Vaginal oestrogen helps UTIs but recurring thrush is difficult to manage

[LaliqueSaltGrinder]

Started on vaginal estrogen about 2 years ago and it has been amazing, I was getting so many UTIs before starting using it and it just made things so much more comfortable.

But I have had a couple of bouts of thrush and at the moment I just cannot shift it. It is uncomfortable and canesten gives a bit of relief but not much. i have read that using vaginal estrogen changes the flora of the vaginal area and increases risk of thrush but if I stop using the estrogen it's back to the UTI's and pelvic pain. What do I do? I will try to make a GP appointment, will probably get to see them sometime in September...

It usually wouldn't keep giving you thrush because my understanding is it makes the vagina more acidic which deters thrush. Some irritation or thrush like symptoms can happen when first using it because the pH balance is changed, but not once the tissues have healed from atrophied.

Have you done a test for thrush?
Because itching etc can be a sign you need more estrogen.

Maybe you actually need to use it more- many women find 2 x a week not enough and there are posts here from women being told to use it 3, 4 or even every day (through consultants.)

TBH your GP is unlikely to be of any help unless they take a swab to confirm it's thrush.

It's trial and error- and if you've not done a swab yourself, it's worth doing that or asking the GP for one.

I found I wasn’t ok with the cream but fine with the tablets/pessary

I haven't tested no, but I did find my symptoms got better but didn't disappear with a dose of Canesten. My GP was adamant that 2 times a week was plenty. (But I have had poor advice from them in the past tbh).

I may ask to try something other than the cream.

I find it incredibly difficult to deal with my GP. They have no online consult, you have to play the 9am lottery for an appointment and they only see you quickly if your leg is hanging off.

They may not have it at your surgery but quite a few will have a nurse or pharmacist on site that is the HRT specialist and the wait to see them is quicker - it might be worth asking if you haven't tried that before.

Same as above. I switched to the pessary twice a week, and am fine now. I was very prone to thrush on the cream. I think it might have been something in the carrier.

I am going to ask to switch, I might just drop them an email even though that is not what the system is meant to be for. We don't have any menopause clinic, or specialist, it's just shit. But on the other hand if you go in all confident and say "I want to try" they are usually happy to write the prescription.

Aaaaaargh I have just logged into the GP online prescription service and clicked "send us a message" but that service is unavailable because yopu have to message 8am to 2pm Monday to Friday. Because quite clearly people are unable to read emails sent over the weekend. FFS.

I tried this but unfortunately non urgent 4 -6 week wait to see a doc. Had a phone consultation and he said 1 pump of oestrogen a day and build up to 3. Said it would take 6 months to notice a difference.

You can buy a thrush test in supermarkets and pharmacies.

I had what I assumed was thrush for years and years. Like you I used other treatments. When I started on vaginal estrogen it went away.

If you have soreness and redness it can be lack of estrogen.

Do you have the thick white discharge of thrush?

@Cheese55 OP is not talking about estrogen gel- it's vaginal estrogen cream (if that's what you meant.).

This also happens to me. Oestrogen cream has been great for the UTIs and prolapse but definitely increases my bouts of thrush. I've found that taking an 'intimate flora' probiotic every day has helped reduce them a bit though and also having a stash of the Fluconazole tablets at home so I can take one as soon as the thrush symptoms start.

If you're sexually active I'd suggest using condoms until it all settles down as candida can be passed back and forth even if a dp isn't symptomatic and yes as others have said just use canestan daily until it settles. If it doesn't ask for an oral anti fungal as sometime it needs a systemic zapping as well as topical cream.

Tbh i don't think any practices take econsults/messages over the weekend whicn is annoying as obviously when patients have the time to submit them!

Boric acid (even just 1 or 2 pessaries a month) keeps my thrush under control. Before that I was taking fluconazole tablets but I was concerned that I had been taking them for too long

None of my symptoms went and stayed away until I used vaginal oestrogen every day. Saw a urogynae privately and he said he didn’t rate the cream but did think the tablets were good. Also coconut oil before and after a wee.

I find only the oral Fluconazole tablets shift it- no luck with the pessaries or the cream. You can buy them from online pharmacies without a prescription, hence why I have a stash in case they're needed!

Cream and pessaries tend to work slightly differently.
The cream can also be used externally and it can work a treat on sore skin. The pessaries only work internally. It's possible to use both.

Feeling less sore today. Think I will still ask for pessaries rather than cream.

If the soreness is external, the pessaries won't work for that, as they work where you put them- the vagina.

It's still worth buying a test for thrush to see what's going on.

Oh yes I know thank you. I do still use the cream externally occasionally but it’s meant to be internal use only, which is what he was referring to re the preference.

It's not meant for internal use only. You can use it externally too. There is a video online with a top UK consultant gynaecologist (one of the top 5 in the UK) discussing this in an intrview, and he suggests women use it externally too. (I've used it both ways for over 20 years with my consultant's agreement.)

Oestrogen cream made me itch like mad. So did pessaries. The only thing that works is Blissel gel. You can use it externally as well as internally. It’s another option for you.

Slightly off topic, but I’m interested that it’s really working for your UTIs. I’m taking it too (the pessaries) and still had two UTIs this year.

I was having so many UTIs before I started on vaginal estrogen - like one a month. It wasn't just that though, I had constant pelvic pain like low level period cramps, and sex was uncomfortable. I have also been diagnosed with a minor prolapse so keeping the tissues healthy is very important. I will look at the moisturisers but will those address the atrophy in the same way?

No I don’t think so. Atrophy is caused by lack of estrogen and only the vaginal estrogen cream can replace that.