Often women will tell me they never had a hot flash…. thus say they had no problem
going through menopause. My response, “You are having issues with low estrogen
whether you feel it or not”. Here are symptoms of low estrogen:
Osteoporosis
Cardiovascular Disease
weight gain
GSM (genitourinary symptoms of menopause)
decrease in skin & hair quality
decrease in memory
Let’s take a deeper dxive into the Genitourinary Symptoms of Menopause. These
symptoms used to be called Vaginal Atrophy or Senile Vagina. By renaming it we
explain where (vagina & bladder) and why (menopause is causing low estrogen).
27% to 84% of menopausal women will get the condition that can significantly
impair health, sexual function and quality of life. This is an underdiagnosed and
undertreated condition. According to NAMS (North American Menopausal Society) the
symptoms can be effectively managed with vaginal lubricants, vaginal estrogens,
vaginal DHEA, systemic hormone therapy.
Whereas hot flashes may go away in time, symptoms of GSM are progressive without
estrogen therapy. . Despite the high prevalence of GSM and lack of improvement
without treatment, only a minority of affected women seek help or are offered help from
their doctors.
Vaginal problems seen? Vaginal dryness leads to decreased libido because sex hurts.
Due to low estrogen the clitoris and labias atrophy. Think about the male bias in
medicine here: Imagine the reaction men would have if they suddenly found sex to be
painful, they were newly prone to urinary tract infections, their penises became dry and
irritable, even showing signs of atrophy and shrinkage?
Bladder problems seen? Getting up in the night to urinate, urgency, frequency,
incontinence and frequent urinary tract infections. This leads to repeated rounds of
antibiotics that don’t work.
How does vaginal estrogen help bladder symptoms? Estrogen is anti-inflammatory and
relaxes smooth muscle in the bladder which decreases spasms. How do we get
estrogen into the bladder? Consider the relationship between the vagina and the
bladder? They are Condo Mates … that is they share a common wall. You treat the
bladder by applying estrogen to the vagina.
Treatment for GSM?
Vaginal estrogen provides sufficient estrogen to relieve GSM with minimal absorption
and is preferred over systemic estrogen. You put the medicine where you need it. We
compound the following creams at a reasonable price. These creams may be inserted
vaginally or applied topically to the external genitalia. Inserted vaginal creams tends to
be messy …. what goes up, comes back down. Applying cream to the external genitalia
follows a concentration gradient…… the cream will migrate from an area of high
concentration to an area of low concentration without the mess. You will apply the
cream at bedtime every night for two weeks. Then use two to three times a week.
Estriol 1mg/gram Vaginal Cream: Estriol is the weak estrogen of pregnancy that does
not roll to make estrone (the estrogen implicated in cancer). Helpful for patients that
have had breast cancer.
DHEA cream 13mg/gram: DHEA is a precursor to estrogen and testosterone. It is
considered a switch hitter. When applied topically once in the cell, it can roll to make
estrogen or testosterone ….. whichever the cell is low in. So whereas estrogen creams
can help with vaginal dryness, DHEA can help with libido and response.
What about the patient who says that “menopause is natural” and you shouldn’t take
anything for it? Dr. Kelly Casperson’s response, “If you want to be all natural don’t have
air conditioning, don’t wear shoes, get rid of your car, ditch your glasses”.
I’m not here to argue with the “natural” police. You do you, but don’t tell other women
what to do based upon a made-up “natural is better” story. Maybe you are scared of
hormones, don’t want to take medications or just trying to figure out what to do?