Pelvic pain/pressure, burning esp. after urination

by KJ
(US)

I have spent alot of time on the website and read about progesterone and cystitis. I pray this is my answer!! For years I had urinary frequency but no bladder/vaginal pain. If I had mild irritation on occasion it would go ago quickly with a glass of baking soda water and didn't interfere with my active lifestyle. That all changed in July 2010 after using a hot tub while on vacation that was full of strong chemicals such as chlorine. I was treated for a UTI and given several rounds of antibiotics(last took in Oct. 2010) Since 7/10 I have had terrible pelvic pain, urgency/frequency, and burning issues. I have had all the tests and been to many dr's. In 2010, I was tested by a urologist who said I did not have IC but pelvic floor dysfunction, for which I went to pt and after many months got my muscles back 100% normal but still no relief. I started to research the hormone connection and asked for testing. My estrogen was almost non-existent and my progesterone was in the low normal range. I went to a specialist in 6/11 who had treated many with my same bladder symptoms with great results. Unfortunately I wasn't one of them. He said I was allergic to progesterone and prescribed bio-identical bi-est for my low estrogen levels and progesterone drops for the "allergy." He had me so afraid to touch any progesterone as he said it was the reason for my symptoms, along with hormone imbalance. My local MD who deals with bio-identical hormones re-tested me recently and of course I am now Estrogen Dominant. I will see him next week when I assume he will slowly lower the estrogen and then add progesterone. I just want to enjoy my life again - it's been almost 2 years of misery! Please tell me that once I get some progesterone and get the hormones balanced I can feel good again!! I have started using alkaline drops in my water and that does help sometimes with the burning but not always.THANKS in advance for your reply and comments on my situation!!

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Apr 04, 2012
Pelvic pain/pressure, burning esp. after urination
by: Wray

Hi KJ Urinary frequency can be caused by several things. One strangely is an imbalance between calcium and magnesium. Calcium causes contraction of the smooth muscle, which could be a factor. The chemicals in the hot tub could well have contributed to this. Another of course is inflammation followed by an infection. UTI's are generally considered distinct from IC (interstitial cystitis). Suggesting bacteria, viruses or fungi are responsible for the UTI, whereas the aetiology of IC is unknown. As the bladder is connected to the urethra, I find it difficult to conceive of two separate problems. Antibiotics are given for UTI's, often unsuccessfully, or repeatedly in the belief it's killing the pathogen. In 1911 Bernard Shaw wrote “… the characteristic microbe of a disease might be a symptom instead of a cause.” I tend to believe this. Pathogens are opportunists, if a cell or tissue is damaged they will take advantage of this fact. More and more studies are finding that inflammation is behind our diseases and disorders. Inflammation results from a disturbance in the immune system, often due to a lack of antioxidants. Which is usually a result of the pollution, processed food and drink, stress and more to which we are now subject. Inflammation seems to fit the bill for both UTI's and IC, but as the urethra is more easily accessible to bacteria etc, it doesn't surprise me they are found there. Several studies have found IC is due to inflammation, and a subsequent damage to the lining. Why not the UTI's too? D-mannose is sometimes effective. It's believed that the bacteria, if present, will adhere to the D-mannose and be excreted. A more likely explanation is the lining of the urinary tract, including the bladder, has become damaged by inflammation. The lining is a thin layer of glycoproteins, these are a combination of a sugar molecule and a protein. The D-mannose can be used for glycoprotein biosynthesis, see here. This would strengthen the lining preventing possible attack from bacteria or inflammation. The amino acid arginine can help too, see here. Mast cells are implicated, see here. Progesterone inhibits mast cell secretions, see here.
Continued below.

Apr 04, 2012
Pelvic pain/pressure, burning esp. after urination Part 2
by: Wray

Hi KJ Excess oestrogen and a lack of progesterone appear to be reasonable cause, see here and here. Oestrogen is an excitatory, inflammatory hormone, it's involvement is hardly surprising. Particularly when looking at the statistics, far more women get UTI's and IC than men. Interestingly oestradiol increases mast cell histamine secretion, which is initiated by substance P. This is a pro-inflammatory, nociceptive neuropeptide. Even more interesting, progesterone and it's metabolites are suppressed by substance P, see here, unless sufficient is used, see here and here. How any doctor could say you, or any woman or man is allergic to progesterone is beyond me! We make it every day of our lives, men too. Besides which we secrete over 400ng/ml per day during the third trimester of pregnancy. Imagine if many women were allergic to it?! Oestrogen is an inflammatory hormone, so can exacerbate inflamed tissue, but progesterone can't. I feel it was the worst thing you could have been given, see our page on HRT for more info. It is safe to come off the oestrogen cold turkey, although far better to do it gently, but always having used progesterone for about a month before doing so. This will ensure you get no Oestrogen Dominance symptoms. Although I normally recommend 100-200mg/day, I feel you should start on no less than 200mg/day, possibly more. The excess oestrogen you now have will need to be suppressed. We've found from Saliva Tests we run that the ratio of P:E2 should be 600:1 and over to feel well again. You might like to read these comments here, here and here, from others who had to use high amounts to feel well. Finally please see our page on Candida too. Take care Wray

Apr 09, 2012
More questions for Wray
by: KJ

Thanks for your response. I have been using the D-Mannose to protect against UTI's for over a year but it doesn't help with the burning issue. I know this may sound strange but since the urethra and vaginal opening are so close together, it's hard to really know where the "burn" is coming from. Like I said, after much testing, I was told by a urologist(Dr. G) that I do not have IC. And even though Dr. R was wrong about me having a prog. allergy, he did feel that my pain and symptoms were due to hormonal imbalance. What I don't understand is that when he prescribed the bio-identical estrogen in June 2011, my progesterone level was in the low normal range but my estrogen was almost non-existent...so why would I have pain then if my estrogen was low?? Have others been successful treating vaginal burning with the right amount of progesterone? I need some encouragement because 2 years of this pain and searching for a way out of it has worn on me and my family. I need to get my life back! Please tell me there is hope if Dr. S prescribes enough progesterone! He errs on the side of caution so I know he won't give me as much as you are suggesting right away and I know there is then the issue of estrogen dom but I am not comfortable dosing on my on. I am so tired of feeling like my most sensitive area is burning!! HELP! I could handle hot flashes but not this unrelenting pain every day!!

Apr 11, 2012
More questions for Wray
by: Wray

Hi KJ Although you say your oestrogen was almost non-existent and progesterone low normal, did they check the ratios? I doubt it as they rarely do, this is far more critical than the amount. Do you have the results, as you could check the ratio yourself, or were you just told them. I understand what you mean when you say 'where the burning is coming from'. The two are so intimately bound, I suspect the whole area is inflamed. So you don't have IC and the antibiotics or the D-mannose seems to have helped the UTI. And giving you oestrogen hasn't helped either. But you still have the pelvic pain, urgency/frequency, and burning issues? But particularly the burning. I don't think it's the 'lichens' either, ie lichen sclerosis, lichen planus and lichen simplex chronicus, well did they check for those? And I don't think you have vulvovaginitis, as this comes with infections. If so I think you could have vulvodynia, or vulvar vestibulitis syndrome (VVS), was this mentioned? See here, here, here, here, here and here. The first paper I've given you is very comprehensive, it goes through all the variations. In the USA 61% of chronic pain patients are women, starting anytime between menarche and menopause, usually decreasing then, this suggests an hormonal imbalance. In some cases symptoms of VVS increase at mid-cycle and at menses, when the oestrogen to progesterone ratio is high. Have you noticed a worsening of symptoms then? Unfortunately the cause of VVS is unknown, but it appears nerves are either compressed or damaged in the pudendal region. VVS is associated with a number of other symptoms, one is peripheral neuropathy, nerve pain again. Progesterone is known to regenerate nerves, see here. Mast cells are also implicated, progesterone has an inhibitory affect, see here. Whereas oestrogen stimulates mast cell secretions. Continued below.

Apr 11, 2012
More questions for Wray Part 2
by: Wray

Hi KJ Significantly higher levels of TNF-alpha are found in women with VVS, progesterone inhibits TNF-alpha, see here and here. It's rare for me to get a query about VVS, one woman tried 200mg/day and found it didn't help. I doubt it would, as I've found in any severe situation far more progesterone is needed. Women with asthma, seizures, heart palps, endo and migraines require far more, 400-500mg/day. One woman with lichen planus is finding 200-300mg/day is helping, that's another vulval problem with unknown aetiology. Please be aware that using small amounts will probably make matters worse. Ideally some of the progesterone should be applied to the area itself, but skin creams, including progesterone creams, all have a pH similar to the skin, ie 4.5 to 5.5. This is acid and can cause stinging if the area is inflamed. Let me know if the VVS fits your symptoms. Take care Wray

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