keeping on top of it but worth it to keep doing what I love. There is no upper limit on oestrogen - it’s as much as needed. Plus the way I think about it is if you were hormone deficient in other ways such as being diabetic or hypothyroid we would take as much insulin/ thyroxine as needed and not feel we need to battle through

@ipredictariot5 , thanks for your input. It's good to hear from another cyclist. It does sound like more oestrogen really helps. If I've had no other postmenopausal problems at all, only this recent VA issues, it does make me rather reluctant to use HRT - with all the associated side effects / cancer risks, mood swings, headaches, thrush, acne etc etc when I feel otherwise so happy and healthy. I don't want to add a whole new set of problems - but then I really, really do want to be able to cycle again.

I wish I knew whether ongoing vaginal soreness/ raw burning feeling was actually caused by my use of Ovestin, as it does feel really astringent when I apply it and have no idea whether I should be applying more or less. Do you not find you get burning and extra soreness when you've applied topical Oestrin? I don't know if this is caused by other ingredients in Ovestin or if I've got thrush or what's going on.

I only wear cotton leggings/ trouser for cycling and change - including my underwear - after exercise of any kind. I don't use shower gel in the vaginal area and I now only have one of two incredibly weak coffees per day and as they're so weak, it doesn't seem to make a difference to my symptoms whether I have the coffee or not.

I saw a recent article on the news about a woman in her 80s doing a very long cycle ride and I actually felt so jealous! I'm going around at present seeing women on bikes of my age and older and wishing I could ask them "Are you on HRT?" "Do you use Ovestin?" "How do you manage to keep on cycling?"

@JinglingSpringbells I have tried using more or less Ovestrin but there doesn't seem to be an exact pattern to worsening or improving symptoms - both the localised soreness and the cystitis type feeling. The single oral treatment for thrush does seem to come with warnings of lots of side effects, from the leaflet, so I'm slightly worried about taking it and also taking it whilst still currently on antibiotics, as it also says not to take with antibiotics - or at least some types of antibiotics.

I'll ask the consultant about Vagifem, although I do remember at my appointment that she said something about only prescribing Ovestin. I know medical advice can vary from medic to medic and won't take what she says as the absolute and only view. I want to use my next appointment effectively and could ask about Vagifem as an addition to Ovestin. My first appointment went at break-neck speed and she didn't examine me physically at all. So I hope I can explain everything to her succinctly so she can best advise.

Someone needs to have a look. It may be you need a gynae / urology or dermatology opinion/review.
you need a clear diagnosis as although oestrogen will help almost universally it doesn’t sound right if you are not finding any improvement/ worried it might be astringent.
did your GP examine you when you first went?

she's seen 2 GPs including one privately, and at least one consultant.

The single oral treatment for thrush does seem to come with warnings of lots of side effects, from the leaflet, so I'm slightly worried about taking it and also taking it whilst still currently on antibiotics

So does aspirin and paracetamol.

I mean this kindly, but you are coming over as over-thinking a lot of this. You kind of close the door to lots of suggestions here on the basis that they wont work or are dangerous.

Using something for thrush is pretty benign as a treatment and far less dangerous than all the antibiotics you have used for months, but you've done that unquestioning because the dr said to use them.

Yes Ovestin does sting me slightly but it wears off very quickly- in about an hour. It used to sting more when I first used it. Maybe just stop applying it externally. You should be finding that with the effects of gravity, what you insert will work its way down and out anyway.

TBH if you read all the warnings on the ABs you'd never take any!

Can you see there is a bit of a difference between what posters suggest and what you are happy to do as long as it's what a dr says?

You're tending to find all the negatives in any suggestions, on the basis that you will get any or all of the side effects- yet you are happy to take 3 courses of strong antibiotics. It's not logical :)

Also, your private consultant should have allowed 45 minutes for a first consultation. That's the time they usually give and even up to an hour.
if it was rushed, that's another reason I'd never go back.

@ipredictariot5 I was examined twice by the same private GP and she only commented that there was nothing significant to see other than VA of a normal level for a woman of my age. I've seen her a few times since the problems began and then the female consultant (gynae/urology specialist) once - which so far was for a 30 minute initial appointment.

I too wonder if it might be skin-related along with hormonal VA as I've always had very sensitive skin and after trying so many products suggested by the GP and consultant - (thrush cream with hydrocortisone, Replens Sylk, Yes VM and now Ovestin) My poor old vagina is really sore and raw in a way I've never previously experienced!

@JinglingSpringbells I'm so sorry if I'm coming across as over-thinking and closing the door on suggestions. I've actually really benefited from yours and others input and only because of this, have started using Ovestin at all, have used more than the consultant advised, have begun to think about HRT and am not at all ruling out taking the oral thrush medication.

I'm kind of expressing my thoughts and considerations here but in terms of behaviour, have made what for me are really significant changes to my previous way of being. Lifelong, I've never needed or used medications for anything. So even starting to use Ovestin now has been a big change. I'm also keen on understanding the science and evidence behind treatments before just going along with what the doctors say.

I did read up on prophylactic antibiotic use before complying with the consultant's prescription but am going to be discussing with her the contraindications when I see her. I also just want to check about taking the oral thrush medication whilst still being on an antibiotic before going ahead with that.

You have been enormously helpful and I do value your experience with all this. It's a steep learning curve for me as I thought I'd sailed through the menopause and was out the other side and beyond!

Lifelong, I've never needed or used medications for anything. So even starting to use Ovestin now has been a big change

Not even for a headache or sore throat?

No one stays the same for life. It's pointless saying you've managed so far without something and appearing upset about having to, like it's a failure. You've never been without estrogen in your life and now you have for 10 years. On the relative scale of illness and medication it barely registers. It's no more than using handcream on sore hands or lipsalve on sore lips (especially now it can be bought with no prescription.)

I also just want to check about taking the oral thrush medication whilst still being on an antibiotic before going ahead with that.

I think that some drs prescribe thrush medication simultaneously as a prevention when they prescribe ongoing antiBs.

@JinglingSpringbells thanks again for your support and advice. No, I've rarely used even paracetamol even but I do take your point about no longer having enough oestrogen and have liberally used Ovestin since getting useful advice from you and others here. I'm not sure whether I've been using too much and that his has made soreness worse. I stopped for a couple of days and on day one, I thought things felt better and then on day two, all symptoms (cystitis type and soreness) came back with a vengeance. Will use it again tonight. There seems to be no consistency with better days and worse days and use of Ovestin now but I don't feel at all nervous about using it.

I'm seeing the consultant soon and hope she's helpful but if not, will look for alternatives.

Someone posted a great infographic on the risks of breast cancer and HRT the other day. I wish I could find it. Perspective is everything.

Posting another update. I saw the consultant for the follow-up appointment and she was absolutely adamant that I mustn't use Ovestin more than twice a week. She said this was the proper dose and if I used more, I might get a cancerous breast lump....so this is really different to what everyone on here has been saying.

She said no need to consider HRT and to carry on with Ovestin and also prescribed Dermol 500 for soreness, which does seem to be helping a bit. She said if I saw a dermatologist, they'd only prescribe steroid cream, which wasn't a good idea.

She said no to Vagifem as 'you can't smear it on', even though I was asking her whether Ovestin could be making the soreness worse and she's basically prescribed one more tiny tube of Ovestin for the next 3 to 4 months.

I'd come to the end of the antibiotics and we agreed they hadn't seemed to make much difference, so I'm no longer on them.

She told me there was no reason to take the medication for thrush, as I didn't have the classic symptoms for thrush.

So I asked for an examination this time and she took a look and I also suggested she took swabs to look for thrush etc. I also said maybe could she do a smear test, as it's so long since I had one. She did try, with what she called the 'Virgin Speculum' but couldn't actually open it up but said she could see a small part of my cervix and it looked OK. She said it was 'tucked around a corner' so I do wonder if this has meant the Ovestin isn't fully reaching the cervix.

Perhaps most disappointing of all was that she said Vaginal Atrophy is very difficult to treat once it occurs and I got the impression she thinks there's really not much more she can do for me.

When I explained to her how important it was for me to be able to cycle and exercise again and do wild water swimming, she just said that I'd have to try cycling with some kind of rubber ring on the seat (she's clearly not a cyclist!). She said sea water will sting and sea swimming can cause more UITs? The GP had told me there wasn't any evidence that wild water swimming increases UTI. So I don't know who to believe. Does anyone on this thread know if wild water swimming increases the risk of UTIs?

Since the appointment I have tried cycling a couple of time and briefly swimming in freshwater. Cycling does make me very very sore but I love it so much. No sign of another UTI so far, thankfully and Dermol 500 is helping a bit compared to any other soothing cream I've tried.

I've got two cycling/ sea swimming holidays coming up over the summer and no idea how I'll manage if there's not much else the consultant can suggest.

As I've now put on more than half a stone in weight since all this began over 6 months ago and am much more unfit, I do feel demoralised. I suppose I can continue to use Ovestin a bit more than she's told me to but it does feel strange that she's so adamantly against more than twice a week usage, when others on here have had medic suggesting far more frequent use.

I'm still getting ongoing soreness and I'm still getting cystitis-like 'urgency to wee/ tenderness' sporadically, which seems to have no correlation with anything I'm doing or not doing. Not sure what to do next.

I had an online appointment with a specialist menopause clinic. I can highly recommend. This clinic was in Germany. (I’m not, they all speak English). Honestly, I could not have received better care. The stuff your doctor said about vaginal atrophy is rubbish.

There’s a uk online. I actually tried this one first, but didn’t go ahead because of prescription difficulties (EU, Brexit blah blah) @mutterphore they were super responsive.

https://onlinemenopausecentre.com/menopauseclinic2/?gclid=Cj0KCQjwpPKiBhDvARIsACn-gzBoVzuqs-BgnnYpuDVoUrdHKPgnaYFm_NgbMO6W-BxPpGqUhwDX6YIaAiUXEALw_wcB

I wish more people could afford this option. GP care for women’s health is so random and often so substandard it makes my blood boil. Your cervix looks ok because she could see a bit of it?? Good god.

So she's dismissive of dermatologists and then prescribes you Dermol 500 as an emollient? What an absolute joke. The guidelines for Dermol 500 have changed recently, it's not recommended to leave on the skin any more, but ok to wash with if it doesn't cause a reaction. Any dermatologist would know that.

@Nixer thanks for this information about Dermol 500, which is making me really concerned! The consultant told me to apply it liberally 4 times a day and use also as a shower gel in that area too. She never mentioned not using it long term nor any risks of leaving it on. It's literally the only thing so far that soothes the soreness, so I now don't know what to use instead.

@W0tnow, thanks for that recommendation of a menopause clinic. I'd prefer to see someone face to face. The local menopause expert at the same GP practice seems to be booked up for months. Really don't know what to do for the best right now. The consultant I saw came highly recommended....

I am going to stick my neck out and say this doctor is absolutely not the person you should be seeing. The starting point is you should be able to get control of this and not have to restrict your activities. The not being able to see your cervix then saying it looks OK is not acceptable - if she can’t see it she needs to work out how to do so. And being dismissive of dermatology makes my blood boil.
this is a great site for patients
https://patient.info/doctor/atrophic-vaginitis
as you can see from here there are a range of further options beyond what has been tried and specifically mentions clinicians lack of knowledge
i use ovestin twice daily and vagifem most days and have been told there is no upper limit
I think you need a second opinion and it needs to be a menopause specialist service. If you can afford it and
depending on where you are in country I know of this clinic
http://www.drpaulabriggs.co.uk/monalisa-touch.aspx
I do not know much about the Mona Lisa touch and it may not be suitable for you anyway. In the first instance you should be properly investigated and have someone supervise the treatment

https://thebms.org.uk/find-a-menopause-specialist/

I had video consult. Ok, it’s not face to face, but it’s also not rushed. I felt like I had all the time in the world.

@ipredictariot5 thanks for your advice. I just remembered that the consultant also told me to use liberally Sudocrem and Vaseline along with the Dermol 500. I just googled and can see that Vaseline is not recommended. Not sure about Sudocrem.

Anyway, thanks for the link to that site and also to that treatment. I just can't understand why so many people on here have said their doctors are completely fine with recommending more regular use of Ovestin and Vagifem alongside, whereas my consultant was very emphatic that twice a week Ovestin is the recommended dose and no more. I actually told her I'd heard that maybe Vagifem would be worth a try but she only prescribes Ovestin.

I searched for a local menopause specialist but she has no appointments now until August. I've not tried remote, non-local medical care before but could consider this I suppose.

@mutterphore I double checked as my info was from women in a lichen sclerosus Facebook group, although I did see a dermatologist myself a few weeks ago and Dermol 500 is not on her list of approved emollients. (her list is Epaderm, Hydromol, Cetraben or Diprobase. I've used the first two and slightly prefer Epaderm.)

Some info here from Feb 2020 (which also suggests not to wash with Dermol, the LS facebook group seemed to just say not to leave it on):
https://www.overtonparksurgery.com/wp-content/uploads/2020/02/Dermol-500-letter-to-patients-from-CCG-.pdf

But there are other corners of the internet where Dermol is still mentioned.

Just seen your later post, Sudocrem can be a little drying but some women like it - I find it quite soothing. Vaseline is a barrier so could be useful to apply before peeing if urine is burning you but a decent emollient will be better for that.

@Nixer thanks so much for double checking. You're a star! I wonder if I should try Epaderm? Is it available over the counter or only on prescription? I could also try Sudocrem.

I've emailed my consultant asking about Dermol 500 and saying I've heard it shouldn't be used as a moisturiser anymore but I doubt I'll hear back from her as her secretary is away, so can't pass on messages.

It's all so difficult as it goes against the grain for me to go against medical advice but all my own research and all the advice here, does suggest that I can and should use Ovestin more frequently and the one product that seemed to help - Dermol 500 - isn't OK to use, despite what the consultant told me to do.

I am absolutely horrified by your specialists advice! 😳😳😳

I am under two different specialists - one at Newson health and one nhs gynaecologist at Norwich- and both have advised to use the Ovestin as much as I want to. I don’t even really measure it anymore. I pull the plunger back past the measuring mark and use probably double that 3 times a week. That’s the only way it makes any difference to me. I also use a large sploge of it externally each time. No one has ANY issue with this. In fact both have said Ovestin has such a low oestrogen content it won’t affect any of the blood tests I need to have for autoimmune issues from time to time so I can continue to use it - even at my “high” dose whereas I have to stop my systemic HRT. Your specialist sounds borderline negligent. Awful, awful advice!

Those emollients should all be available over the counter (and on the internet). I forgot to say, it's usually recommended to try the ointment form of emollients as ointments have fewer ingredients and so fewer things to be irritated by. But some people prefer a cream.

@mutterphore I am simply going to agree with other posters who say this consultant is misinformed. (Something I have thought all along.)

I'd even go as far as saying that IF she is registered with the British Menopause Society list of specialists, that you consider making a formal complaint about her.

This is because she said that you could get breast cancer form using vaginal estrogen. This is truly shocking to say that to anyone and I don't understand why she is saying this. It's completely and utterly untrue. She ought not to be practising if this is what she says.

I may have mentioned before that using Ovestin 2 x a week for a year is the same estrogen dose as in 1mg of systemic estrogen which women on HRT use daily. Some are using 2 mgs daily, which would be the same as using Ovestin 4 x a week for a year. Ovestin is 0.1% oestrogen, so 100 applications is 1mg.

I didn't read all of your update because once I'd got beyond the 2nd paragraph, I felt so annoyed that all I can say is find some other consultant. OR do your own thing by using Vagifem bought over the counter and the Ovestin.