153. The Genitourinary Syndrome of Menopause and The 2 Safeguards All Users of Vaginal Estrogen Need

Women have been told for decades that vaginal estrogen stays where you put it, which means no progesterone and nothing to monitor.

I do not believe that is true, and this week I lay out why.

We start with what genitourinary syndrome of menopause, or GSM, actually looks like, including the urinary half of it that almost nobody connects back to hormones. Then I make my case for what happens to the estrogen after it leaves the vaginal tissue, and what two safeguards I think every woman using it should have.

I also share an ultrasound finding that changed how I think about yearly screening, in a patient who was not using hormones at all.

In this episode you'll learn…

• What separates local hormone therapy from whole body hormone therapy.

• What genitourinary syndrome of menopause (GSM) covers beyond vaginal dryness.

• Why dryness comes from estrogen loss rather than from aging.

• How the tissues change without the blood flow estrogen provides.

• Why painful sex often goes unmentioned until a relationship is already threatened.

• Why recurrent urinary infections after 50 are a hallmark of GSM.

• Why medical training has left doctors unprepared to recognize GSM.

• What drives the bladder spasms behind urgency and frequency.

• How pelvic floor treatment compares with thousands of Kegel contractions.

• What common overactive bladder medications carry as long term risks.

• Why the vagina has long been used to deliver medication into the body.

• How absorption from vaginal estrogen varies enormously between women.

• Why some women need progesterone despite using only vaginal estrogen.

• Why blood testing will almost never detect vaginal estradiol.

• Why whole body hormone therapy does not always remove the need for vaginal estrogen.

Check out my article "Why Is Your Bladder Going Crazy After Menopause?": https://mirelacernaianu.substack.com/p/why-is-your-bladder-going-crazy-after-menopause

Connect with Dr. Cernaianu

https://www.herabeautyandwellness.com/

https://www.instagram.com/herabeautyandwellness/

https://www.facebook.com/people/Hera-Healthcare-Mirela-Cernaianu-MD/100063462643162/