GSM and burning

[IdleGossip]

Looking for some hope!

I have had an awful year with repeated bouts of thrush and vulval pain/burning. It gets better for a bit, worse again. I m currently in a bad spell. Saw the GP last thursday, she said it was definitely thrush and she could see how sore I was, also thought there was potentially lichen sclerosis but she wasn't sure. She did swabs.

She gave me a fluconazole tablet which did appear to work initally but it's Tuesday night and I'm so sore again. Swabs showed no infection.

I have been on Estriol twice weekly - internally - for about 2 years and it appears to be working but externally I have zero idea what is going to help. I;m so fed up with it all.

Vagirux is good if you can ask to try it. I switched to that and use estriol cream externally…when I don’t use them my symptoms return.

Plus the vagirux are tiny little tablets similar in size to the pill so they’re less messy, in fact once it’s in you can’t even feel it.

I get annoyed that my life is now taken over by having to apply hormones several evenings a week, it’s necessary but yet another chore to add to the ever expanding list all to maintain a normal life in perimenopause

Have you found that estrogen applied externally has helped?

Use pessaries or estring an impregnated vaginal ring internally and estriol cream externally.
If your GP thinks lichen sclerosus then wash only with epimax/dermol cream, and ideally your GP needs to give you strong steroid cream, such as dermovate or elocon to use initially twice daily then step down to once daily at night then three times weekly.

It took me two years to get on top of mine. Mixture of dietary changes - no caffeine, no decaf, no citrus, no alcohol (although I can now have a glass of wine if I also have water) and daily oestrogen pessaries. Also systemic oestrogen. Removed the coil. Pelvic floor therapy.

she was unsure about the lichen. She said there were a couple of tiny white patches but said it was not a definite. I am seeing her again on Thursday and she said she may wish to refer me to gynaecology - which will be fine as we have private cover so can see someone quickly.

I think my problems are twofold - yes the atrophy which I need estrogen for, agreed. Happy to use pessaries. I don't have a cervix any more but don't suppose that matters. And a gel or cream for externally.

But also the persistent thrush which is just not going away. More fluconazole, maybe.

When I first started using vaginal oestrogen I also got thrush a lot. I used some kind of probiotic for a couple of months which seemed to help.

I have no idea where to start with probiotics - do you mean tablets or those drink things?

Oh it was like a vitamin size, not a drink. I just took one every morning. I’ll find the link.

I think it was optibac.

Has your GP checked for diabetes?

Yes. No glucose in urine, no ketones, no infection. I was worried about diabetes too.

These ones in the purple box? Can't do any harm - have ordered.

I really feel for you it was so awful when mine wasn’t under control. I know some women have had success with moisturisers externally but I just use the estradiol daily - I got a referral to a urogynaecologist in the end.

Thanks Tofu, I am lucky to have private cover and could see someone next week privately if the GP recommends.

I had a referral to a vulval dermatologist for lichen who was amazing. They are much better than gynaecologists for vulval skin health.

My symptoms were burning soreness - which turned out to be an unusual presentation of lichen because it never itched. It was actually quite mild visually so completely missed by my GP and gynae.

Lichen needs steroids. You could try hydrocortisone yourself - if you've repeated bouts of thrush then the cannesten with hydrocortisone would seem like a good idea (short term).

Hydromol was very helpful too. Buckets of the stuff.

Also I'd definitely tell your GP you have private and just ask directly for a referral letter. They'll get it and just write you one. I've found it best to just ask for exactly what you want.

Vulval dermatologists are few and far between it seems, the two I have found have no appointments until January. I could see a urogynaecologist next week. Will ask GP what she thinks.

I am going back tomorrow to ask about whether all signs of thrush have gone and if not, more fluconazole. Then a switch from cream to pessaries for internal use, and something to use externally too. Have ordered the probiotics recommended upthread.

Ah good luck. I found the urogynaecologist brilliant at explaining it all, sympathising, advocating for daily pessaries, but they said they didn’t know about pelvic floor stuff, so I paid to see someone else on that. They were also great at suggesting things I’d never heard of as more invasive interventions if needed (mine was VA and bladder issues).

That is true. I have found the NHS is actually quicker than private for vulval dermatologists because they prioritise based on clinical need rather than just in order of who asked for an appointment first.

I will see what the GP says tomorrow. I think part of the reason I am sore is because of the Canesten cream, I don;t think it agrees with me.

Back to update after gp appointment. Swab clear for thrush which is odd as I responded to the fluconazzole. She has referred me to gynae. As the current NHS wait for routine referral is over a YEAR, I am using our private cover.

Good luck! Hopefully you’ll get some answers

Have you tried using your Estriol cream externally, OP? I've only just started using it (I've just finished the loading phase) and while I'm very far from better, visibly everything looks significantly better. It only took a couple of doses for a lot of the red raw areas to clear up. It all still feels very prickly and delicate though.

I just feel everything is shrivelling and shrinking. And it;s making me uncomfortable,