Some things are just plain hard to talk about. Especially, when it comes to issues, “down south.” And after going through menopause there are some changes that need to be discussed. It’s hard to talk about vaginal dryness, vaginal irritation. It’s hard to talk about urinary leakage, incontinence. Trying to bring up a conversation with your doc about painful intercourse or tender vaginal tissues can be difficult. It’s easy to talk about cholesterol, family genetics, and cutting back on sugar to improve glucose. It’s not so easy to ask your doc if there is something to help with painful sex.
That is why this article and accompanying podcast talks all about how estriol can be helpful for the vagina and urinary tract after menopause.
The body makes three different types of estrogen, Estrone (E1), estradiol (E2) and Estriol (E3). Estrone is made by adipose (fat) tissues and is also prevalent in young teen women just starting their periods and in puberty. Estradiol is the strongest form of estrogen. It is helpful for the brain, heart and bone. Estriol is made more often during pregnancy and it is the most gentle of estrogens. And estriol is great for vaginal tissues and the urethra.
Applied topically to the vaginal tissues, estriol can very much help with atrophy. Menopausal vaginal atrophy is where the cells of the vagina stay immature. These immature cells are called parabasal cells. When supplied with estrogen, the parabasal cells will develop into mature vaginal cells. In the case of menopause, the estrogen levels have dropped. Meaning that there is a high amount of parabasal cells. Causing vaginal dryness, and the tissues can regress and become smaller causing painful intercourse. Vaginal atrophy can also change the vaginal microbiome making a woman more susceptible to vaginal infections such as bacterial vaginosis and yeast/candida.
The drop in estrogen during or post menopause can also increase the risk of urinary tract infections. The lack of lubrication and atrophy can change the microflora of the vaginal canal (vaginal microbiome). This can be less protective against organisms (specifically E.coli) that can cause a urinary tract infection (UTI).
The urethra (that is the tube that connects your bladder to the outside world) can become lax when in menopause because of the drop in estrogen. I liken it to an elastic waistband. When the estrogen drops in menopause the urethra becomes loose, or loses that elasticity. Not only does this make it also easier for the bacteria (E.Coli) to crawl up the urethra to cause a bladder infection or UTI, it also can cause urinary leakage and/or urinary frequency. Urinary leakage, also called stress incontinence can be helped with topical estriol application. By applying estriol vaginally it has direct access to the opening of the urethra to help with tonification.
Using estriol topically to the vaginal canal and tissues can be very helpful with vaginal atrophy, urinary leakage and reduces the risk of urinary tract infection. In application, it is really only needed 1-3 times a week. It is best to apply at night, as it is less messy and has an easier absorption while you are lying and sleeping.
In past articles and podcasts, we have always talked about how important it is to take progesterone anytime a woman is taking estrogen and she has her uterus. This is super important in the case of taking estradiol (again the strongest of the estrogens). That is because estrogen can cause a thickening of the endometrial/uterine lining. And that is a risk for uterine cancer. Estriol does not have quite the same effect on the uterine lining that estradiol does.
Although, it is upon the discretion of your practitioner that is recommending the estriol, often many women can forgo the progesterone. As long as they are not taking estradiol or they do not have a uterus (hysterectomy). In the United States estriol is a prescription that can be made at a compounding pharmacy. It is not normally found at your big-box pharmacies. Although it can be found online, please just be wary about buying without consulting a practitioner that is familiar with the product and the treatment using estriol. We have listeners of our podcast and readers of our blogs all over the world. And in some countries estriol can be found without a prescription at a local pharmacy. But in these cases it would be wise to consult with the attending chemist/pharmacist before using estriol.
Commonly we get the questions about how long a woman can use estriol for vaginal atrophy and urinary stress incontinence. As mentioned, estriol is very safe and gentle and can be used long term. We have many patients in their 70’s that use estriol vaginally. But we do advise guidance from a practitioner experienced in the treatment of estriol.
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Perimenopause is the time in a woman’s life prior to entering menopause. Most people are familiar with menopause, which is when the ovaries stop producing hormones and women stop their periods. There are many options to deal with menopause (which is an entirely different podcast and blog). But perimenopause is a completely different animal compared […]
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Episode 052 – What Biest Ratio is Best for Menopause?
This is such helpful information. I have often wondered who 80:20 is good for and who 50:50 is good for.
One thing I'm still confused by is the estrogen weight gain component. You said that estrogen (as well as menopause in general) could be the cause of her weight gain. I can relate. I was very thin my whole life, now 53 and about 30 lbs overweight. But you also said she might benefit from getting her estrogen balanced, and she was not using enough.
If too low a dose made her gain weight, won't an increased dose cause more weight gain? I have heard other podcasts and read articles that in menopause, we gain weight because our estrogen falls. Estrogen seems to be blamed for weight gain, whether it's high or low. Can you help clarify? There's something I'm not understanding. Thank you! Tracy
Often estrogen has been the scapegoat for weight gain. I'm sure you have heard too much causes weight gain. Too little can pack on the pounds. It can be pretty confusing. So which is it? Is too much estrogen causing my pants to become uncomfortably tight? Or is it too little estrogen that has given me the gut I never had?
Well, it’s not that simple. Estrogen levels do have a hand in weight gain and weight loss. But it is not the only variable. It really is the combination of the balance of estrogen with other hormones in your body. To name a few main players, progesterone, insulin, and cortisol, as well as enzymes, lipoprotein lipase (LPL), and hormone-sensitive lipase (HSL). Okay, I know that sounds vague and doesn't answer the question. Let's back up a bit and look at what women are saying about estrogen.
As soon as menopause hits, women complain that they are instantly 15-30 lbs heavier. Not because of diet or lifestyle. It's like menopause adds an unwanted 15-30 lbs overnight. Then some women are on hormone replacement therapy, taking estrogen, and are horrified because the HRT caused them to gain 10 lbs in a month. So what is it? Did the lack of estrogen in menopause cause that 20 lb weight gain? Or did that hormone replacement estrogen create rolls that were never there? Well, actually, both are true. Before you throw out your jeans in favor of high-waisted yoga pants, let’s learn about the other players in weight gain.
Progesterone will buffer estrogen. Estrogen does like to grow things'. That is why in puberty, you grow breasts and hips. Progesterone helps to balance some of the growth' that estrogen can cause. That is why in perimenopause, when the progesterone drops and the estrogen is running the show, the weight gain begins. That is also why when a woman starts estrogen therapy for menopause but not enough progesterone, there is weight gain.
‘Doc, I really don't feel like myself. I think it's my hormones. Could it be my hormones? Can you test my hormones?'
How many times have I heard new clients tell me this story? They go to see their GP, Gyno, or Internist, asking to have their hormones tested. Only to be told that there is no testing for hormones. Or that it's not necessary to test hormones. Only to leave feeling dismissed, with no answers to why they do not feel well.
While I understand that your GP, Gynocologist, and Primary Care Physician are not the jack of all trades,’ there are many tests for hormones. There are blood tests, urinary testing, and even saliva testing. The more difficult part of hormone testing is the interpretation. The basic lab values assigned by the labs are very vast, and without experience and training, it can be quite difficult to determine if there is a hormone imbalance.
If you are feeling like you have a hormone imbalance or having symptoms concerning your hormones, below is a list of common hormones to be tested and why. Because blood lab testing is so popular, I am going to stick to blood testing. Later we will have more labs and interpretations for urine and saliva.
To start, blood testing is just a look at one moment in time with respect to your hormone levels. In a menstruating woman, her hormone levels are changing every day. But in a menopausal woman where the ovarian function has ceased, her hormone levels are going to be pretty level day to day. So in a female that is still having her period, I like to try and aim for getting the blood drawn around day 12 and/or day 21. In a 28-day cycle, the estrogen will surge around day 12, and the progesterone will surge on day 21. This can give us better insight into her levels of progesterone and estrogen. In a menopausal woman that has not had a period or has sporadic periods with common menopausal symptoms, I will have her draw her blood any time of the month.
FSH and LH:
FSH stands for follicle-stimulating hormone, and LH stands for luteinizing hormone. These are not actually hormones. They are stimulating hormones.' Meaning both the FSH and LH are released from the pituitary gland (in your brain) in response to estrogen and progesterone production. The FSH and LH work in what is called a negative feedback loop.’ Meaning if the levels of estrogen and progesterone are high, then the FSH and LH are low. In turn, if the estrogen and progesterone levels are low, then the FSH and LH are high. It is like when you want your husband to take out the garbage. If he doesn't, you might raise your voice until he does. It is the same with all stimulating hormones. If the ovarian production of hormones is low, as in menopause or perimenopause, the FSH and LH levels will look high.
Estradiol and Progesterone:
Always test estradiol to get specific results for estrogen levels. Estradiol is much more specific for estrogen levels than simple total estrogens. Ideally, in a menstruating woman having the blood test around day 21 will give you insight if that woman is ovulating. It will so give you insight if there is progesteron
Michelle’s Question: Hi, thank you so much for sharing your knowledge with us!
In March 2022 at 42 years old, I had a total hysterectomy with bilateral salpingo-oophorectomy because of stage 4 endometriosis, grapefruit-sized fibroids, ovarian cysts, and my left ovary adhered to my colon.
I was immediately put on an estradiol patch. I was recovering and doing well until the beginning of June. Then I started having hot flashes, 24/7 anxiety, insomnia, and not feeling well every day.
Since March, my dosage has gone from .25, .5, .75, and 1 mg. But I saw no improvement in my symptoms and have said this was the worse summer of my life.
I am debilitated by it. After much research, I decided to try bio-identical creams that have estriol, estradiol, progesterone, pregnenolone, and DHEA.
Even though I no longer have a uterus, I know that my body is used to having these hormones and am hoping they help me get through this surgical menopause and be able to function again. Is this a combo hormone protocol you've ever done for your patients?
If so, should I apply estriol and estradiol in the morning, and progesterone, pregnenolone, and DHEA at night?
Surgical menopause is much different from what you could call your typical menopause. Honestly, there is nothing typical about menopause. Some women breeze through menopause and others have symptoms so severe it can seriously affect their quality of life, not to mention the people around them. And I (Dr. Davidson) can say this honestly, being just shy of 50 and feeling the effects of menopause. But being that I am a hormone doctor, I have some advantages to easing my transition. This is why we do what we do, here at Progress Your Health Inc. We know that hormone imbalance can alter how you feel. From your energy to your sleep, to your libido (or lack of) and more. Hormones can even affect your actual overall health.
Menopause is when the ovaries naturally start to decline and then cease producing hormones. Those hormones in particular are estrogen (estradiol) and progesterone. Menopause is a natural part of life. Those ovaries have worked well for a long time and are ready to retire, naturally so. Making that transi
Laura’s Questions: I am on 25 mcg of Levothyroxine for 6 yrs with hypo symptoms, every one! My endocrinologist just took a panel, and the results are the following:
TSH 2.36 uUI/mL Reference Range = 0.45 to 4.5 uUI/mL
Free T4 1.1 ng/dL Reference Range = 0.82 to 1.77 ng/dL
Free T3 2.9 pg/mL Reference Range = 2.0 to 4.4 pg/mL
Should we up my dose of Levothyroxine to 50 or should I just switch to Synthroid or Armour? Thanks!
Short Answer: We typically don’t recommend or prescribe Levothyroxine or Synthroid for our patients. Both of these medications only contain the T4 hormone. This is referred to as T4 Monotherapy. These medications do a good job of lowering the TSH level but do not always help the patient feel better. We like to prescribe thyroid medication that contains both the T4 and T3 hormones. In our experience, our patients tend to feel much better on a combination medication, rather than on a T4-only medication.
In our opinion, we feel that sustained-release compounded thyroid medication is the best option most of the time. This type of thyroid medication gives the doctor many dosing options, which is certainly good for the patient and their overall symptom profile. Because this medication is compounded, the T4 and T3 hormones can be changed independently of the other hormone. With a commercial prescription, there are only so many dosing options, and both hormones are affected when raising or lowering the dosage. Also, the sustained-released nature of the medication helps to reduce any unwanted side effects that are common with commercial instant-release thyroid medications.
Related Podcast Episode:
PYHP Episode 038 – Do You Have a Low Free T3 Level?
Check out Dr. Davidson’s new book – The Perimenopause Plan
Buy the book on Amazon.
If you have questions about your thyroid or any other hormone related issue, feel free to contact us.
The post Is Armour Thyroid Better Than Levothyroxine? | PYHP 120 appeared first on .
Patient Question: Why am I getting acne in my 40s?
Short Answer: Women’s hormones are always changing. From puberty to middle age, to when the ovaries cease producing hormones in menopause. When we hit our 40s, our progesterone starts to decline. And our estrogen levels drop slightly as well. But the androgens, which are testosterone and DHEA do not decline. That means that there is less progesterone and estrogen to buffer the effects of the androgens.
Testosterone and DHEA are great, useful hormones for a female’s body. They help with muscle mass, motivation, ambition, libido, bone density, and stress management to name a few. But in our 40s when estrogen and progesterone start to decline that makes the androgens the ‘leaders of the hormonal pack.’
There is no buffer against the negative side effects of androgens. One being, acne. Women in their 40s are usually still getting a period and cycling. So that means that the breakouts and acne are worse anywhere from 7-14 days before their period. That is because women really only make progesterone in the last half of their cycle. Those days being days 14-28. Because of the decline of progesterone, acne can be quite prominent before a period.
But because the estrogen may have declined a bit in our 40s, we are still apt to have breakouts all month long. Because acne in the 40s is from the unopposed androgens, the acne is mostly on the chin and jawline. Although the neck and back are also common in a lot of women in their 40s. And the breakouts are more cystic in nature. They are deep and hard to “pop” (which we all know we should never ever do, and yes, I can’t help it either). And cystic acne lasts for weeks. So when one cystic pimple is starting to heal, aggravatingly three more show up. It is very frustrating.
In addition too unbalanced androgens, stress, and cortisol levels can exacerbate acne. Women in their 40s are busy. There are family commitments, work, home life, and trying to stay fit is certainly not as easy as it was in our 20 and 30s. Plus the drop in progesterone and estrogen lets the androgens (testosterone and DHEA) make us feel more easily ‘testy.’ The stress and unbalanced hormones cause cortisol levels to rise. Which unfortunately also makes the breakouts worse.
We really like to use Acnutrol and Inflammatone to help with breakouts.
Below are some other episodes where we discuss other issues related to Perimenopause.