Menopause: treating atrophic vaginitis and complications

In the last post I alluded to my recent long running and distressing genital issues. In short, I was sore and very red and very, very worried about it all because of a) the discomfort and b) the inability to enjoy sex.

I share this information to help other women and their partners because the problems I experienced are rarely discussed. Everyone will expeience some problems over time, but only a smaller proportion experience the chronic issues I've experienced so early.

I believe I’ve suffered a number of interacting conditions, so it was hard to solve the problem – atrophic vaginitis, bacterial vaginitis, thrush, vulval eczema etc. Plus of course the effects of ill-conceived remedies based on my own ignorance!

I normally use Ovestin cream on my private parts to overcome the negative impacts of menopause.

Doctor Dan prescribed a steroid cream to treat the inflammation and told me to avoid everything else besides warm salty water! The steroid cream settled my inflammation within a week, but it had the potential to mask any other issues such as allergic reaction and infection.  

Without oestrogen cream (I use estriol cream) my genital tissues become less robust and my vaginal pH became less acid.  Hence without hormone cream I suffer pain upon intercourse and am prone to microbial imbalances, thrush etc. The condition is called atrophic vaginitis with overlain infections.

But wait …one of the most common side effects of Ovestin cream is skin irritation…. The gynaecologist recommended stopping all treatments for a week … where upon I contracted a bad case of thrush because without hormones, I am hugely prone to infections! Thereafter followed 2 courses of Canestin cream!

Now I needed quick access to a topical source of non-irritating oestrogen. The only option easily available in Australia is a compounded cream. I found a pharmacy and they conferred with my doctor to formulate a cream. More delays!

The pharmacist asked me to trial some cream bases to see if they irritated me. A reliable trial was very difficult. I chose the base which did not irritate my face and which did not appear to irritate my private parts (I just tried a small patch).

Eventually I got my cream. I applied the cream almost every day until the yellow discharge (from cervical atrophy which occurs without topical oestrogen ) went away. However, I was still a little sore. I could not see the white cottage cheese like material that is characteristic of thrush and there was no bad smell, yet my inner labia and associated areas were mottled red. I could manage sex only once a week.

I am prone to skin irritation and allergies, so I concluded I may be irritated by something. Also irritated skin is easily colonised by microbes which makes things worse.

One option was the cream was irritating me – yet an alternative would be difficult to find. Hence, exploring other causes seemed like the best thing to do.

I cut back on soap and shampoos and rinsed with warm salty water acidified with plain vinegar. I figured this would tend to soothe and also knock back infections. I also applied steroid cream daily after my shower. I mixed in Vitamin E hoping that would promote healing.

Importantly I could not associate any worsening in my condition with these treatments – if anything makes things worse one must stop IMMEDIATELY.  

Knowing that female genital tissues take a long time to react to treatments, I waited patiently and things did seem to be good some times. However, I was still sore at times.

I tend to suffer skin infections in parts near my private parts – thrush and the like.  I guessed these might be transferred to my private parts, so now I treat any parts that might become infected everyday after my shower with vaginal Canesten or even with dilute hydrogen peroxide.         

My partner’s female doctor suggested that the henna I use on my hair and any soap could be irritating – in fact, some women apply henna to their pubic hair and consequently experience irritation of the mucus membranes.

So .... currently I am obssessively protecting my private parts from all shampoo, soap and hair treatments. I wash my hair over the sink. If I use soap on the upper part of my body, I wipe it off many times with a wet flannel before taking my shower.

Finally I seem to be getting some control and needing the steroid cream less. I will need a few more weeks before I know things are working well.

The lesson: keeping one’s post-menopause genitals in working condition requires careful management of a whole system of matters and influences.  Medical advice and pharmaceuticals are important, but in the end, one’s personal management is the key to success.