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/