Me again and my vagina 😭

[Maltybiscuit]

I've posted several times over the previous month's about severe itching and soreness around and inside and also anus.
Ive already had an internal exam by a doctor two weeks ago she said all looked fine , although she prescribed Clobaderm ointment incase!
I still think it could be lichen sceloris, she's referred me to a dermatologist but who knows how long the wait will be.
Over the last 24 Hours it's ramped up I can now see what look like sores just inside , red raw, weeing is like a million paper cuts and I'm holding on to the sink for dear life ! I've an appointment with 111 face to face doctor at 5pm.
Here is what I've tried so far.
Clobaderm ointment (very reluctant to use this though without a LS diagnosis)
Vagisil cream
Vagisil powder
Emoillent for washing
Ovestin which has helped with urge incontinence.
I started in HRT 7 weeks ago I use Everol Sequi 50 patches and then the conti for 2 weeks , I feel no different but determined to see if through for 12 weeks, I had the itching before this but it's definitely got worse.
I wash my underwear separately, I've purchased new underwear , I don't use fabric conditioner and little powder , I dry it outside where possible.
I've tried thrush treatments and fluconzole tablets , I've had an antibiotic course for a UTI but I don't have a UTI.
My GP didn't take any swabs !!
My diet hasn't changed , I drink lots of water. I had a Hba1C blood test done in Friday result will be in tomorrow in case it's type 2 diabetes.
Sex is of the question, exercise is killing me , I have a physical job and don't know how I'll cope this week.
Who knew a vagina could cause so many issues.
Is there anything ive missed wise ladies ?
I'm sorry for the long post but I'm feeling pretty desperate today.

That’s crap @Maltybiscuit 😢😢

so sorry to hear you’re having such a hard time. I’m on Estrogel and on the lowest dose - I could do with going up a dose up every time I try, I get severe itching and pain in my vulva & vagina - it honestly feels like the entire region is on fire. If I drop down a dose, it takes about a week to subside and clear. And each time I try and go up a dose, the fanny on fire starts again. I’ve tried it numerous times, and each time it happens. Could this be related to your HRT??

Was about to suggest some vagifem and a vaginal moisturiser, both will help until you see a specialist. I use YES as it's a water based moisturiser. Available on Amazon.

Vagifem can be prescribed by your GP or bought over the counter (brand name Gina) at a pharmacy. It's more effective than Ovestin estrogen cream. It's a tiny pessary that you insert before going to sleep. Use it nightly for 14 nights, then twice weekly. If that doesn't help, it might be worth asking about an oestrogen ring which is placed at the base of your cervix.

Re. Everol Sequi. It will have zero affect on your vagina, only topical oestrogen does that. Also, many women do not get on at all with Everol, it is also impossible to modify the dosage levels if needed as it's a patch. Ask if you can change to oestrogel instead along with a separate progesterone.

@Helpmymenopausalfanny is estrogel your hrt medication ? Sorry for my ignorance ?
I'm on Everol Sequi patches and the only cream I've been using is the ovestin hormone cream as prescribed , I've literally never known pain like this 😔, can you change to a different type ?? I feel for you

Also, if you're in London, there's a gynae called Miss Beski who is very familiar with lichen sclerosus. An older female friend of mine suffered with it terribly, and your symptoms are identical to hers.

@highfidelity sadly I'm up North , I keep thinking it's not LS I don't have the white patches as far as I can see , but who knows without any swabs I really don't know what's going on , glad your friend saw an expert

Not everyone gets the white patches with LS.

I don't want to freak you out, more so as my friend was worst case scenario, but she had the same paper cuts and itching you talk about, along with the pain and rawness. The reason she ended up with Miss Beski was because the skin of her vaginal walls became so dry, so thin and so raw, they fused together and Miss Beski had to separate. My friends case was so severe because her GP didn't send her to a specialist in time, nor prescribe her the correct vaginal oestrogen or even tell her to use a vaginal moisturiser.

At the very least, the itching you describe is indicative of you needing a different dose of oestrogen and why I suggested moving to a cream rather than staying with Everol. Although I did not have the issues you have, Everol made the symptoms I did have far worse. Moving to creams rather than a patch made it easier to modify the dosage levels. I also needed far more progesterone than the patches supplied.

What seems certain is that the current HRT regime you're on does not work for you. You need to get this addresses ASAP.

If you can afford, go see a private gynae. Start there, not a dermatologist.

@highfidelity thanks for this. I've only been on the patches for 7 weeks and the GP said she won't review until I've done 12 weeks ,.at least I'm half way through or more.i definitely don't have any fusing of the skin down there. It was the GP who referred me to a derm rather than a gynae but I'll certainly ask when I can next get an appointment.
I know someone who went to a private gynae and they were just given the same treatment as I already have so worried about spending money on something I already have , but saying that everything needs to be an option when one feels like this.i hope maybe the sexual health clinic could do swabs ?

You don't need a sexual health clinic, they won't be able to help you with this - they only swab for sexually transmitted infections. This isn't that.

The fusing didn't happen to my friend immediately. It was over a few years because the doctors weren't listening to her and were insistent it was thrush. This happened to her post-menopause. If the GP has just prescribed some topical oestrogen and HRT in the first instance, her case might not have been so extreme.

The reason I am sharing her story with you is because sometimes, it's better just to take action and go see a specialist.

When I was put on Everol, like you, I was made to wait 12 weeks. I knew within two weeks of using it it wasn't the right treatment for me and was making everything worse. Knowing what I know now, namely that I persevered with HRT that wasn't working for me, I am really cross with myself for not seeing a specialist sooner.

Even though you can pay to see a gynae privately, they can prescribe on the NHS - Louise Newsom is a good place to start and mentioned on the menopause boards on here. As far as I know, if you tell the gynae you're using Everol and it's not working for you, they're not going to prescribe the same thing. Like I said, you can't modify the dosage, but you can with creams. So at its most basic level, creams and gels are the preference. Additionally, if you don't want to pay, ask your doctor if they can refer you to the menopause clinic as there's a possibly they can do that. However, this is what I did but my GP wouldn't and why I took the private route.

Ultimately, you need to decide what is best for you, particularly in terms of your quality of life. You deserve better treatment than you're currently getting. Not only that, you deserve a doctor who actually listens to you and know about this stuff in depth.

Obviously I'm not a doctor. And the advice I'm giving you is what I have been through myself along with what my friend dealt with. The fact of the matter is that very few GPs can deal with an atypical perimenopause, particularly if it's manifesting in the way you're suffering.

Good luck with everything.

I would get a Juno swab done it will be much more comprehensive than anything the nhs or a private gynae would do.

@highfidelity thank you for all your knowledge.
As far as the doctor said there is no menopause clinic in my area that's just not a thing here apparently maybe in other counties ?
I'm convinced that a swab could rule out other things like thrush , BV, herpes? etc maybe this could be a simple fix ?
GP went through a few options if hrt and I opted for the patches as it seems the most trouble free and the dose can be tweaked with a higher or lower dose patch if I'm correct ?
Apart from this flare in itching and cuts I don't feel any different in on the patches better or worse so I'm prepared to do 12 weeks because surely chopping and changing isn't going to do me any good as I'm not giving things a chance to work.

What @highfidelity said. I had a year of misery just like you until I saw a proper menopause specialist

Sorry you don't have a menopause clinic in your area. We have them in London but it's hard getting a referral and largely dependent to your post code. (Where I live now, I would get referred, previously, I could not).

Ok. Let's break this down.

Do you have foul, fishy smelling discharge? If you don't, it's not BV.
Re. thrush. Have you tried taking any thrush treatments? That's what they kept telling my friend she had. She didn't.
It could be herpes, but it's probably not. But, if you want, go to your local sexual health clinic and get swabbed. However, it's so common that many don't even swab for it any more, so you need to check in advance that they will swab you for this. Or else, order an at home kit. It's also worth considering that herpes isn't constant like this - it's dormant and pain-free for most of the time.

I disagree the patches are the most trouble free. They're not. The progesterone in the patches is not body identical, and it can be this which is causing the issue. What patches are are convenient. Creams need to be applied daily. Patches do not. Patches are also the cheapest, so they tend to be made out to be the best option.

Again, am not a doctor, but for now, start using a water based vaginal moisturiser . Given the pain you're already in, maybe just bite the bullet and try some thrush treatment, if only to rule that out.

When you next see you GP, consider asking to switch to Vagifem, if only to see if that's more beneficial than Ovestin. I would recommend you do some reading up on different types of HRT too rather than be reliant on your doctor. They're often working to budgets and recommend based on that, not what's best.

Working out what HRT is the right fit is a bit like doing a jigsaw puzzle with no picture and many of the pieces missing. But, you will get there in the end, and the end for you is for all these issues to disappear.

Thank you @highfidelity I've got the yes arriving on Wednesday , I hope to be able to get another gp appointment within 6 weeks to discuss all of this.
In the last two weeks I've tried thrush treatments oral and vaginal and didn't work so I guess youre right , no foul fishy discharge or anything like that. I'm just desperate so keep trying to come up with alternatives.
She didn't force the patches on me , we talked at length about different types and I opted for the patches , seemed easy to stick on and change twice weekly , zero effort and hopefully big gains but not yet. The other 12 symptoms are still there , maybe I don't need HRT at all but the itching started a long long time ago and is getting worse .....

That's great re. Yes. I truly hope it soothes.

I had a similar conversation with my GP. The patches were also my decision because they seemed like the best of the lot. However, knowing what I know now, not only because of my own experience but also from reading about different HRT types, I know they're not the best option.

Itching is incredibly common for many during perimenopause. It's to do with declining oestrogen levels. But, if your other hormones aren't balanced, then the issue isn't solved. Like I said in my previous post, I needed way more progesterone. But, that's me, not you. And because your current regime isn't working, it seems certain you need more specialist help.

Out of curiosity, and because I didn't read your last thread, could you list your other 12 symptoms. Thanks.

@highfidelity it's certainly a jigsaw.
In December last year I had bloods done for hormones and the following symptoms I was 44 at the time.
Rage
Shortening cycles and sometimes two periods per month
Brain fog
Insomnia
Aching joints
Intense vaginal perinium and anal itching
Night sweats
Low libido
Forgetfulness
Urge incontinence
Anxiety over nothing
Panic attacks out of nowhere
Because of my then age and the bloods being normal it was all dismissed.
I went back a further two times was given antibiotics for a UTI but I didn't have a UTI the lab confirmed , and full blood tests eveyrjing came back normal.
Just before my 45th birthday in April I went back third time lucky and was prescribed the Everol Sequi 50.
During this time I've had my Hba1C done (I had a baby at 41 and had gestational diabetes insulin dependent) then was pre diabetic which I've no reversed on my latest test, however having has the test only last Friday I've got glucose in my urine sample today ??? Today's out if hours doctor couldn't explain that one.
I know there's definitely an answer out there for me and I'll find it , if it wasn't for you helpful ladies on here I'd be a lot worse off for sure

I’ve had cuts there and it’s HORRIBLE- my gp suggested I use diaper rash ointment just to form a bit of a seal over it, and the relief is amazing.
just so you can use the bathroom without pain -

Could amy of the products you've been using have contaminated your urine sample and contain sugars or starches of some kind?

As I'm sure you know if you've had GD, it's a common cause of finger prick false positives if you have sugar on your fingers. I was told that some pattern printed kitchen rolls also give a false positive because of starch based printing inks. Maybe that's at play here too?

Can you get them to give you some urine dip sticks so you can check for sugars regularly and see if there's a pattern? If you feel able to fingerprick perhaps take some readings to see if you're ever too high.

@deplorabelle funny you should say that as I've been tracking my blood sugar with all my GD kit I still have , morning readigs have been fine but my own urine sticks also show glucose. Hopefully it's nothing and I'm proud to have reversed my pre diabetes at least. Something is heading in the right direction at least

These are all associated with perimenopause. I am 47 and already thee years post menopause. (My last period was in 2020 when I was 44. I first had symptoms when I was 39/40, but only went to the GP at 42 when they really hit hard).

Bloods aren't an effective for perimenopause as our hormone levels fluctuate during the day, and the bloods merely show a snapshot of the moment the bloods were taken. Also, many GPs can't even read the female hormone panels correctly. I know mine did not. (Now I know how to decipher them, I could see my GP missed some salient facts about my hormone levels and never should have prescribed Everol Sequi in the first place.

The first GP I saw similarly dismissed me because of my age, late 30s coupled with the fact I was still menstruating regularly. However, I had many of the symptoms you had, along with others you do not.

The fact you're still dealing with -

Rage
Brain fog
Insomnia
Aching joints
Intense vaginal perinium and anal itching
Night sweats
Low libido
Forgetfulness
Urge incontinence
Anxiety over nothing
Panic attacks out of nowhere

Is without a doubt because Everol Sequi is not working for you - your hormones still are not balanced. Also, you might need testosterone to balance things, it will also bring your libido back, but many, if not most GPs won't prescribe it.

Another question -

Think about the patches - you have ones with just ostrogen and the other with both oestrogen and norethisterone (progesterone). Do you find the entire month hard, or is one part more bearable than the other? This was something the specialist I saw asked me, and yes, one half of the month was much more unbearable than the other.

If you don't want to discuss this on an open forum, feel free to drop me a PM

@highfidelity yes I agree about the bloods so after I'd been dismissed twice I did more reading and question asking here and went I'm armed with the NICE guidelines ready for a battle but saw a different GP again and she was lovely and prescribed albeit the patches but we did discuss gels and tablets.
I agree something definitely isn't working with the Everol for me and I need to try and get yet another appointment to discuss this with her.
You mention about feeling different on the different patches , I haven't had any experience of this I feel the same all the time just no different really from before I ever used it , that is apart from the itching ramping up.

The reason I asked if you felt any difference the month is that some of the patches are solely oestrogen, and others are a combination of both oestrogen and progesterone. It was something the specialist I saw asked me about when I told her I had initially been prescribed Everol Sequi. And yes, for me, I found my issues were worse during the first part of the month when I was using the oestrogen only patch.

What is most interesting about perimenopause is that for many, it is plummeting progesterone levels that are causing all the issues - issues that are also caused by declining oestrogen. But because we are told that it's all about declining levels of oestrogen, the progesterone or lack of, is often overlooked. When GPs are looking at bloods, it's usually oestrogen levels they're concentrating on. This is what happened to me and many others, and when we're prescribed oestrogen, things get worse rather than better. (Interestingly, had I listened to advice on the Menopause boards on here, I would have been told to increase my dose of oestrogen which would have made everything worse.) For me, I only needed progesterone and once we got the dose right, every symptoms disappeared within a few days.

As I said many posts ago, HRT can take time to get right. I know once I saw a specialist, the dosage was tweaked twice initially in the first few weeks and all was great for about 18 months. Then I thought I had something I termed lockdown fatigue - low mood, brain fog, extreme tiredness and inability to sleep, but then many of my stranger symptoms returned and I called my doctor who did some more bloods and I wasn't producing any oestrogen at all (although my progesterone levels were wonderful!). She added in testosterone and oestrogen, and it took another few goes to find the right level of oestrogen for me. Even now I'm post-menopause and produce no oestrogen at all, I'm still on the lowest dose because anything higher make all the horrid symptoms return.

But, back to you. I really do feel that your vagina is the most important thing to address. This can definitely be resolved independently and why there are separate topical doses of oestrogen. Given everything you've been through so far, I strongly recommend you trial Vagifem which your GP will prescribe for you. As for HRT, now you know Everol isn't working for you, move on to the next combination. On a positive note, it really can't get worse for you and I feel strongly that once you can control your own dosing levels, you will find the right balance.

Apologies for rather hijacking the thread, I'm just so conscious of my experience and nightmare with Everol that I hate anyone suffering similarly. I have only become so knowledgeable because of the failures by the GPs I saw prompted me to do a lot of my own research. And of course, seeing a specialist was enormously helpful because she explained everything in detail - she understood and was interested in women's health in a way none of the GPs I saw had been.

I really do hope you're able to find a way forward, and do let us know how you get on.

Have you researched GSM (genito-urinary syndrome of menopause)? Autoimmune progresterone dermatitis?

I meant to post this link (although the one I did post is relevant too).

@highfidelity thank you so much for all your messages and support , I'm trying to stay positive ,.I've managed to get a doctor appointment for 5 weeks time !! This is the best they can do but it's better than nothing I guess , in the meantime I'll try and just stay positive and do lots of reading and have my notes r ady to ask lots of questions to the doctor when my time comes