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In this episode, Dr. Eric Osansky is joined by urogynecologist and pelvic health expert Dr. Betsy Greenleaf to explore the vaginal microbiome and its connection to gut, hormone, and thyroid health. Dr. Betsy shares how her frustration with repeatedly treating urinary tract and vaginal infections without addressing why they kept returning led her to investigate the microbiome. She also explains how vaginal microbiome testing has evolved from traditional cultures and PCR testing to next-generation sequencing, along with some of the limitations that still exist when interpreting these results.
Dr. Betsy breaks down the important role of Lactobacillus, estrogen, and healthy vaginal tissue in maintaining an acidic vaginal environment. She explains why declining estrogen during perimenopause and menopause can change the vaginal microbiome, why vaginal probiotics may not be enough on their own, and how gut dysbiosis may contribute to recurrent vaginal and urinary problems. Dr. Eric and Dr. Betsy also discuss vaginal lasers and other regenerative approaches, gut microbiome testing, recurrent UTIs, the relationship between thyroid hormones and vaginal health, and why thyroid imbalances can disrupt menstrual cycles.
The conversation also takes a closer look at low libido and why simply adding testosterone may not address its underlying causes. Dr. Betsy discusses the roles of the brain, stress, sleep, hydration, inflammation, gut health, hormones, and relationship dynamics in sexual desire. If you want a clearer, more balanced understanding of the vaginal microbiome and how it connects with your gut, hormones, thyroid, and overall health, you’ll get a lot out of this episode.
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