Challenges & Solutions in Hormone Nomenclature, GSM & Social Media Censorship

Hormones, censorship, and midlife health—oh my! In this episode of The Dusty Muffins™, Dr. Aoife O’Sullivan, Dr. Christine Hart Kress, and Dr. Rebbecca Hertel tackle the challenges of hormone nomenclature, why social media censors words like “vaginal,” and what that means for women’s health education. They also break down Genitourinary Syndrome of Menopause (GSM)—what it really is (spoiler: way more than “vaginal dryness”) and the latest treatment options that actually work.

With equal parts humor and science, the Muffins cut through stigma and misinformation to help you understand your body, advocate for better care, and laugh along the way.

🎙️ Subscribe now so you don’t miss future episodes that bridge science, society, and midlife health.

The Dusty Muffins:
✨ Dr. Aoife O’Sullivan → @portlandmenopausedoc 
✨ Dr. Rebbecca Hertel → @drrebbeccaherteldo 
✨ Dr. Christine Hart Kress → @christinehartkress_dnp
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(Disclaimer: The Dusty Muffins are doctors, but they’re not YOUR doctors. This is for entertainment and informational purposes only. Always consult your own healthcare provider for personalized medical advice.)


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Episode Transcript

Speaker 1 (00:04):
Welcome to the Dusty Muffins, where menopause meets sisterhood and strength.
We're three menopause specialists coming together to laugh, share, and
empower you through the wild ride of menopause and perimenopause.
Whether you're curious, confused, or just looking for a real talk,
you're in the right place. We're here to answer your
burning questions, educate, and advocate all with a dash of

(00:27):
humor and a lot of heart. So pull up a
chair and join the conversation. Before we dive in, Please remember,
while we're doctors, we're not your doctors. This podcast is
for educational purposes only and is not a substitute for
medical advice. We encourage you to partner with your own
medical clinician to address your unique health needs. This is

(00:50):
the Dusty Muffins.

Speaker 2 (00:53):
I am a doctor Areca Hurdle.

Speaker 3 (00:54):
I'm on board certified osteopathic Family medicine physician in a
Menopause Society certifieditioner. I have a private tele medisine practice
and I see patients in several different states.

Speaker 1 (01:06):
I am doctor Ifa O'Sullivan, a Board certified family physician
and Menopause Society Certified practitioner, and I see patients through
my telemedicine practice here in Oregon and Washington.

Speaker 4 (01:18):
I'm doctor Christine Harcrass, a Board certified Women's Health Nurse
practitioner and menopause certified practitioner, and I see patients via
telemedicine in several states as well.

Speaker 2 (01:28):
Welcome back to the Dusty Muffins.

Speaker 3 (01:29):
We're three menopausepecialists, break down the science, share the laughs,
and get real about midlife health.

Speaker 1 (01:35):
Today. We're talking about something that affects over half of
postmenopausal women but hardly gets talked about at all. Genito
urinary Syndrome of menopause or GSM.

Speaker 4 (01:47):
YEP, that's the medical name for a cluster of symptoms
women experience in the vagina, the volva, the bladder, and
the urinary track after estrogen levels drop. Let's bust myths,
talk treatment and reclaim sexual and urinary health.

Speaker 1 (02:02):
YO, once we get over our fit of the giggles.
We all had a fit of the giggles.

Speaker 3 (02:08):
There there's a bunch of mid you know, blinkery going
on around here.

Speaker 2 (02:16):
I'm messing around.

Speaker 1 (02:18):
Well, I've been explicit. Podcast. You can say midf.

Speaker 2 (02:22):
We can say all right. Then there's a whole lot
of midfuckery going on around here. We love it.

Speaker 4 (02:28):
Look at you trying to get us down to g
Way to ge. We got explosive for the reasons, sister, Truth, Truth.

Speaker 1 (02:35):
Don't you leap us?

Speaker 3 (02:36):
It's nice, I think. Before we get into this, though,
we had quite an interesting meeting yesterday which was really cool.
And yes, you know, a bunch of us working women
working on a Saturday for the greater good of all
of us.

Speaker 2 (02:55):
Who wants to take it away?

Speaker 1 (02:58):
Well, doctor Louise Newson had a great idea to set
up a zoom meeting and sent out an invitation and
I think maybe about twenty of us joined anyone who
was free, basically, and the topic was we're having difficulty
on social media at the moment saying the word sex hormones,

(03:22):
sex in general. But everyone, we've all been taught in
our training to refer to estrogen, progesterone, testosterone as our
sex hormones, which most of us do not love, right.
We don't love that term because it boils it down
to reproduction and sex, and that's not what these hormones
are only about, right, They're so important for our brains,

(03:43):
our heart, our bones, our skin, our pelvis everything. So
calling them sex hormones really does seem like a misnomer anyway,
So we were trying to come up with an idea
of something else to call it other than sex hormones.

Speaker 4 (03:59):
Yeah, because you know, we're kind of you know when
people think about horm you know, progesterone, estradial and testosterone.
The other problem is is that you know a lot
of patients get pushedback of you're too young for pick
a hormone, which is not true because you have a
deficiency of those hormones when you are breastfeeding. We see

(04:22):
it when you're on birth control pills, we see it
with pcos, you know, during radiation for you know, breast
cancer or other type of cancers. And so you know,
it's really a lifespan hormone and it's not just about
perimenopause and menopause, although that's what we've been mostly talking about.

(04:43):
But I think a lot of us are trying to
also shift that these are life span hormones that the
whole body, as you said, IFA needs.

Speaker 3 (04:53):
Yeah, And I think the other issue too was censorship
on Instagram. Right, So the the big issue is that
when you use sex, you get censored in Instagram either
you take it, you get taken down, you get blocked,
or your content is not shared two new followers. And

(05:13):
so you know that's an issue because we all educate
on this platform, and you know, when we have a
medical term, we should be able to use our medical jargon.

Speaker 2 (05:25):
But they don't like it.

Speaker 3 (05:26):
So this was yet another reason to say, Okay, we
need to get together and come up with some different nomenclature.

Speaker 1 (05:35):
Yeah.

Speaker 4 (05:36):
Some of that we that we tossed around, naming it
something other than menopausal hormone therapy or hormone replacement therapy.
We talked about neuroendocrine hormones.

Speaker 3 (05:49):
Mitochondrial hormiochondrial hormones.

Speaker 1 (05:52):
Yeah.

Speaker 5 (05:52):
Yeah.

Speaker 1 (05:53):
The concern was that unless you're a scientist or you're
really into longevity, you know, you may not really understand
what I'm whytochandria is or neuroendocrine. You know, they're really
good medical terms, but they're not for people out in
the public who don't have medical training. They're not that helpful.
So I think it was doctor Shiva Gofrani, wasn't it

(06:14):
who suggested just use the names of the actual hormones themselves. Progesterone,
estrogen testosterone pet PET. So I put that up on
my Instagram and I've had two comments, I think, saying,
but won't we get confused about people won't get confused
about whether it's for their pet or not. But we've

(06:35):
been ordering cat scans and pet scans on our patients
our whole careers, and I've never had a patient say, wait,
is that for my cat? That you're doing on my head?
Is that for a cat?

Speaker 3 (06:47):
I mean no, it's not going to happen right right
exactly exactly, they know, you know, and I think, you know,
it may not be perfect yet and maybe it'll end
up being changed, but I think it's a great you know,
it's a great place to start. And that's kind of
where all of you know, everything has a place that
we start, just like GSM. Right, it was not the

(07:11):
general urine a syndromomenopause. It was a trophy vaginitis or
the atrophic vagina or the CENL vagina. I mean it
had some multiple different names, I guess, which is a
nice segue into our episode here. Unless we have some
more things that we want to talk about with this pet.

Speaker 5 (07:30):
Well, I just I think the other.

Speaker 4 (07:32):
The one other thing I can just add that I
think was really important that came out of the conversation
was that when the hormones are declining, it's not just
a phase and it is true deficiency. Like once your
overaes go into retirement, you're not going to restart making

(07:53):
your hormones, just like when your thyroid goes could put
or your pancreas goes could put. You're not on thyroid
replacement therapy.

Speaker 5 (08:01):
You're not on.

Speaker 4 (08:02):
Met foremen or insulin for a short period of time.
You're always on it. And I hear so many times
women are like, oh, I'm done with menopause.

Speaker 5 (08:11):
No, you're not done. You still don't have hormones, and.

Speaker 4 (08:14):
You're still going to have the ramifications of not having
those hormones. Even if what you mean is it doesn't
bother me. I'm not having hot flashes. It doesn't mean
that it's not doing things for your lifespan, that it's
not having negative health background your lifespan.

Speaker 2 (08:34):
Yep. And I like that lifespan and health span right
for the health of women.

Speaker 3 (08:37):
I've always liked that versus women's health, you know, I
think that's really important too, and not just you know so,
and it also encompasses all things progesterone, esrogen, testosterone, all
things all humans of all ages. And that's also important
because these are important hormones right for us at all

(08:58):
ages come into play.

Speaker 1 (09:02):
Doctor Jessica Shepherd had some lovely ideas too, didn't she
to kind of expand on it a little bit more
and add in neuroendocrine and stuff. Is because then you could,
you know, come up. I think she had said, was
it PNT and that could be penta and you could
have a pentagram which looks, you know, kind of like
the outline of a hormone for a molecules. And I

(09:25):
think the overall wish was to keep it as simple
as possible, which I think is why it ended up
being pet right, just nice and simple, the name of
the three hormones easy to remember, and you won't get
your Instagram account flagged.

Speaker 4 (09:41):
Yes, and you can have them whenever you are. Was it,
Kelly CASTERSI was talking about a male who is having
tremendous problems with sleep, who now is on progesterone and
sleeping that's great.

Speaker 5 (09:55):
Yes, I was like, oh, so hormones are for everybody.

Speaker 1 (10:01):
Yeah, he's not going to go around saying I'm on hahort,
you know, right exactly, you prefer to say I'm on
pet therapy, or.

Speaker 4 (10:12):
I might call it p e T and not pet.
Maybe that's pet, you know what.

Speaker 1 (10:18):
I mean, Yeah, instead of like MHD p et ET.
I like that exactly, Yes, yes.

Speaker 4 (10:25):
And that way we get rid of the pet therapy,
pet scans, pet pets.

Speaker 5 (10:31):
Everybody loves their pets. Yeah.

Speaker 1 (10:35):
I think it's just a matter of us using it
online and talking about it and explaining it. And I
think it'll make sense in the end because we can't
say sex hormones anymore, so we have to say something.

Speaker 3 (10:47):
So that's what and that's what it comes down to, really, is,
you know, getting that stigma off, you know, because I
can see some you know of listeners, followers, whatever, you know,
saying things like, okay, so now what we've been calling
it this forever and a part of that is that
it just doesn't do it justice.

Speaker 2 (11:09):
And so you know, that's kind of our point.

Speaker 1 (11:11):
It's always been a ship name. That doesn't make it.

Speaker 2 (11:14):
Right, yep, yep, exactly.

Speaker 1 (11:16):
Just all the time. It doesn't mean it's good.

Speaker 2 (11:19):
Right, you know.

Speaker 3 (11:20):
And I asked even my med student like, what would
you do? And you know, she had said something about
gonatal you know, neuroindocrine hormones, but then you use gonadal
and and that's not you know, like Kelly had said,
it's only twenty percent of where they're made.

Speaker 2 (11:34):
So I said, okay, that's true too.

Speaker 1 (11:37):
And also, if I went along my block and asked everybody,
do you know what gonnadal means? You know, I'm sure
a lot of them would kind of hit the mark,
but a lot might know what that is.

Speaker 4 (11:47):
Really they probably think testicles your now, well yeah and
listen they you would be maybe you wouldn't be surprised.

Speaker 3 (11:56):
But it's amazing how many people do not know the
proper anatomy, you know, like they don't know what scirtaman is.
I mean I have to be like, it's your ball sack.

Speaker 2 (12:07):
And then they're like, oh okay.

Speaker 1 (12:10):
Yeah absolutely, yeah. You see that all the time in
primary care.

Speaker 2 (12:15):
Yeah all right.

Speaker 3 (12:16):
So when I'm doing asking you know, these men about
you know, testicular exams and squirdle exams, they like.

Speaker 2 (12:23):
Look at me like your balls and a ball sack.
I just have to like, yeah, oh.

Speaker 5 (12:29):
My gosh, see it, Like the slang terms make me.

Speaker 4 (12:31):
More like giggly and like feel like whatever than just
calling it what it is. And people go by the
slang terms because calling it what it is makes them
feel yeah, weird.

Speaker 2 (12:44):
Yeah.

Speaker 3 (12:45):
And so now for my kids, I teach them both
things because what I don't want, you know, I don't
want them to have their friends talking to them about
their balls.

Speaker 2 (12:52):
And they're like, what are you talking about? So we
just talk about these the word.

Speaker 5 (12:59):
In the hurdle ushold, that's right. I know.

Speaker 3 (13:01):
I'm usually just like go, you know, put check her away.

Speaker 5 (13:08):
That's because you have so many children grows playing with.

Speaker 1 (13:14):
Lasa with Lindsay and have to be gonuts to the wall.

Speaker 5 (13:19):
Right, that's right. I should tell her the wall. We
might need to change it the gonuts.

Speaker 2 (13:25):
Put your pet to the wall.

Speaker 4 (13:28):
So how is it that we are the Dusty Muffins
and have yet to talk about gs like? It just
seems so bizarre that we have not talked about GSM yet.

Speaker 1 (13:40):
How is that not?

Speaker 3 (13:43):
I feel like we talked about it like a little
bit and then but we were like, oh, we're going
to go back and give it a proper.

Speaker 5 (13:51):
What was our first episode? What the hell was that?

Speaker 1 (13:53):
I think we started off explaining what perimenopause was, right.

Speaker 3 (13:57):
Like the yeah, and then we went through the midst
saying yes, right, want the Dusty Muffins at your next event.

Speaker 2 (14:05):
We do panels, live podcasts and talks that bring the
heat literally, corporate SeeMe or retreats.

Speaker 1 (14:10):
We've got you.

Speaker 3 (14:11):
So hit us up at the Dusty Muffins three three
three at gmail dot com or DMS on Instagram at
the Dusty Muffins.

Speaker 1 (14:18):
So let's say, let's start at the beginning of this.
So GSM is a newer term genito urinary syndrome of menopause,
and it's encompassing everything that could go on in the
vagina and the vulva, the bladder, and the pelvic tissues
in general when you do not have your hormones in

(14:41):
the quantity that you need them, and that could be
when you're breastfeeding, when you're pregnant, after you've had a baby,
if you have PMSM, PMS pm d D, if you
are on the birth control pill and that's lowering your
testosterone and you're getting the symptoms. So in so many cases,

(15:03):
not just when you are perimenopausal or postmenopausal. Right, yeah,
So they tried to come up with this term that
was a more general term.

Speaker 2 (15:12):
Maybe it should be general urinary syndrome. Oh yes, you
see a big lightbulb going. Yeah, iinary syndrome, period.

Speaker 5 (15:24):
Of whenever it happens and whatever.

Speaker 3 (15:26):
Right, because OCP, I have a patient that way, and
I actually had presented it in our little team discussion.
You know, we talked about she actually had the general
urinary syndrome and it had started when she had gotten
her Mincy's and you know, she's very young in age
and we needed.

Speaker 2 (15:44):
To put her on birth control.

Speaker 3 (15:45):
And I had that discussion with her like I need
to know if you have all of our pain, and
kind of went through the whole thing, and sure enough
ended up coming in. I had to do a Q
tip test and it was I was like a kid
in a candy shop. I couldn't believe how specific pinpointed
where this pain was and put her on vaginal estrogen.

(16:06):
She's like because she did not want to go off
the birth control pill. So I said, well, let's try
justin bagil estrogen. Let's see if we can at least
do that for you, and.

Speaker 2 (16:16):
Cleared it right up.

Speaker 3 (16:18):
It was incredible. I was just like jumping around like
you know, but yet I was like, if no one
would have ever told her, and if no one would
have ever examined her volve the way I did, you
would never know.

Speaker 2 (16:36):
You would never know.

Speaker 5 (16:37):
And we were never taught, no.

Speaker 2 (16:39):
This was from ishu wish. I just you know, like
this is all from.

Speaker 4 (16:43):
But we were never taught back in the heyday that
you could give estradal vaginal cream to anybody that wasn't
post like menopausal, finished with their periods and you know,
they you know, studies suggest seventy five percent of menopausal
women have GSM. But I don't know about you, but

(17:05):
I mean, I think it's more like in my patient population,
like ninety nine point nine percent report at some point right, something.

Speaker 3 (17:15):
Right right, And it's at some point like I don't
know about you guys, but sometimes it's perimen apostle. That's
the very first thing, and it's only the week before
their period or the week of their period when their
estrogen's low. Sometimes it is more of a late menopausal
issue where you know, they don't they don't get it
until a little bit later. But yeah, I would suffice
to say that it's got to be you know, damn

(17:36):
near one hundred percent at some point, you know, if
you're not on any type of PETS.

Speaker 1 (17:42):
Let's list out the symptoms then exactly you get during
genital you're in genital you'rein a syndrome.

Speaker 4 (17:50):
Well, with less such estrogen, the vaginal lightning becomes thin
and dry, so things fail, dry, painful with intercourse.

Speaker 1 (18:01):
Yeah yeah, yeah, yeah, yeah yeah. Let's list off symptoms.
Let's keep going with the symptoms, and then I think
it would be a good idea, Christine, actually to go
into more of the like the underlying biology and physiology
of it and why it happens.

Speaker 4 (18:14):
So the symptoms pain with intercourse, in vaginal dryness.

Speaker 2 (18:21):
Thinning of the vaginal mucosa.

Speaker 1 (18:23):
You can have itching around the vulva and the vagina.
You can have recurrent urinary tract infections. You can have
the sensation where you're having like you're having a urinary
tract infection and every time you go give a sample
it's normal. You can have the symptoms where you have
to pee multiple times during the day and even get

(18:45):
up at night to pee.

Speaker 4 (18:48):
Or even you know, you I see so many women
who have you know, have self treated themselves with boric
acid because they're pretty convinced that it is yeast infection.
They have itching sometimes discharge, you know, from inside the vagina,

(19:08):
and then when we evaluate under the microscope there are
there's not an infection at all. And I think all
of that becomes really frustrating for women because I'm sure
you saw you guys saw see in primary care people
coming in I got a urinary track infection, and the
cultures are all negative or they keep.

Speaker 2 (19:29):
Or clensions, we'll just treat them without a culture, which.

Speaker 3 (19:31):
Don't get me started on that one, but clteral adhesions,
pain with pain with orgasm or the inability to orgasm.

Speaker 1 (19:41):
And decrease sensation in the clitteress right where you're just
not as sensitive anymore. And then urinary leakage too, like
having to race to go to the toilet and sometimes
not making it, or coughing or sneezing, which I think
a lot of women just take for granted and we
put down to maybe having to baby or whatnot, but
that often gets much worse as well as dress and continence.

Speaker 4 (20:06):
And the other thing that I used to see all
the time are caruncles, which is the prolapse of the
urethra and it looks like a little red kind of
bulge or a little red like little pebble size protrusion
from the urethra, you know, and it's just there's not
enough estrogen to support that urethra, and you have a prolapse,

(20:30):
just like you can, you know, have other prolapses. And
then the other thing that is very very common is
for women after menopause to go in for their paps
mirror and they'll have an atypical PAP. And so because
the estrogen is so low and the and the cells

(20:51):
are thin, they're dry. When the pathologist looks at it
under the microscope, some of the cells look short, some
of the cells look tall, some look crooked, but they
just don't look perfect. And so they'll they'll call it
an atypical PAP because you have they have two choices.
It's either normal it's not, or it's very concerning for
abnormal cell development. And so then you know, women get

(21:14):
really concerned because they have to come back and have
their paps repeated. And so, you know, I always tell women,
if even if you hate the therapies, at least use
it for two weeks before your PAP smear so that
you can have a normal PAP.

Speaker 3 (21:28):
Yeah, we also will see resorption of the labia minora also, right,
So then that puts us at risk for recurrent UTIs
and when to play off the PAP. And so when
a clinician is examining abolva and vagina and cervix, those
are also changes that occur.

Speaker 4 (21:46):
Right.

Speaker 3 (21:46):
They're pale, they're what we call friable, meaning just very
easy to bleed. It's tender to even be able to
put a speculum in. If you can get a speculum in,
you get stenosis or narrowing of that vaginal and troitus
or entrants.

Speaker 1 (22:02):
And that urethra when you get that prolapse, because those
cells that line the urethra are the same cells that
are inside the bladder. Now you have a situation where
even something rubing against that urethra on the outside can
give you symptoms as if it was coming from inside
the bladder. So if we can even fix the outside,

(22:24):
you won't get those symptoms anymore on the inside.

Speaker 2 (22:28):
That's right, that's right.

Speaker 3 (22:29):
And you know, and these women are really suffering, you know,
to the point where they can't wear underwear or pants
are uncomfortable, you know, and it really is disruptive to
their life, not just their intimate life, but they're just
life in general. Right, it hurts to even wipe. They're

(22:49):
bleeding when they wipe after having after avoiding or peeing
in the toilet, you know, it just it's unnecessary.

Speaker 1 (22:58):
And often because they're not sure what going on, they
don't even mention it to their doctor, and the doctor
doesn't even know to ask, Like I didn't know before
a few years ago that I should be following up
with all my young women who are on the birth
control pill asking if they're having janitor you're an earthen
symptoms or breastfeeding women, breastfeeding women exactly. Yeah, so you

(23:22):
have to know, and your doctor has to know. And
at the moment, we're in a situation where nobody knows basically,
so these women not women suffering.

Speaker 3 (23:30):
Yeah, and they stop having intimacy with their partners, you know,
and then their partner is you know, pissed off, and
then their relationship is failing or they're getting a divorced.
And this is legit what happens to you guys, Like
we're not being you know this, this is truth. This
happens Like they get people their relationships fail because they

(23:50):
stopped being intimate because one because their female partner is
having pain, and then they just stop because they don't
know why and they don't know it be fixed, right.

Speaker 4 (24:01):
And you know when you're ovaries or you know, at
full tilt production, you know, the vaginal walls are really elastic.
There's lots of fluids secrete it during intercourse, and when
you're don't with less estrogen than that, elasticity decreases. And
that's where a lot of women will have pain or

(24:23):
feel like, well, gosh, we fit together just fine until
now or at the foreshet, which is the opening of
the vagina, you get a lot of women will get
those micro tears and those things hurt when you just
feel like, I mean, it reminds me of when you're
trying to push a baby out and your baby's crowning

(24:44):
and oh my goodness, that's like the worst pain you
don't want to push through. That feels good when you
finally do, well, now we got it coming in instead
of going out.

Speaker 3 (24:54):
Yeah, yeah, yeah, exactly exactly, And you know they don't
really understand that. That's why you know, these women are
just like I keep getting UTIs I hear it. I'm
sure you all we hear it all the time, and
we're just like someone needs to look at you know,
the cultures are negative. You know this is not it,
and you know there are changes in that microbiome, the

(25:15):
pH changes, you know.

Speaker 1 (25:18):
Yeah, talk about that, Rebecca. Let's like start at the beginning.
And so your drops.

Speaker 3 (25:24):
Yeah, so you're right, the estrogen completely drops, and so
that causes changes in that natural microbiome. Right, So we
have we have bacteria, good bacteria, and we have good yeast,
and it's at this balance, right, and so anything can
get it off, and then you have an overabundance of
either you know, bacteria or yeast. And you know, we

(25:48):
have a pH. Does anyone have the numbers offhand? Because
I can't recall the numbers more.

Speaker 4 (25:52):
Than well, when it's a problem, it's more than six
point yes.

Speaker 3 (25:56):
So we go more basic. You want it lower, yeah, right,
we wanted that pH lower, and so that as at
estrogen declines, we have more of a basic what's the
word environment in the vagina.

Speaker 2 (26:13):
Yeah.

Speaker 1 (26:13):
Yeah, So as we lose our estrogen, we lose so
much of the collagen and elastin in the skin. Right,
even the skin of the vagina and the vulva, and
that has a massive effect on the cells down there.
You know, they get thinner and the blood supply is
not as good, and so now you're dealing with thin
tissue that doesn't have a good blood supply, doesn't have
a lot of collagen and elastin, and those epithelial cells

(26:36):
that line it are supposed to make tons of glycogen,
which is the food for our microbiome. And so when
they're not making any glycogen, our microbiome doesn't have any
food and it dies off. And so that's this whole
ripple effect. And actually we need testosterone to down around
our pelvis. Right, it's not just a.

Speaker 2 (26:59):
Yeah, we lose that cushion.

Speaker 3 (27:01):
Or when I use the analogy to my patients, I say,
we want to keep it like a grape unless like
a reason because that is literally what happens, right, It's
all about it.

Speaker 2 (27:09):
And they're like, okay, that makes sense, right.

Speaker 4 (27:14):
And you know when I you know, was you know,
in charge of the emergency room, we'd always see sitting
in the er. Are those seventy and eighty year old
women who would come in and their families would say,
she's confused, she's not acting right, things are changing in

(27:34):
her behavior or her cognition. And ninety five percent of
the time it was a bladder infection that ascended into
the bloodstream and caused euro sepsis. And we know that
treating using preventative measures, whether it's systemic therapy, and also
I think we all concur you need both systemic and

(27:56):
vaginal therapies, but reduces the risk of UTIs by fifty percent.
So this is part addressing this as part of the
nursing home prevention plan. You know, it's like, you know,
when you're making money, you have you have, you know,
diaper cream. You know, we have Ann in a nursing
home who keeps having UTIs. She really needs vaginal estrogen

(28:18):
to be applied to her every every day for that prevention,
like a diaper cream.

Speaker 2 (28:25):
Yep, yep. Not like we are saying.

Speaker 3 (28:27):
You know, in the business of medicine, that also saves
medicare a ton of money, right.

Speaker 5 (28:35):
It's like six to twenty two billion dollars.

Speaker 2 (28:37):
Yeah, I mean, it's like an insane amount of money here.
So let's just like for.

Speaker 5 (28:41):
A tube of what ten dollars cream?

Speaker 2 (28:46):
Yeah, I mean, come on, guys, let's get times on that.

Speaker 1 (28:49):
Doctor Rachel Rubin and her crew did that study right
where they looked at the numbers.

Speaker 3 (28:54):
Yeah, and then the guidelines just came out this year, right, Yeah, every.

Speaker 1 (28:58):
Guidelines Medicare aged woman, let's just talk about Medicare aged
women was given their vaginal estrogen, we would save billions
and billions of dollars per year. I mean it's a
nursing home prevention element, but also intensive care unit prevention. Yes, right,
Like when you have a page visit. Yeah, like you

(29:19):
see elderly women who are in the hospital being treated
for a pneumonia and they're getting better and they're on
their way out, and the next thing they spike a
fever and they're delirious and now we're now we know Jesus,
now they're after getting a urinary tract infection, and so
they end up in the intensive care unit. And for
anyone listening who hasn't watched the FDA YouTube two hour

(29:43):
long on one point five exactly speed it up. But
like doctor Rachel Rubin again told the story about her
moment the intensive care unit and how you know her
having vaginal estrogen would have made such a massive difference
and she had to fight for that and that shouldn't
be the case.

Speaker 2 (30:03):
Yep.

Speaker 4 (30:04):
Right, well, at least now with in the hospitals, the
the catheter associated urinary track infection is such a you know,
big discussion point too is you know, not putting in
catheters because then in the intensive care unit they don't
there's very few.

Speaker 5 (30:22):
Times when they actually need to have a catheter. There's
other things and that's all.

Speaker 3 (30:26):
And let's also talk about the decrease in reimbursement when
you have a readmission. So you know, that's like let's
talk about.

Speaker 2 (30:34):
The insurance data model.

Speaker 3 (30:35):
You get hit for things like you know, hospital choired
pneumonia or UTIs or readmission rates and things like that.
So those are all preventable things that it's so easy
and it's so inexpensive, you know. And and I think
for the clinician, yeah, I say, for the clinicians on here,
make sure you're asking ask they may not bring up.

(30:59):
And for the women that are listening to this, make
sure that you're telling them bring it up. You may
be re educating your clinician, and you know that's fine,
they can go look it up. But for I think
either way you know, we have to start talking about
these things.

Speaker 1 (31:13):
So, yeah, one more thing before treatment. Yeah, just I
think in our in medicine at the moment, we have
led women and doctors to believe that when we stop
doing pap smears at age sixty five, that no one
needs to look at your vulva or your vagina again
for the rest of your life. And unfortunately, for a
lot of women, they're okay until age sixty five, and

(31:35):
that's when the genitor urinary syndrome hits them and they
won't mention it to their doctor, and their doctor's not
asking and the doctor's not looking. So I think we
need to really bring that to light as well, that yes, okay,
you don't need paps after six five s will need
someone to look at your tissues every year and talk

(31:56):
about them and make sure that you don't need any treatment,
because the chances are you do. I barely even know
any women in their forties who don't need vaginal estrogen
or let's that's sixty five.

Speaker 3 (32:06):
That's right, And sometimes they don't realize they need it
until they try it, and then they're like, yeah, I
didn't really realize that.

Speaker 6 (32:11):
So many patients he said, oh, I have no problems
and then they use it and they're like.

Speaker 5 (32:15):
Oh wow, okay, what it had year different?

Speaker 1 (32:18):
Mind that back.

Speaker 3 (32:19):
Yeah, so, well, we wrought toys. Not the kind of
toys you're thinking of, but we wrought toys to show you.
I know.

Speaker 4 (32:27):
So I get asked a lot by women, you know,
if they're already on systemic therapy, do they need to
add therapy vaginally? And you know, the systemic therapy is
FDA approved for the prevention of genitor Uriner's syndrome, of
menopause and all other life times. But it's just frankly

(32:49):
not enough. The tissue everything from the pubic bone to
the tailbone needs to see direct application. It's just like
you know, putting lotion on your legs or moisturizer to
your face. The tissue needs to see it and where
and it works where you put it. And the what

(33:10):
we use inside or inside for the vulva, the vagina
and the bladder is not systemically absorbed unless unless you
have that pole to know, unless you have we'll talk
about that.

Speaker 1 (33:23):
Yeah, let's talk about treatment. Yeah yeah, yeah.

Speaker 2 (33:27):
Do you want to start with this since I have
it here?

Speaker 5 (33:29):
Yeah?

Speaker 2 (33:29):
Sure, all right?

Speaker 3 (33:30):
Cool, So this is a fin ring. This is really
great because this is one of the systemic treatments. So
I had to tell that you actually insert vaginally, so
you know it's going to go in and it's gonna
like sit in here.

Speaker 2 (33:47):
You know. However, your vagina is the molds around it right.

Speaker 4 (33:51):
Right, like the birth control ring, but like the new vase,
but not yet exactly there.

Speaker 3 (33:57):
Around the service that's right, exactly there is and so
it kind of like sits up like this. There is
one that's called the East ring that is not systemic,
that just for GSM, and this one is the femurin.
This one is systemic. So his two birds with one stone.
But it is expensive, although you can get it pretty

(34:17):
through some insurance companies. I think military covers it, right
Christ transition pharmacy, it's pretty reasonable.

Speaker 4 (34:25):
Much is transition pharmacy. Okay, so one ring last three
months and it's one yeah, okay, I'll out of pocket, right,
or just a discount that they give you.

Speaker 3 (34:39):
Yep, that's the discount they give you. It's it's you
pay cash for it or your HSA or FSA. You
could use two.

Speaker 2 (34:45):
I think that's what I use.

Speaker 1 (34:46):
Yes, it costs you one and eighty dollars pockush, Yes.

Speaker 4 (34:49):
What does it cost if you were to use like
the good RX app if insurance didn't cover it?

Speaker 5 (34:54):
What have you guys seen?

Speaker 1 (34:55):
Six hundred dollars six hundred free.

Speaker 2 (34:57):
I haven't seen it because I've been going with change harmony.
So what I will say.

Speaker 4 (35:03):
Was, this.

Speaker 3 (35:05):
Is and I didn't realize this because I kind of
got slacky on my external vaginal estrogen here. I was like, oh,
maybe I don't need this, So internal was all fine,
but I will tell a story when I'm getting ready,
and you know, our scous is like to come and
try and fondle in any way that they can, and.

Speaker 2 (35:28):
I was like, how that hurt? Stop it?

Speaker 3 (35:32):
And I was dry, like I just didn't realize that
that was not comfortable at all, And so I thought
I got to keep using my vaginal estrogen, so that
for me was not enough for the volva and introitis
that was still still.

Speaker 1 (35:51):
You still had to ye externally.

Speaker 2 (35:53):
Yep, yep.

Speaker 5 (35:54):
Wow.

Speaker 4 (35:55):
That summering in northern Virginia is eight seventy five fifty
nine through the good.

Speaker 2 (36:01):
It's so ridiculous crazy, it is great.

Speaker 3 (36:04):
It is a set it and forget it.

Speaker 2 (36:06):
It is. It can be a little stimulatory to your partner.

Speaker 3 (36:11):
With yep, yeah, yeah, because some pimecil hit that that
ring and that can be more stimulating for them. You know,
if it falls out, you wash off, put it back in.
Those types of things. So pretty easy, easy, peasy. I
would say it doesn't last a full three months, by
about two weeks before it's being done. But if you
have like some extra patches or gel or you can

(36:33):
just get your ring early and put it in.

Speaker 4 (36:35):
And so doesn't quite last the ninety days for some women.

Speaker 5 (36:40):
Yep.

Speaker 4 (36:41):
What I think a lot of women are afraid of
the rings because they're afraid it's.

Speaker 5 (36:46):
Gonna get lost. What do you say to patients about that, Well.

Speaker 3 (36:51):
It definitely can't get lost because there's just only goes
so far and then you're hitting a cervix or you're
hitting a pout if you've had a.

Speaker 2 (36:58):
Hysterectomy with that and they taken the cervix.

Speaker 3 (37:01):
So just like here you guys, right, So it sits
in the vagina here, Your cervix is here. It is
not wide enough opening that it goes anywhere, so you
may not be able to like get your finger in
there to pull it out. Some people will tie like
a little dental floss to that before they put it

(37:22):
in minted or plate. Yeah, I guess whatever you would that.

Speaker 1 (37:25):
For your pleasure.

Speaker 5 (37:30):
I guess you'd smell that then.

Speaker 1 (37:33):
Minto fresh right.

Speaker 2 (37:35):
Or might tingle and burn a little bit.

Speaker 5 (37:38):
What about the.

Speaker 2 (37:39):
Kind that has a cinnamon way to Let's just make
me kingle a little bit.

Speaker 5 (37:44):
Okay, I think Rebecca, you need to try it out.
I want to know if you can smell mint or cinnamon.

Speaker 2 (37:50):
I mean I must have long enough fingers. That is fine.

Speaker 1 (37:53):
I think you should do this.

Speaker 5 (37:54):
Smell it.

Speaker 1 (37:55):
You should do this for our patients and our listeners.
You should do it and tell us.

Speaker 3 (37:59):
Yes, some dow tayle little dental floss to it so
that way when they put it in like a tampon,
then they can actually find It's easier to just find
the strength if you don't have the dexterity you know,
or you do have short fingers, because your vaginal canal
is unique to you. Not everyone has the same length
of a canal, so feeling off in midlife. I'm doctor
Becker Hurdle, and I offer Concioue telemedicine across multiple states.

(38:22):
Focused on hormones, eat, libido, and sleep and longevity. Let's
get you thriving, So visit www dot aopathicmidlife health dot com.

Speaker 5 (38:31):
That's a great pro tip.

Speaker 1 (38:34):
I'll talk about the cream. So the vaginal estrogen cream,
it comes in two different options, so you've got Estra
Dial or Premarin. Primaran is usually very expensive because it
is brand name and es Trace or Estra Dial is generic,

(38:54):
so in general it's cheaper to get the Estra Dial.
The best way I know how to get it for
people who have to pay for you know, a big
copay is to go through Mark Cuban's cost plus website
where they sell it for about thirteen dollars with a
five dollars shipping. So I've had patients who were asked

(39:17):
for two hundred dollars for that tube of cream as
a copey at their pharmacy, and I tell them ahead
of time. If you get anything crazy like that, tell
me and I will send it to cost Plus. Yeah,
and I think with a good RX coupon as well,
it's cheaper. But I think Mark Cuban is probably the
best place that I've found it. So we tend to
give you a little bit of a loading dose with

(39:38):
the vaginal estrogen cream because for a lot of women,
they're very low on their hormones down there and they
need a little boost to get them up and running,
and then you can cut down on the dose. So
I tend to do it every night for two weeks.
I've tried all different ways, and I tend to now
just even use one gram of the cream. But you

(39:59):
can use one gram two grams of cream every night
for two weeks for a lot of my patients, I'll
say you can get rid of the applicator if you want,
because unlike any product you would ever have for a man,
this they give you one applicator and you're supposed to
wash it and reuse it over and over and over.
And I tried washing that thing that has crevices. Yes,

(40:23):
you can't get the out of it.

Speaker 3 (40:25):
And if you plunge it on accident, then it's on
the floor.

Speaker 5 (40:30):
I know.

Speaker 4 (40:32):
I think the only way I probably would come clean
is in the dishwasher. But I don't know what your
family meant to think about that.

Speaker 1 (40:38):
Well. I have said to patients in the past, those
of them who really want to use the applicator, I say,
just buy a bag by exactly. It's like buying a
packet tampons. Right, It's all good, and I'm not happy
about it. I wish it didn't have to be like that.
But if you want to use the applicator, you can
do that, or you can get rid of the applicator.
The first time the applicator, you screw the applicator onto

(41:02):
the tube and then you press on the tube and
the cream goes up the applicator. The applicators marked one, two, three, four.
Those are grams, and you want to go up to
one gram or two gram or whatever your doctor's prescribed.
And then you can just push that out onto your
finger right the first time, and you're probably gonna get
cream from the tip of your finger to the knuckle maybe,

(41:23):
and then you'll know that's one gram if you've pulled
up one gram, or to the second knuckle, could be
two grams. But you'll get an idea of what's normal,
and then you can get rid of the applicator. You
don't need to use it. You can put that cream
into the vagina yourself with your finger. Tonny, she just
fucked her applicator, oh, out into the.

Speaker 5 (41:47):
I can't there.

Speaker 6 (41:49):
I feel like I'm giving the instructions on the airplane.

Speaker 3 (41:52):
You know, mat core your knack first, put it on
your volva first.

Speaker 1 (41:57):
Rebecca is doing.

Speaker 6 (41:59):
I hope anyone who's listening will switch to youtubeties.

Speaker 1 (42:07):
All right, get your vulva out then, because I'm going
to teach how to do it. So get your cream
on your finger and take maybe put on the back
of your other hand, Take half of it and put
your finger into the vagina and sweep it around in
there and get it onto the walls. You're thinking of
it like a moisturizer, like your facial moisturizer. Then get
the rest of the cream off the back of your hand,

(42:29):
and let's do all the outside of the vulva. You
want to make sure you get the clitterus and the
hood of the clitteris the urethral opening is just below that.
That's really important because a lot of your symptoms could
be coming from there. And then we're going to do
the opening of the vagina and especially round to the
back part. And then those smaller lips, the labia minora,

(42:49):
they're the ones that don't have any hair on them usually,
And you're thinking of it again like a moisturizer. You're
rubbing it in. You don't have to use a ton
of cream. And there's your treatment on and you do
that every night. Oh you can do some something.

Speaker 2 (43:04):
Yeah, itching right around that parane and make them.

Speaker 3 (43:07):
I tell them to put a little vagual estrogen there,
and they're like, because they always think it's hemorrhids, but
sometimes it is.

Speaker 1 (43:12):
But yeah, you're right, you're right. I've actually had patients
tell me their hemorrhoids get better when they start using
the vague.

Speaker 5 (43:22):
Remember that the other day, Yeah.

Speaker 1 (43:24):
It does, and you can see may not have started.
There's a soft tissue there, there's collagen in there, elastin
and those tissues and so when it disappears, they just
flop out. So then when you've done that for two weeks,
you can cut back to twice a week or three
times a week and you should be able to sustain
those results. Usually within eight weeks you have your normal

(43:45):
tissues back. I would say, would you agree, girls.

Speaker 2 (43:48):
Yeah, and I'll tell you.

Speaker 3 (43:50):
I'll tell you too that there and there are a
couple of different ways so I used. I started off
with with every day.

Speaker 2 (43:56):
For two weeks.

Speaker 3 (43:57):
What I did notice that some of my patients would
get often given it a yeast infection, so I went
I cut down to just doing it just one way.
But both ways are completely fine for patients. So but
I know some of you will will listen to this
and be like, oh, my doctor only has me do
it twice a week. We never did a loading dose.
So some physicians find and clinicians use the loading dose

(44:20):
and some don't, and it's not wrong either way.

Speaker 1 (44:23):
So yeah, I just.

Speaker 4 (44:24):
Find it works better with the load. But I tell
patients do it as seven is. Really I tell them
seven days is non negotiable if you want to get
it fixed quick and then but if you're going to
throw the whole thing in the garbage and never use
it again, then at the seven days, then.

Speaker 5 (44:44):
Transition to the twice weekly.

Speaker 4 (44:47):
You know I had, you know not, I had kind
of guestimated where gram was on my own finger, and
then I one day did it and I was like, oh,
I I had been cutting myself short. I was only
using a half a gram finger. So measure your finger.

Speaker 5 (45:09):
Measure and you can even pull.

Speaker 3 (45:10):
It out like we said here, pull it out and
then put it right on here and see because that's
one gram here. So if you don't want to use it,
but you want to know for sure, it's a way
to do it.

Speaker 1 (45:21):
Yeah, or pull the cream up into the.

Speaker 2 (45:25):
Don't and you don't have to be like, oh my gosh,
I forgot it. Okay, so you forgot it, use it
the next day.

Speaker 3 (45:31):
Or if you're going to be intimate, listen, we want
you to have fun, use it after, use it the
next day, you know, or change it with your patch
if you're using the patch. So it's you know, the
best way to use it is to use it.

Speaker 1 (45:46):
Yeah, And it's fine to be intimate having used your
cream anyway.

Speaker 2 (45:50):
You know.

Speaker 1 (45:50):
The chances are if you're a postmenopausal woman, your partners,
if it's a male partner, their estrogen's higher than your
estrogen anyway, so little bit extra is not going to
make any difference. There's when I say micro amounts of
estrogen in this cream, I really mean micro. We did
the math on it, didn't we. Girls. The If you

(46:12):
do the cream as you're prescribed for one year, so
you've done your two weeks, you've done twice a week
or three times a week for one year, there's as
much estrogen in there as there is in between one
and two birth control pills that we give women every
single day, not one to two packets, one to two pills.

(46:35):
That's how little estrogen there is in these products. Don't
be scared of them. Lash them on.

Speaker 4 (46:41):
Yeah, and and if you I get asked often, you
know what, if we have sex, can I then do it?

Speaker 5 (46:48):
Sure?

Speaker 4 (46:49):
It may be a little messier with semen coming out,
but yeah, that's fine.

Speaker 2 (46:53):
I am mean that it was deposited. Sometimes people don't
like to deposit semen. That's true.

Speaker 4 (46:58):
If they deposit, have a deposit. I, you know, was
not using my vaginal estrogen.

Speaker 5 (47:04):
I didn't like it. And again because.

Speaker 4 (47:06):
I realized I was underdosing myself of what I thought
was a gram, but I just didn't like it. I
already have testosterone gel and vvy gel. I'm like, oh
my gosh, I'm wet all over my legs right into
all that crap dries and is not sticky. So I
wanted to try this vagei FM, which I never recommend
starting with it because I don't find that when you

(47:29):
start with it and you're dry and things aren't elastic,
that it works very well. And when I was in
gyn clinic, women would come in and I could see
all their tablets kind of backed up in there. But
I love this. I know it's not great for the environment.
A little plastic tube, much smaller than me than a
small tampon. And then you just click and it's this tiny,

(47:51):
tiny little tablet. You I can actually feel that tablet
melting in my vagina, like it feels a little like
I don't know, it feels a little activating. I don't
know if it bubbles or what happens when it hits there,
but it feels cool, kind of mentholly when it first

(48:12):
maybe like that flopper, That's what I'm imagined.

Speaker 2 (48:19):
Oh, don't worry, just looks so happy.

Speaker 1 (48:23):
What the hell is going on?

Speaker 5 (48:26):
I don't worry about.

Speaker 4 (48:28):
The only thing better would be that vibrator. But yeah,
so I like this. I've been very happy with this, Okay. Yeah.

Speaker 1 (48:37):
And then there's a little suppository type yeah, in vaccines,
and so the UFM is the tablet, and then we
have a kind of softer suppository as well, which is

(48:58):
a similar thing, and you put it, you use it
every night, and then for two weeks and then twice
or three times a week forever.

Speaker 5 (49:06):
And forever forever.

Speaker 1 (49:08):
What else are we missing. So we've done the tablet
arosa in for rosa memory a string, Yeah, inter rosa.

Speaker 3 (49:16):
DHA so that breaks down. So that's the DHA supository
that you insert, and that breaks down into estrogen and testosterone.
So if we're not compounding an estradiol testosterone cream for
the volva sometimes inter rosa we'll start with perhaps first.
The problem with that is expensive and not typically covered.

Speaker 4 (49:40):
So there's a there's poor Man's poor Man's in Eurosa. Yeah,
there are dissolvable dh A tablets five milligrams.

Speaker 5 (49:53):
There is a particular company. I think it's Douglas Labs.

Speaker 4 (49:57):
I'm gonna go look it up and you can just
pop that into your vagina.

Speaker 5 (50:02):
It is Douglas Labs. That was doctor Irwin Goldstein's milligrams.

Speaker 2 (50:08):
Huh was it five or ten? Five? Five?

Speaker 4 (50:12):
Five milligrams, And so that was his recommendation sort of
the poor Man's into rosa.

Speaker 5 (50:18):
The people don't like that.

Speaker 4 (50:20):
Inter rosa a lot because it's really oily, and the
dh A tablets are not but non you know, non
estrogen and breaks down and there's androgens, which you have
a lot of androgens like testments like substance androgens, and
so I think that that can be really helpful for

(50:43):
people who have blunted orgasm or just you know, all
the estrogen only products are not working. And then there's
you know the next that's usually my next go to
is inter rosa or dh A tablets.

Speaker 1 (50:57):
It's very difficult to get intra rosa co for it.
The one that I use with myself and my patients
who can't get it covered is comes from a company
called bez Weecon be easy w E c K and
I think and it's a little suppository. Oh you have them, Christine, Yeah,
a little suppository with like jay butter and olive oil.

(51:20):
Maybe they're tiny, get it there it is, Yeah, it is.
It looks like a little bar of soap.

Speaker 5 (51:27):
Yeah, little bar.

Speaker 2 (51:28):
That's from this Bezwecon place.

Speaker 1 (51:30):
Yeah, they're so good. I find them fabulous. And they
have DHA in them and shade butter and maybe coconut
oil or something, but really natural. Now they're about twenty
five dollars a month. Okay, but that's you can. Yeah,
there's different they they partner with different clinicians and so

(51:54):
if you just google them, you should be able to
find compare prices and find the cheapest one for you super.

Speaker 4 (52:00):
On Amazon, I know, at the guy N office, big bottom,
and then they marked them up.

Speaker 5 (52:05):
They were too.

Speaker 1 (52:06):
Yes, okay, good to know. That's good to know. I
contacted them to see could I just buy some for myself,
and they they sent me their whole contract thing to
sign up with them. I didn't do it because I
don't have a physical office to sell them. But yes,
you can mark it up if you want to. So
that's what I mean, like, hunt around and find the
best price. But DHA can be life changing.

Speaker 2 (52:28):
There's extra strength and oh yeah.

Speaker 1 (52:33):
If you find you're doing your vaginal estrogen and things
are not improving, it means that you need some DHA
or testosterone down in the pelvist and you must get
that or things are not going to improve.

Speaker 2 (52:45):
Yep.

Speaker 4 (52:47):
And then there's the PEMA bean, which I have trouble
say in that word. It's a selective estrogen receptor modulator.
It's a serm. I always refer to those, or like
the designer estrogens. It's good for vaginal pain with dryness.
It acts like estrogen and the vaginal tissue, but opposes

(53:09):
estrogen in other tissues. The only issue with that us
pemaphene is that you cannot combine it with estrogen due
to risk of blood clots.

Speaker 5 (53:20):
So it's a solo only.

Speaker 4 (53:22):
It doesn't stimulate the breast tissue, it doesn't stimulate the
endometrial tissue. But for women who are not using systemic therapy,
it's a good option. It's once a day daily pill
and you know women. I've had patients on it and
they said it works like a champ.

Speaker 1 (53:43):
It's an oral taps.

Speaker 4 (53:45):
An oral tablet, yeah, oral, yeah, yeah, Well what about
the box warning? What about the about the package inserts?
Who wants to tackle the package?

Speaker 1 (53:53):
And so that's what that way, that's what that ft
A meeting was about.

Speaker 2 (53:59):
That.

Speaker 1 (53:59):
We want everyone listening today to go and watch please,
because back after the Women's Health Initiative study, when they,
you know, unfortunately told the world that estrogen could cause
these horrific symptoms and problems in women, every estrogen product
after that got labeled with the same warning. So even

(54:22):
this vaginal estrogen, which I would compare to the one
percent hydrocortisoon that you put on a little bit of
dry skin and you get over the counter, compared to
ivy solumedrol steroid that's injected into your vein when you
go in in anaphylaxis to the emergency room. You know,
that's the difference between the different types of estrogens we're
talking about here. So there's no way that black box

(54:44):
warning should be on the vaginal estrogen products. And that's
what that whole FDA meeting was about to try and
convince the FDA to take that off because it's a
barrier to care. Women are scared. We all have patients, right,
and we've talked to them about this, We've tackled it
head on. We've said, take that insert and throw it
in the trash, that's where it belongs. And they follow

(55:04):
up and you say, so, how are things going with
your imaginal estrogen? And they say, I read the insert,
I know you told me to throw it away, and
I was too terrified to start the treatment. It's terrible,
it's it's horrendous. If this was a male thing, and
we saw what happened with testosterone, right, they did a
quick study and then changed everything and said if.

Speaker 3 (55:27):
They it is safe, if they were told that their
testicles were going to shrivel up and go away, like
are they bey on minora.

Speaker 5 (55:35):
Do they'd be slathering in all up there?

Speaker 1 (55:41):
Yeah? Was that you? That's like Christine, it would be
in like what do you call those machines where you
can like put your machine a vending machine.

Speaker 4 (55:52):
And it should I mean it really should be over
over the countener. I mean it's really ridiculous, like you
should be able to get it everywhere. And you know,
I think that the vaginal estrogen products are first line
measures and then if and then if you want things
like moisturizers, then knock yourself out. And so I'm gonna

(56:13):
seges right.

Speaker 2 (56:15):
Yes, we'll keep talking and because we'll.

Speaker 4 (56:19):
Hear providers say first line therapy is luber Kitt and moisturizer. No,
first line therapy is estrogen, vaginal estrogen products.

Speaker 5 (56:28):
And then compliment what you need?

Speaker 2 (56:31):
All right?

Speaker 5 (56:32):
What do you got for moisturizers over there?

Speaker 2 (56:35):
I got a little rosebud.

Speaker 1 (56:37):
I'm gonna get some of that.

Speaker 2 (56:38):
It's expensive. We got a baby bud. Yes.

Speaker 4 (56:44):
And I thought this was yeh because it looks like
my lip whip and the print is so small on it.
I didn't know that it said. I didn't know what
it said. I couldn't read the print.

Speaker 2 (56:58):
Did it feel good.

Speaker 4 (56:59):
It does work really lovely on my lips both.

Speaker 1 (57:04):
But does the nip whip work really lovely on your vulva?
Is the next question.

Speaker 5 (57:08):
I don't know. Well, I need to ask Carrie Graham.
This is the dull dulce Vida.

Speaker 4 (57:14):
I don't know as though that would smell very good
on my ulva, be a little.

Speaker 2 (57:18):
Bit smells good.

Speaker 5 (57:19):
I love my good I'll ask my husband if you
would like that.

Speaker 2 (57:23):
If you can, it's really nice, see you nice and shiny. Yes,
that is so nice. You could use it.

Speaker 5 (57:30):
The honor bomb.

Speaker 2 (57:31):
This, No, this one's the rose Bud.

Speaker 5 (57:33):
Oh, that's Rosebud.

Speaker 1 (57:35):
Another one, so the Rosebud for one point seven nces.
Ninety day supply is ninety dollars for a one time
purchase and if you subscribe you get twenty percent off,
and it's seventy two dollars. I am going to order
some of this to see if it's good.

Speaker 2 (57:50):
You don't mean much. It's very shoes.

Speaker 5 (57:53):
Uh huh.

Speaker 2 (57:54):
Yeah. I clearly was having some issues too.

Speaker 5 (57:57):
I've got another one.

Speaker 4 (57:59):
This is the first one that I had used, and
I was looking since.

Speaker 3 (58:06):
You looked up the Oh, this is scented, y'all. So
if you don't all don't like scented this thing, don't.

Speaker 1 (58:11):
Go with this.

Speaker 5 (58:13):
How much is that Honor one?

Speaker 2 (58:16):
Which one?

Speaker 5 (58:17):
The Honor one? The Rosebud?

Speaker 2 (58:19):
Sorry, this time?

Speaker 1 (58:22):
Ninety ninety dollars?

Speaker 2 (58:24):
It's so pretty.

Speaker 5 (58:25):
Oh it is pretty. Yeah, I like that.

Speaker 4 (58:28):
So I have another one. It's from Intimate Rose. It's
called Enchanted Rose. Can you guys say that?

Speaker 5 (58:34):
Yeah? It? It is too wonderful as well.

Speaker 4 (58:40):
This was the first one that I've tried, and this
is fantastic. So now I can't turn on my computer
or look at how much this one was. But it
was twenty six ninety nine for this big tube and
I've had this for quite a while. But good for
daily use, like I think moisturizers are great for daily use.

Speaker 2 (59:03):
I put it on the rest of my body. We
should probably put it on our bulba too.

Speaker 1 (59:07):
Rebecca is the scent from the Rosebud?

Speaker 2 (59:09):
Nice, it's very nice. It's okay, Roses, it's very nice.

Speaker 4 (59:13):
Yeah, yeah, you know, oh it.

Speaker 5 (59:18):
Is rose the PhD.

Speaker 3 (59:22):
I just started using this just because I was trying
to sample them all out.

Speaker 5 (59:27):
Do you like?

Speaker 3 (59:28):
Let you know this one's from PhD uh huh. This
one's unscented, so for those of you that don't even
get it unscented, I thought this was pretty nice. Also,
maybe a little bit thicker than the rose bud, which
will be people yep, exactly, but not super thick. It

(59:49):
is not like a dectin rate or even basiline.

Speaker 2 (59:55):
That is nice.

Speaker 3 (59:56):
So these or moisturizers, you guys, okay, these are just
like you are not not necessarily using this with a partner.
This is part of your daily routine. You're going to
put this on and then if you wear panties, put
your panties on.

Speaker 4 (01:00:07):
So you know, I was saying that my every time
we go somewhere, someone gives us a bottle of lube,
and I'm like, I am never gonna have enough sex
in my lifetime for the amount of blube that I have.

Speaker 5 (01:00:21):
It's just and im now I'm looking.

Speaker 4 (01:00:23):
This one expires in January of twenty twenty six.

Speaker 5 (01:00:27):
Oh you got some time, I know, but I haven't
used enough.

Speaker 4 (01:00:30):
I'm gonna tell my husband because his colleagues are listening
to the podcast, tell him love it.

Speaker 3 (01:00:35):
There's the invert too, right, the vaginal inserts that are
moisturizers too.

Speaker 1 (01:00:41):
Oh yeah, the Bonafide, the high High.

Speaker 3 (01:00:44):
Aaluronicaluronic hold on, yes, go ahead, Christy and I'll find him.

Speaker 1 (01:00:49):
Highaluronic acid is a wonderful moisturizer for the vagina.

Speaker 5 (01:00:53):
Yeah.

Speaker 4 (01:00:53):
Bonafide has some really reverie right reverie one.

Speaker 5 (01:00:59):
Yeah, so you're finding it.

Speaker 2 (01:01:03):
Oh yeah, when you keep going.

Speaker 4 (01:01:06):
LUBERCN is for friction. This is for sex. This is
what this is for. So this is velvet rose by
Intimate Rose. I like this a lot. Stripes. This reminds me,
it's oh my glide. This reminds me a little bit
of baby oil ish. And then the other one is
go love. It's intimate CBD serum. So it has CBD

(01:01:29):
ultimate comfort, pure pleasure with a little.

Speaker 5 (01:01:31):
Bit of CBD which is supposed to help with arousal.

Speaker 4 (01:01:34):
I don't think it did, but it's at least convenient
to travel with them.

Speaker 2 (01:01:39):
And what you got.

Speaker 1 (01:01:40):
I have some uber loop here, which.

Speaker 3 (01:01:45):
Uber lube can be also a little moisturizing. I tell
my patients that you can actually use it for lube
and moisture. I think it's nice enough for both.

Speaker 5 (01:01:53):
I love uber lube, I do too good clean love.
That's pretty much the main.

Speaker 4 (01:02:00):
Ones that people use because there's nothing in them that's
going to be irritating.

Speaker 2 (01:02:04):
And it's pretty guys. I mean, let's be real. I know.
It's like when you like get this out, you're like when.

Speaker 5 (01:02:10):
Your kids are going through your drawerings, like, what's up
with the pretty liub? Mom?

Speaker 2 (01:02:16):
See out my drawers as if they're looking for something.

Speaker 3 (01:02:22):
I am always like, if it's the nightstand, just beware
of whatever you're going to find out.

Speaker 1 (01:02:27):
I don't know what you're going to in there. Go
in there at your own.

Speaker 2 (01:02:30):
And at your own risk.

Speaker 1 (01:02:32):
You got it, Okay, all right, keep going so well.

Speaker 5 (01:02:41):
Lasers you know Mona Lisa. Yeah, they're expensive.

Speaker 4 (01:02:47):
They're like twenty six d dollars for me, and you
have to redo them annually.

Speaker 2 (01:02:54):
And I did that v thing or v VV or
something you sit on.

Speaker 5 (01:02:59):
The ball environment, I think like.

Speaker 3 (01:03:01):
A laser thing. It was like a vagile facelift. It
didn't last for that long.

Speaker 1 (01:03:07):
But yeah, I think there's two reasons why women go
turn to things like the lasers. A they're worried about
the safety of vaginal estrogen, and B they have tried
vaginal estrogen products and have only improved to a certain extent.
Maybe those are the women that no one offered them testosterone,
and so they're looking for something extra, or they don't

(01:03:29):
want to use something two three times a week and
they want something that will give them six months of
a normal vagina involved, you know. So I think people
go looking for things for different reasons. And there's mixed
evidence about the lasers, right, there's evidence that says they
don't work at all, and then there's some evidence that
says they can be helpful. So I think it's a
real personal thing for you if you if it's if

(01:03:52):
you want to try it, it's available, but it's expensive.

Speaker 4 (01:03:55):
Are you guys finding that patience because they want better
absorption and because they hear us talk about compounded estra
dial and testosterone creams that we do give to patients
are using their testosterone gel.

Speaker 5 (01:04:12):
I'll tell you what I do in their vulva.

Speaker 2 (01:04:15):
I'll tell you what I do.

Speaker 3 (01:04:17):
Funny that you said that, because I was just about
to be like, should I talk about what I do?
So I put my testosterone every day on you know,
whether it be lateral fire up here, and whatever is
left in my hand, that is the hand that I
use for my vaginal estrogen.

Speaker 1 (01:04:32):
That's what I do. Oh good, that's what I do too.

Speaker 3 (01:04:35):
Yeah, because I'm like, it's not very much, but I
think it's just enough.

Speaker 2 (01:04:40):
And if I were, you know, obviously I need to
start using all of that again. But yeah, it just
made sense to me. I'm like, well, I still have
a little bit on my hand.

Speaker 3 (01:04:47):
I'm not gonna wash my hand because then I'll put
that vaginal estrogen on, rub it all in between those
fingers that I use, and then apply.

Speaker 5 (01:04:55):
I have patients it directly.

Speaker 4 (01:04:57):
It would be irritating without.

Speaker 3 (01:05:01):
I think, so yeah, that's that's one reason why I
haven't done it directly. I think, could you maybe do
like a quarter of a drop or whatever, or like
you know, put your one or two drops on your
shoulder or your leg and then have a little bit more. Yeah,
you could probably play around with that and see.

Speaker 1 (01:05:19):
But I get patients who come and they have been
using the full dose, usually on the compounded cream, the
full dose, applying it to the labia and the vulva,
and I definitely warn them that you are somebody then
who could really develop clitteral megal, you know, enlargement of
the glitterists if you're doing that every day there. Yeah,
and you know you're not going to wake up one

(01:05:40):
morning with a two inch glitterist. It's going to be
a gradual process. So if you're putting it on every
day and you notice that your clitterest is getting bigger,
then you have to stop, right.

Speaker 2 (01:05:50):
You have to stop. That is irreversible.

Speaker 1 (01:05:52):
You've got to start putting on your thigh or your
delt or somewhere.

Speaker 4 (01:05:56):
Yes, are you finding that you're getting high testosterone levels
with them putting it on there? That's what That's what
I hear people on social media.

Speaker 5 (01:06:04):
That's why they're doing it.

Speaker 2 (01:06:07):
Yeah, I haven't.

Speaker 3 (01:06:08):
Probably I haven't tested. To be honest, I haven't tested enough
because I don't tell them to do that. I don't
even tell them the way that I do it. And
but I can tell you that mine are not. My
levels aren't crazy, for sure. I probably am. I have
anywhere between fifty and seventy that's where I feel good.
Closer to seventy. Sometimes they break out, so I go
back down a little bit. So I'm really sensitive to
the androgen itself. And that's like one drop, that's that's

(01:06:31):
all I use.

Speaker 1 (01:06:32):
It's tiny, that's good. And then pelvic floor physical therapy
is our last kind of measure to help with all
these our pelvic flavor physical therapists. We do not have
enough of them. They are absolute angels that fall from
heaven and they're like little unicorns, and we love them
so much and we need more, and women need to

(01:06:52):
know that they exist too.

Speaker 3 (01:06:54):
Yes, yes, they're wonderful and that is a great adjunct.
And I don't think that's an either or an or,
you know. I know I get patient.

Speaker 2 (01:07:00):
Referrals from public for physical therapists.

Speaker 3 (01:07:02):
Which I think you think you thank you because they
will notice it first and then be like where can
you get yourself some bagil estrogen.

Speaker 2 (01:07:09):
And then giving it to them?

Speaker 1 (01:07:11):
Right, So I've gotten referrals from PTAH where the patient goes.
My therapist says, I've progressed to this point and I
can't get better and.

Speaker 2 (01:07:19):
This without it. You got it.

Speaker 3 (01:07:22):
It is such a great collaboration with clinicians in that
space and vice versa. Right, We're just like, we can
only do so much.

Speaker 2 (01:07:29):
You need some.

Speaker 3 (01:07:30):
Public floor or let's see if it works, you know,
in addition to you know, evolve our specialist if needed.
If we're not the ones obviously our tele medicine practices,
we cannot see your blah blah, so don't.

Speaker 2 (01:07:44):
Yeah, I think you could upload it to the e MR.

Speaker 5 (01:07:48):
I mean, I'm just kidding it.

Speaker 6 (01:07:51):
But.

Speaker 2 (01:07:52):
Yeah, you know.

Speaker 3 (01:07:53):
And the problem is is then finding someone who actually
knows what they're doing and what they're looking and how
to examine it properly, and the Q TIP tests and
all that. But those are things that you're a menapaspecialist.
We'll talk to you about and tell you who to
look for and what to look for and the questions
to ask.

Speaker 4 (01:08:10):
Right and symptoms definitely do not get better with time.
And even though you may feel uncomfortable, you know bringing
it up. I know it's in my screening question, so
I always bring it up. It's something that you know,
we want to talk about it. I mean, most of

(01:08:31):
my patients first visit, they're leaving with vaginal estrogen, the
vest authority of them.

Speaker 5 (01:08:36):
So just ask for it. Everybody can have it, lots
of it.

Speaker 1 (01:08:40):
Yeah, And that black box label warning when you open
the package and you take out this massive piece of
paper that unfolds and it says, if you use this
cream you might get breast cancer, heart attacks, strokes, probable dementia.
That's all bullshit. You can tear it up, you can
throw it in the trash, you can do whatever you
want with it. That does not apply to your vaginal

(01:09:02):
estrogen cream.

Speaker 4 (01:09:03):
And then you should hand it back to the pharmacist. Yeah,
take it out, take it out and hand it back.

Speaker 2 (01:09:11):
Yeah.

Speaker 5 (01:09:12):
Here, I don't need it.

Speaker 1 (01:09:14):
And I think the key takeaway from today is talk
to your doctor. Bring this up with your doctor.

Speaker 2 (01:09:21):
Yep, yep, I love it all right, that's why we're here.
We're breaking the silence, one muffin at a.

Speaker 1 (01:09:29):
Time, one dusty muffins. It's taken us this long to
get to it, but we're here. We've got three dusty
muffins talking about dusty muffins.

Speaker 3 (01:09:38):
That's right, trying to prevent you all from having dusty muffins. Yes,
so that's you know, that's it. And we tell you guys,
remember when you listen to us, make sure that you'd
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All us on all the platforms. YouTube, if you want
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if you guys have questions and topics that you want

(01:09:59):
us to cover, give it some email or d m
us as well. We'd love to go over that kind
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sure that we get some podcasts on whatever y'all are
are thinking about talking about wanting to hear us talk about.

Speaker 5 (01:10:12):
Yeah, what's our email?

Speaker 4 (01:10:13):
Dusty Muffins Triple three at gmail dot com.

Speaker 1 (01:10:16):
Sorry, yah exactly. And leave a comment on the YouTube
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Speaker 3 (01:10:22):
Comment yes, yes, yes, so all right, guys, Lady is
always a good time always.

Speaker 2 (01:10:28):
Bye bye Muffins, Bye,