July 30, 2025 • 27 mins
There’s a prescription I think almost every woman should eventually be on, but most of them don’t know that it could improve their future. Things change as we age, but there’s no reason to suffer unnecessarily, especially when there are cheap and easy solutions that can help you live more as you get older, rather than less. If you want to improve your overall resilience while lowering your risk for urinary tract infections, urinary incontinence, vaginal dryness, pain with sex, and more, I think it’s worth your time to learn about vaginal estrogen and eliminate these problems before they even start.
come to my website: www.healthcouragecollective.com
email me: healthcouragecollective@gmail.com
Introduction: The Prescription Every Woman Should Know About
00:24 The Importance of Vaginal Estrogen
01:17 Personal Reflections and Exceptions
01:52 The Consequences of Ignoring Vaginal Health
05:14 Statistics and Realities of Women's Health Issues
09:07 Medical Community's Shortcomings
09:59 Understanding Vaginal Estrogen and Its Benefits
14:31 Challenges and Misconceptions in Prescribing Estrogen
16:09 Different Forms of Vaginal Estrogen
24:52 Compounded Products and Alternatives
26:15 Conclusion: Empowering Women with Knowledge
Are you ready to give your cells their best chance to not have to stop living before they die by allowing them access to physiologic levels of hormones, but aren't sure how to even get started? Join the waitlist for my new beta program here and help me figure out how best to help wonderful women like you get the hormone care they deserve!
Come visit me: www.healthcouragecollective.com
email me: healthcouragecollective@gmail.com
come to my website: www.healthcouragecollective.com
email me: healthcouragecollective@gmail.com
Introduction: The Prescription Every Woman Should Know About
00:24 The Importance of Vaginal Estrogen
01:17 Personal Reflections and Exceptions
01:52 The Consequences of Ignoring Vaginal Health
05:14 Statistics and Realities of Women's Health Issues
09:07 Medical Community's Shortcomings
09:59 Understanding Vaginal Estrogen and Its Benefits
14:31 Challenges and Misconceptions in Prescribing Estrogen
16:09 Different Forms of Vaginal Estrogen
24:52 Compounded Products and Alternatives
26:15 Conclusion: Empowering Women with Knowledge
Are you ready to give your cells their best chance to not have to stop living before they die by allowing them access to physiologic levels of hormones, but aren't sure how to even get started? Join the waitlist for my new beta program here and help me figure out how best to help wonderful women like you get the hormone care they deserve!
Come visit me: www.healthcouragecollective.com
email me: healthcouragecollective@gmail.com
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
There's a prescription. I think almost every woman should eventually
be on, but most of them don't know that it
could improve their future. Things change as we age, but
there's no reason to suffer unnecessarily, especially when there are
cheap and easy solutions that can help you live more
as you get older rather than less. If you want
(00:20):
to improve your overall resilience while lowering your risk for
urinary tract infections, urinary and continence, vaginal dryness, pain with sex,
and more, I think it's worth your time to learn
about vaginal estrogen and eliminate these problems before they even start.
You're listening to the Healthcarege Collective Podcast, Episode two hundred
(00:40):
and thirteen. Every woman should be on this prescription.
Speaker 2 (00:48):
Welcome to the Health Courage Collective podcast, the show for
women who are too busy to slog through hours of
generalized and applicable and often contradictory health information, but too
smart to ignore that a few minutes of focus attention
now can prevent years of separate in the future. I'm
your host, Christina Hackett, a pharmacist who doesn't want you
to live on prescriptions. A certified coach specifically trained to
(01:10):
maximize your potential and a compulsive learner obsessed with preventative,
cutting edge, holistic and integrated medicine. I'm on a mission
to increase your physical and mental resilience so you can
fearlessly look forward to your next forty plus limitless years.
Your time is now. Let's go.
Speaker 1 (01:30):
Hi, my friend, and welcome to the episode. I hope
everything is going well for you. How is your paranoia?
Have you been able to use a little inverse paranoia
this past week? What differences have you noticed when you
walk around believing that everything is orchestrated for your good.
As a pharmacist whose income depends on people filling lots
(01:54):
of prescriptions, I'm pretty adamant that I would love for
the vast majority of people to not take any medications
as a general rule, with some exceptions. This is my
number one exception. Well, you know, there are life threatening
situations in desperate emergencies and major conditions, so maybe that's
(02:16):
not a great way to put it, but I do
think that almost all women should be on this medication eventually.
Here's why. What if we lived in a world where
half of the population suddenly had a dramatic physiologic change
that resulted in a vastly increased risk of urinary tract infections,
urinary incontinence, bacterial infections, constant discomfort and pain with sex,
(02:40):
and even though there's a super easy and pretty cheap
prevention for all of these things, we tell them to
all just suck it up and deal with the consequences
of each of these five plus conditions separately. It is
crazy to me that this is the world we live in,
and I'm pretty sure if it were the other half
of the population that were all suddenly forced to deal
(03:01):
with the major daily life consequences of this change to
their physiology, it wouldn't be so ignored, which is pretty awful.
Urinary tract infections or UTIs provide you with burning pain
that is particularly disruptive to work, productivity, and sleep, and
in older people often presents with delirium, confusion, lethargy, loss
(03:25):
of appetite, or life threatening falls. They can even progress
to sepsis. Something else that is a very big deal
to me is that every course of antibiotics you have
to take wamps your microbiome and makes you way less
resilient in a big way. Being able to avoid a
course of antibiotics for any reason is a really big
(03:48):
win in my book, and I don't have to tell
you that urinary incontinence pretty much changes your life. Having
to wear bulky pads all the time, not knowing what
might happen or when, or feeling like you can never
be out of eyesight of a restroom can change what
experiences you say yes to, your perception of yourself, and
(04:08):
your sense of independence and personal power. Vaginal dryness can
cause general discomfort and pain like all the time, which
affects every aspect of your life, and it alters your
vaginal pH and vaginal microbiome, increasing your risk for bacterial
vaginosis and other problems, again, decreased resilience and increased risk
(04:31):
for having to take antibiotics. It can also lead to dysperunia,
which is pain before, during, or after sexual activity. Your
life satisfaction is affected when your personal relationships are affected,
and your relationship is definitely affected if one of your
ways to connect with your partner now causes sharp, throbbing, burning,
(04:52):
or aching pain, even if it's not outright painful, pleasure
and often desire is usually vast. Life decreased when there's
vaginal atrophy because there is a lot less blood flow
to the area. Again, not something I think men would
just passively accept as being off the table for them
once they reach a certain age, especially when it doesn't
(05:14):
have to be. We talked a little more about this
in episode one sixty six with Lanakur. If you want
to hear more about that. There aren't great exact and
specific numbers, but your risk of a UTI is somewhere
around twenty percent as a pre menopausal woman and somewhere
around fifty five percent after menopause. Again, I'm not sure
(05:35):
what exactly that means, like over the course of a
year or what. Don't know, but the risk more than
doubles that we know. There aren't great numbers for this either,
but seventy to thirty percent of pre menopausal women experience
urinarian continents, and according to what I found, eighty three
percent of women over age seventy have urinary in continence.
(05:58):
That's pretty shocking. There are other contributing factors to that,
but this is one piece to that puzzle. I know
an awesome pelvic floor physical therapist named Christina who I
might ask to come on the show if you feel
like it would benefit you to hear from her. Which
I think it would more fuzzy numbers. Risk of bacterial
vaginosis around thirty percent premenopause and forty to fifty seven
(06:22):
percent postmenopause. Faginal dryness is a problem for about seventeen
percent of women premenopause and at least fifty six percent
of women postmenopause, and dysperunia is about ten percent pre
menopause and fifty to eighty four percent postmenopause. Most women
(06:42):
don't try to get help for these issues from their
medical provider, and many of the ones who do are dismissed,
so they go about their lives silently, changing the physical
activities they're willing to participate in and the adventures they're
willing to take, feeling guilty about their participation or lack
thereof and their romancetic relationship, or disappointed in their experiences,
(07:04):
and taking antibiotics as often as the need arises, affecting
all areas of their health, including their mental and metabolic health,
but especially their immune system at a time when their
immune resilience is already declining. Why is this our reality?
It's infuriating you probably have some good theories. One could
(07:25):
be that since it's common. We just accept it as normal.
It's just part of aging, but it doesn't have to be.
Another could be that the medical establishment just knows more
about male genitals than female ones. That is a fact,
they are less complicated. Another theory could be that women
are better at suffering in silence than men, or that
(07:46):
historically women were labeled hysterical or whiny if they complained
about anything. But I think the biggest reason is that
the cheap, easy and effective solution to all of this
that I think almost every woman should eventually whose is
so embroiled in misinformed controversy and fear, that medical providers
are so unnecessarily and illogically terrified to the point that
(08:10):
they're not willing to see the clear evidence right in
front of them that they have the opportunity to help
women live better lives. Higher functioning, midlife and mature women
provide a gimungous benefit to society at large. Providing a
benefit to women who've had the time to accumulate wisdom
(08:32):
benefits everyone. The world is better for kids, elderly people, bookworms,
Kanye West, fans, Republicans, democrats, gamers, endangered animals, you name it.
Part of a longer discussion, but all of the increased
risks that we're talking about today can be reduced by
the use of vaginal estrogen. While medical providers have been
(08:55):
seriously misinformed and fearmongered into believing that there are huge
risks to prescribe having estrogen for women, they almost never
think to wonder what the risks of not prescribing it
to her are. Also part of a longer discussion we
won't get into today, but I think it's a good
question to consider for yourself. Are you concerned about the
risks of taking hormone replacement therapy? Good? That's good judgment.
(09:20):
It's good to be prudent and skeptical. But have you
considered the risks of not taking it? Because there are
a lot of them, a lot. But for today, we're
not talking about hormone replacement therapy. As much as I
enjoy doing that, not really. That's more systemic replacement of hormones.
When you use small doses of estrogen vaginally, the effect
(09:42):
stays localized to the genito urinary area, so you're not
getting more estrogen throughout your whole body, Your whole genito
urinary system, including your urethreat and bladder are very hormone sensitive.
Locally applied vaginal estrogen helps keep your vaginal pH where
(10:02):
it should be, decreasing your risk for bacterial vaginosis and
other infections. It cuts your risk for urinary tract infections
in half. Vaginal estrogen increases elasticity and strength of the
vaginal and urinary tract tissues, improving bladder control and regulating
bladder sensitivity, reducing urge in continence. It improves moisturization, blood flow,
(10:29):
and thickness of the vagina, reducing the chances of pain
with intercourse, and increasing pleasure and desire. According to an
awesome physician named Rachel Rubin, less than six percent of
internal medicine OBGIAN or family practice doctors get one hour
of menopause education in their medical training. These are the
very doctor's women rely on for care, and ninety four
(10:53):
percent of them got no training on how to do so.
No wonder they're reluctant to help. They haven't been taught.
How all they've been taught is that hormones are dangerous,
which was all based on an idiotic interpretation of one study.
The medical community should be embarrassed and ashamed that they're
so inept at caring for such a huge portion of
(11:16):
the population. Doctor Rachel Rubin once said women's health menopause
in particular, is important to nobody. When it's nobody's problem,
nobody takes ownership over it. End quote. It's true that
family medicine doctors, internal medicine doctors, even obgyns and rochronologists
aren't trained and don't consider themselves the person to treat
(11:40):
perimenopause and menopausal symptoms. So who does almost nobody? It's crazy.
I learned from doctor Rubin that this problem we're talking
about today used to be called the senile vagina. What
the heck, I'm not gonna say anything about that. The
name was changed to volvo vaginal atrophy or a trophic vaginitis.
(12:05):
Then the name was changed in twenty fourteen to genitourinary
syndrome of menopause, which is better because it's not just
a problem of vaginal dryness that can be corrected with
a lubricant. The bladder, urethra, vagina and everything in that
area is screaming out for hormones. Hormones reduce urinary urgency,
(12:25):
urinary frequency, urinary leakage, urinary tract infections, the vaginal pH
They improve vaginal moisture, blood flow, pleasure, the microbiome, and
ability to resist infections. Doctor Reubin published a study in
the Journal of Urology Practice in twenty twenty four that
showed that if Medicare patients used vaginal estrogen, we would
(12:47):
save Medicare six to twenty two billion dollars a year.
That's billion with a B twenty two billion dollars, and
she says that she thinks that's a pretty concern servative estimate. Hello,
low dose local vaginal estrogen or DHA reduces your risk
of urinary tract infections by more than half, plus all
(13:11):
of the other benefits of improved blood flow and reduced
dryness leading to more general comfort and better sexual function,
improved microbiome and pH leading to reduced risk of infection,
and reduced urinary urgency, frequency and leakage. The cost benefits
are staggering, but I think the quality of life benefits
are just as big. Feeling capable of doing whatever physical
(13:33):
activities tickle your fancy, not having to feel like you're
wearing a diaper, not having to always know where the
nearest bathroom is, being able to choose to be intimate
with your partner and not having to take antibiotics, not
to mention that when you're much older, the consequences of
a UTI are potentially deadly, like falls, delirium, and sepsis.
(13:54):
One of the reasons prescribers are reluctant to put women
on vaginal estrogen is because the official medication monographs contain
what are called black box warnings about seriously scary side effects.
They are definitely proven not to be true, but even
though they don't belong there, they're still there. It's a
(14:15):
whole politics of the FDA rabbit hole. But basically, the
medications contain the scariest warning possible to providers that they
cause blood clots, breast cancer and ametrial cancer, cardiovascular disease, dementia,
heart attacks, strokes, and pulmonary embolisms, even though they don't.
It's been proven that they don't. It's not even a
question anymore, but the warning is sticking around like flip
(14:38):
flops on a movie theater floor. To be clear, you
can get systemic or full body dosing of hormones placed vaginally,
but in the case of vaginal estrogen, the dose is
so tiny that it doesn't go anywhere else. If you've
heard of the dangers of taking systemic steroids like prednozone
or metyl pregnance alone or solvymetroolartexs zone, there are a
(15:01):
ton of side effects in dangers, and you really have
to be careful. I like how one doctor compared the
risk profile of vaginal estrogen kind of like the risk
between intravenous solumeedrol and over the counter hydrochordizone cream. Very similar,
but a much smaller dose locally applied and vastly different
(15:23):
risks and effects. So if you were to take systemic
estrogen for hormone replacement purposes, you'd probably get a dose
of estradile somewhere in the one to two milligram range.
There are a ton of factors that should go into
that decision, but that's just what would be considered quote
normal one to two milligrams. Vaginal estrogen tablets are ten micrograms,
(15:45):
so zero point zero one milligrams, or vaginal estrogen cream
a zero point one milligrams per gram or one hundred
micrograms or zero point one milligrams, so we're talking one
twentieth to one two hundredth of a normal systemic dose
applied locally. Those are the two main vaginal estrogen products.
(16:06):
I think about vage of M tablets, which are ten
micrograms of estradial income already in a vaginal applicator ready
to be inserted, and estrace cream, which is one hundred
micrograms per gram of cream and comes with a vaginal
applicator and you have to measure a certain amount of
cream into the applicator and insert that. They're both available
generically with a prescription in case you're interested, which you
(16:27):
probably aren't. Novo Nordisk made the original brand name Badge
of EM tablets, which were twenty five micrograms and were
sold brand name only, as all new drugs are in
the US at first, starting in nineteen ninety nine, they
enjoyed their ten years of insanely high brand name drug prices.
Then magically, ten years later, in November of two thousand
(16:49):
and nine, Novo Nordisk got a brand new patent for
ten microgram tablets. The story repeated everywhere is that they
care about women and they wanted to align with medical
recommendations to use the lowest effective dose, so new brand
name ten microgram tablets starting to be sold, and Novo
(17:10):
Nordisk discontinued badge Offem twenty five microgram July thirtieth, twenty ten,
so it never had an opportunity to get to a
point where a generic could be made, you know, because
big pharma cares about women. Anyway, It's been long enough
now that there are generic ten microgram vagafem tablets available.
(17:33):
The wagefem dose is to insert one ten microgram tablet
vaginally twice a week. The generic ones are around fifty
dollars for eight tablets. Brand name is like two hundred
dollars for eight, and some sort of generic brand called
uveafm is one hundred and sixty for eight. Most likely
your prescription insurance would help you pay for the generic version,
(17:54):
so you'd be just paying whatever your cope is. The
strace cream dose is around two of cream inserted vaginally
every night at bedtime for two weeks, and then one
to two grams of cream twice a week after that,
depending on how much you used. Your first tube would
last about two months, and the next tubes would last
longer than that. The generic is about forty dollars ish
(18:16):
for a tube that will last for two months or more.
The brand name is three hundred and sixty dollars a tube. Normally,
I'd say there's no reason not to use generic, but
there have historically been many problems with prescription drugs manufactured
in India. I hope it's getting better, but I'm not
totally sure that it is. The Glenmark generic version of
vagafem is likely made in India, the UVAFM might be,
(18:41):
and the Tiva could be, but might not be. As
Tiva makes drugs in Israel, Europe, Australia and South America.
The generic for s trace creams seem to be less
likely to be made in India. Pradagus brand is made
in Israel. Prasco says they manufacture in Ohio, and Alvagen
is in Romania, Korea and Taiwan, so just a little
(19:02):
food for thought there. There also exists Premarin vaginal cream
made of horse estrogen, and it's about two hundred and
fifty dollars a tube. I would say never use that
when you have bioidentical human estrogen options, because that's just stupid.
There is also a prescription called string, which is a
vaginal ring you insert and leave it there for ninety days.
(19:23):
That's also a good option. It contains two milligrams of
bioidentical estradiol that releases at an approximate rate of seven
point five micrograms per day for ninety days. It's a
ring that you insert vaginally and just stays there. You
don't feel it. You just have to remember to change
it every ninety days. The only rail downside to estring
is that it's still brand name only, so it's about
(19:45):
two hundred and fifty dollars for one ring, but there's
a good chance your insurance might help pay for part
of it. And to make things more confusing, there's a
different vaginal ring called femring that it's not bioidentical estradyle
and it is for whole body menopause symptoms, not just
genitourinary symptoms. There's also neuverring, which is totally different except
(20:05):
for that it's also an estrogen containing hormonal vaginal ring,
but neuverring is for birth control. Themorng and estring are
from enopause, but only es string is for vaginal genitourinary help.
There's something else interesting which is relatively new, called intrarosa.
It's a DHA vaginal insert kind of like a suppository
(20:26):
to be used vaginally. It has DHA in it. Maybe
we can talk more about DHA in the future, but
it's a steroid hormone that is often, but not always
included in bioidentical hormone replacement therapy. Send me have a
message at Healthcourage Collective at gmail dot com if you
want to know more about the hormone cascade or DHA.
Dha is upstream in the cascade, so it's the precursor
(20:48):
to testosterone and estrogen. So when you insert DHA vaginally,
it is converted to both testosterone and potentially multiple types
of estrogen, which is kind of cool. It's a prescription
only product approved for painful intercourse due to vaginal dryness
from menopause. Doctor Rachel Rubin published a study just a
(21:09):
couple months ago in March of twenty twenty five in
a journal called Menopause, showing that the DHA insert intra
rosa reduces the risk of UTIs by more than half,
same as estrogen does. But your vagina, vulvar, vestibule, clitoris,
and bladder all have androgen receptors in addition to estrogen receptors.
(21:33):
Androgens are testosterone related hormones, so while estrogen is good
for the genitourinary system of women, so is a little
bit of testosterone, which is why the precursor to both
of them, DHA, seems to be a great option. While
both BAGIFM and estrace are dosed twice a week, the
DHA insert intrarosa is recommended to be used every night
(21:57):
at bedtime. It's six point five miligrams of DA in
palm oil, so it's also moisturizing. My only problem with
intra Rosa is that DHA is super cheap, and we've
been compounding with it at my pharmacy forever, and you
can buy oral DHA over the counter very economically, but
intra Rosa is three hundred and thirty dollars for twenty
(22:18):
eight inserts and there's no generic yet and it's not
even approved for anything other than pain with intercourse. I've
never filled a prescription for it for someone, so I
don't know for sure, but I'd be surprised to see
an insurance company pay for it, at least not without
some kind of prior authorization. Mother may I process since
DHA is over the counter well in the US, but
(22:41):
not in Canada. In Canada, it's a tightly controlled prescription
only controlled substance. It looks like there are a couple
of over the counter DHA things you can buy on Amazon,
Jewelva vaginal cream and Bezwecan DHA inserts. I have no
idea if there are any, or they actually have any
(23:01):
DHA in them, or if they contain lead or grass
clippings or what the joys of the supplement world, but
it's possible that they're good. Now. I know that I'm
biased as a compounding pharmacist, but I really do believe
that getting a prescription for a compounded product would be
a great option. Here. There can be some sketchy, fly
(23:22):
by night compounding pharmacies, especially internet pharmacies, which is too
bad because it's really sad to have to have your
guard up trying to utilize what should be a trustworthy, honest,
and highly regulated healthcare establishment. It makes me crazy because
the pharmacies that I work out care a whole heck
of a lot about providing the best possible products to
(23:44):
their patients. If you had a good compounding pharmacy, a
compounded vaginal product could be really great. A little estra dial,
maybe even a little estreol, a different kind of younger
woman's estrogen, a bit of testosterone, maybe some DHA, and
it's special non irritating cream or suppository base. I think
it could be really great, and it would probably only
(24:06):
cost around forty or fifty dollars ISSH, depending on how
much you buy. Your insurance would almost certainly not pay
for it, though you'd also have to have a prescriber
willing to explore some unconventional options, which isn't always as
easy as it should be. Maybe we'll talk about the
benefits of vaginal testosterone or even systemic testosterone for life
(24:26):
women some other time. To sum up, I think vaginal
estrogen is a good thing, Vaginal DHA is good, and
vaginal estrogen and testosterone together plus or minus DHA is great.
I think almost every woman should eventually be on something
that provides estrogen vaginally. Every woman is unique, so there
might be someone somewhere who shouldn't take vaginal estrogen, but
(24:50):
I'm not quite sure who. There's likely something I'm overlooking,
But since tiny doses really don't get absorbed systemically, even
hormone positive breast cancer and other things that would give
us pause. In the realm of hormone replacement therapy doesn't apply.
Some questions you might have are when should I start
vaginal estrogen. I would say it's up to you and
(25:11):
your doctor, But if you're noticing vaginal dryness, it's probably
time to start. If you're in your late forties or older,
probably time to start. What about if you take systemic
hormone replacement therapy, You're getting estrogen progesteron a testosterone systemically
throughout your whole body and bloodstream. I'm a fan of that.
I have a you to me course teaching the basics
(25:33):
of biodentical hormone replacement therapy if you're interested. Even with
systemic treatment, though, there's a good chance that you might
still need a bit of vaginal estrogen and or a testosterone.
An extra ten micrograms of estradile placed vaginally twice a
week is not going to alter your estrogen levels, So
there's no kind of risk of overdosing on estrogen if
(25:53):
you already take it, and there's a good chance that
the hormone replacement you're on isn't going to be enough
to counter the effects of decreased estrogen and testosterone presence
in your bladder and genito urinary system. If you have
other questions, always send me a message at Healthcourage Collective
at gmail dot com and I will do my best
to answer you. Thank you so much for being here today.
(26:14):
I really care about you being able to give more
to the world as you get older and wiser, and
I think vaginal estrogen plus or minus testosterone and our
DHA is something that can help you to be stronger
and more independent as your estrogen levels naturally decrease. It
might seem like a small thing, but being more comfortable
reducing your risk of developing life changing urinary incontinence while
(26:38):
also avoiding life threatening infections and the resilience destroying consequences
of having to take antibiotics is huge. And I don't
think it's on most women's radar, but now it's on yours,
which is fantastic. Next week we're going to talk about
the problem with trying to fix your problems. Until then,
remember the importance of locally delivered estrogen to your genito
(27:01):
urinary health and it don't be normal. Thank you so
much for tuning into the Health Courage Collective podcast. I
am truly honored that you have paid me the enormous
compliment of your time and attention. I would be so
grateful if you would share this podcast with someone you
know and subscribe so you never miss an episode. This
podcast is for entertainment and information purposes only. Statements and
(27:24):
views on this podcast are not medical advice. This podcast, including.
Speaker 2 (27:28):
Christina Hackett and producers, disclaim responsibility for any possible adverse
events by use of information contained hearing. If you think
you have a medical problem, consult a licensed decision
There's a prescription. I think almost every woman should eventually
be on, but most of them don't know that it
could improve their future. Things change as we age, but
there's no reason to suffer unnecessarily, especially when there are
cheap and easy solutions that can help you live more
as you get older rather than less. If you want
(00:20):
to improve your overall resilience while lowering your risk for
urinary tract infections, urinary and continence, vaginal dryness, pain with sex,
and more, I think it's worth your time to learn
about vaginal estrogen and eliminate these problems before they even start.
You're listening to the Healthcarege Collective Podcast, Episode two hundred
(00:40):
and thirteen. Every woman should be on this prescription.
Speaker 2 (00:48):
Welcome to the Health Courage Collective podcast, the show for
women who are too busy to slog through hours of
generalized and applicable and often contradictory health information, but too
smart to ignore that a few minutes of focus attention
now can prevent years of separate in the future. I'm
your host, Christina Hackett, a pharmacist who doesn't want you
to live on prescriptions. A certified coach specifically trained to
(01:10):
maximize your potential and a compulsive learner obsessed with preventative,
cutting edge, holistic and integrated medicine. I'm on a mission
to increase your physical and mental resilience so you can
fearlessly look forward to your next forty plus limitless years.
Your time is now. Let's go.
Speaker 1 (01:30):
Hi, my friend, and welcome to the episode. I hope
everything is going well for you. How is your paranoia?
Have you been able to use a little inverse paranoia
this past week? What differences have you noticed when you
walk around believing that everything is orchestrated for your good.
As a pharmacist whose income depends on people filling lots
(01:54):
of prescriptions, I'm pretty adamant that I would love for
the vast majority of people to not take any medications
as a general rule, with some exceptions. This is my
number one exception. Well, you know, there are life threatening
situations in desperate emergencies and major conditions, so maybe that's
(02:16):
not a great way to put it, but I do
think that almost all women should be on this medication eventually.
Here's why. What if we lived in a world where
half of the population suddenly had a dramatic physiologic change
that resulted in a vastly increased risk of urinary tract infections,
urinary incontinence, bacterial infections, constant discomfort and pain with sex,
(02:40):
and even though there's a super easy and pretty cheap
prevention for all of these things, we tell them to
all just suck it up and deal with the consequences
of each of these five plus conditions separately. It is
crazy to me that this is the world we live in,
and I'm pretty sure if it were the other half
of the population that were all suddenly forced to deal
(03:01):
with the major daily life consequences of this change to
their physiology, it wouldn't be so ignored, which is pretty awful.
Urinary tract infections or UTIs provide you with burning pain
that is particularly disruptive to work, productivity, and sleep, and
in older people often presents with delirium, confusion, lethargy, loss
(03:25):
of appetite, or life threatening falls. They can even progress
to sepsis. Something else that is a very big deal
to me is that every course of antibiotics you have
to take wamps your microbiome and makes you way less
resilient in a big way. Being able to avoid a
course of antibiotics for any reason is a really big
(03:48):
win in my book, and I don't have to tell
you that urinary incontinence pretty much changes your life. Having
to wear bulky pads all the time, not knowing what
might happen or when, or feeling like you can never
be out of eyesight of a restroom can change what
experiences you say yes to, your perception of yourself, and
(04:08):
your sense of independence and personal power. Vaginal dryness can
cause general discomfort and pain like all the time, which
affects every aspect of your life, and it alters your
vaginal pH and vaginal microbiome, increasing your risk for bacterial
vaginosis and other problems, again, decreased resilience and increased risk
(04:31):
for having to take antibiotics. It can also lead to dysperunia,
which is pain before, during, or after sexual activity. Your
life satisfaction is affected when your personal relationships are affected,
and your relationship is definitely affected if one of your
ways to connect with your partner now causes sharp, throbbing, burning,
(04:52):
or aching pain, even if it's not outright painful, pleasure
and often desire is usually vast. Life decreased when there's
vaginal atrophy because there is a lot less blood flow
to the area. Again, not something I think men would
just passively accept as being off the table for them
once they reach a certain age, especially when it doesn't
(05:14):
have to be. We talked a little more about this
in episode one sixty six with Lanakur. If you want
to hear more about that. There aren't great exact and
specific numbers, but your risk of a UTI is somewhere
around twenty percent as a pre menopausal woman and somewhere
around fifty five percent after menopause. Again, I'm not sure
(05:35):
what exactly that means, like over the course of a
year or what. Don't know, but the risk more than
doubles that we know. There aren't great numbers for this either,
but seventy to thirty percent of pre menopausal women experience
urinarian continents, and according to what I found, eighty three
percent of women over age seventy have urinary in continence.
(05:58):
That's pretty shocking. There are other contributing factors to that,
but this is one piece to that puzzle. I know
an awesome pelvic floor physical therapist named Christina who I
might ask to come on the show if you feel
like it would benefit you to hear from her. Which
I think it would more fuzzy numbers. Risk of bacterial
vaginosis around thirty percent premenopause and forty to fifty seven
(06:22):
percent postmenopause. Faginal dryness is a problem for about seventeen
percent of women premenopause and at least fifty six percent
of women postmenopause, and dysperunia is about ten percent pre
menopause and fifty to eighty four percent postmenopause. Most women
(06:42):
don't try to get help for these issues from their
medical provider, and many of the ones who do are dismissed,
so they go about their lives silently, changing the physical
activities they're willing to participate in and the adventures they're
willing to take, feeling guilty about their participation or lack
thereof and their romancetic relationship, or disappointed in their experiences,
(07:04):
and taking antibiotics as often as the need arises, affecting
all areas of their health, including their mental and metabolic health,
but especially their immune system at a time when their
immune resilience is already declining. Why is this our reality?
It's infuriating you probably have some good theories. One could
(07:25):
be that since it's common. We just accept it as normal.
It's just part of aging, but it doesn't have to be.
Another could be that the medical establishment just knows more
about male genitals than female ones. That is a fact,
they are less complicated. Another theory could be that women
are better at suffering in silence than men, or that
(07:46):
historically women were labeled hysterical or whiny if they complained
about anything. But I think the biggest reason is that
the cheap, easy and effective solution to all of this
that I think almost every woman should eventually whose is
so embroiled in misinformed controversy and fear, that medical providers
are so unnecessarily and illogically terrified to the point that
(08:10):
they're not willing to see the clear evidence right in
front of them that they have the opportunity to help
women live better lives. Higher functioning, midlife and mature women
provide a gimungous benefit to society at large. Providing a
benefit to women who've had the time to accumulate wisdom
(08:32):
benefits everyone. The world is better for kids, elderly people, bookworms,
Kanye West, fans, Republicans, democrats, gamers, endangered animals, you name it.
Part of a longer discussion, but all of the increased
risks that we're talking about today can be reduced by
the use of vaginal estrogen. While medical providers have been
(08:55):
seriously misinformed and fearmongered into believing that there are huge
risks to prescribe having estrogen for women, they almost never
think to wonder what the risks of not prescribing it
to her are. Also part of a longer discussion we
won't get into today, but I think it's a good
question to consider for yourself. Are you concerned about the
risks of taking hormone replacement therapy? Good? That's good judgment.
(09:20):
It's good to be prudent and skeptical. But have you
considered the risks of not taking it? Because there are
a lot of them, a lot. But for today, we're
not talking about hormone replacement therapy. As much as I
enjoy doing that, not really. That's more systemic replacement of hormones.
When you use small doses of estrogen vaginally, the effect
(09:42):
stays localized to the genito urinary area, so you're not
getting more estrogen throughout your whole body, Your whole genito
urinary system, including your urethreat and bladder are very hormone sensitive.
Locally applied vaginal estrogen helps keep your vaginal pH where
(10:02):
it should be, decreasing your risk for bacterial vaginosis and
other infections. It cuts your risk for urinary tract infections
in half. Vaginal estrogen increases elasticity and strength of the
vaginal and urinary tract tissues, improving bladder control and regulating
bladder sensitivity, reducing urge in continence. It improves moisturization, blood flow,
(10:29):
and thickness of the vagina, reducing the chances of pain
with intercourse, and increasing pleasure and desire. According to an
awesome physician named Rachel Rubin, less than six percent of
internal medicine OBGIAN or family practice doctors get one hour
of menopause education in their medical training. These are the
very doctor's women rely on for care, and ninety four
(10:53):
percent of them got no training on how to do so.
No wonder they're reluctant to help. They haven't been taught.
How all they've been taught is that hormones are dangerous,
which was all based on an idiotic interpretation of one study.
The medical community should be embarrassed and ashamed that they're
so inept at caring for such a huge portion of
(11:16):
the population. Doctor Rachel Rubin once said women's health menopause
in particular, is important to nobody. When it's nobody's problem,
nobody takes ownership over it. End quote. It's true that
family medicine doctors, internal medicine doctors, even obgyns and rochronologists
aren't trained and don't consider themselves the person to treat
(11:40):
perimenopause and menopausal symptoms. So who does almost nobody? It's crazy.
I learned from doctor Rubin that this problem we're talking
about today used to be called the senile vagina. What
the heck, I'm not gonna say anything about that. The
name was changed to volvo vaginal atrophy or a trophic vaginitis.
(12:05):
Then the name was changed in twenty fourteen to genitourinary
syndrome of menopause, which is better because it's not just
a problem of vaginal dryness that can be corrected with
a lubricant. The bladder, urethra, vagina and everything in that
area is screaming out for hormones. Hormones reduce urinary urgency,
(12:25):
urinary frequency, urinary leakage, urinary tract infections, the vaginal pH
They improve vaginal moisture, blood flow, pleasure, the microbiome, and
ability to resist infections. Doctor Reubin published a study in
the Journal of Urology Practice in twenty twenty four that
showed that if Medicare patients used vaginal estrogen, we would
(12:47):
save Medicare six to twenty two billion dollars a year.
That's billion with a B twenty two billion dollars, and
she says that she thinks that's a pretty concern servative estimate. Hello,
low dose local vaginal estrogen or DHA reduces your risk
of urinary tract infections by more than half, plus all
(13:11):
of the other benefits of improved blood flow and reduced
dryness leading to more general comfort and better sexual function,
improved microbiome and pH leading to reduced risk of infection,
and reduced urinary urgency, frequency and leakage. The cost benefits
are staggering, but I think the quality of life benefits
are just as big. Feeling capable of doing whatever physical
(13:33):
activities tickle your fancy, not having to feel like you're
wearing a diaper, not having to always know where the
nearest bathroom is, being able to choose to be intimate
with your partner and not having to take antibiotics, not
to mention that when you're much older, the consequences of
a UTI are potentially deadly, like falls, delirium, and sepsis.
(13:54):
One of the reasons prescribers are reluctant to put women
on vaginal estrogen is because the official medication monographs contain
what are called black box warnings about seriously scary side effects.
They are definitely proven not to be true, but even
though they don't belong there, they're still there. It's a
(14:15):
whole politics of the FDA rabbit hole. But basically, the
medications contain the scariest warning possible to providers that they
cause blood clots, breast cancer and ametrial cancer, cardiovascular disease, dementia,
heart attacks, strokes, and pulmonary embolisms, even though they don't.
It's been proven that they don't. It's not even a
question anymore, but the warning is sticking around like flip
(14:38):
flops on a movie theater floor. To be clear, you
can get systemic or full body dosing of hormones placed vaginally,
but in the case of vaginal estrogen, the dose is
so tiny that it doesn't go anywhere else. If you've
heard of the dangers of taking systemic steroids like prednozone
or metyl pregnance alone or solvymetroolartexs zone, there are a
(15:01):
ton of side effects in dangers, and you really have
to be careful. I like how one doctor compared the
risk profile of vaginal estrogen kind of like the risk
between intravenous solumeedrol and over the counter hydrochordizone cream. Very similar,
but a much smaller dose locally applied and vastly different
(15:23):
risks and effects. So if you were to take systemic
estrogen for hormone replacement purposes, you'd probably get a dose
of estradile somewhere in the one to two milligram range.
There are a ton of factors that should go into
that decision, but that's just what would be considered quote
normal one to two milligrams. Vaginal estrogen tablets are ten micrograms,
(15:45):
so zero point zero one milligrams, or vaginal estrogen cream
a zero point one milligrams per gram or one hundred
micrograms or zero point one milligrams, so we're talking one
twentieth to one two hundredth of a normal systemic dose
applied locally. Those are the two main vaginal estrogen products.
(16:06):
I think about vage of M tablets, which are ten
micrograms of estradial income already in a vaginal applicator ready
to be inserted, and estrace cream, which is one hundred
micrograms per gram of cream and comes with a vaginal
applicator and you have to measure a certain amount of
cream into the applicator and insert that. They're both available
generically with a prescription in case you're interested, which you
(16:27):
probably aren't. Novo Nordisk made the original brand name Badge
of EM tablets, which were twenty five micrograms and were
sold brand name only, as all new drugs are in
the US at first, starting in nineteen ninety nine, they
enjoyed their ten years of insanely high brand name drug prices.
Then magically, ten years later, in November of two thousand
(16:49):
and nine, Novo Nordisk got a brand new patent for
ten microgram tablets. The story repeated everywhere is that they
care about women and they wanted to align with medical
recommendations to use the lowest effective dose, so new brand
name ten microgram tablets starting to be sold, and Novo
(17:10):
Nordisk discontinued badge Offem twenty five microgram July thirtieth, twenty ten,
so it never had an opportunity to get to a
point where a generic could be made, you know, because
big pharma cares about women. Anyway, It's been long enough
now that there are generic ten microgram vagafem tablets available.
(17:33):
The wagefem dose is to insert one ten microgram tablet
vaginally twice a week. The generic ones are around fifty
dollars for eight tablets. Brand name is like two hundred
dollars for eight, and some sort of generic brand called
uveafm is one hundred and sixty for eight. Most likely
your prescription insurance would help you pay for the generic version,
(17:54):
so you'd be just paying whatever your cope is. The
strace cream dose is around two of cream inserted vaginally
every night at bedtime for two weeks, and then one
to two grams of cream twice a week after that,
depending on how much you used. Your first tube would
last about two months, and the next tubes would last
longer than that. The generic is about forty dollars ish
(18:16):
for a tube that will last for two months or more.
The brand name is three hundred and sixty dollars a tube. Normally,
I'd say there's no reason not to use generic, but
there have historically been many problems with prescription drugs manufactured
in India. I hope it's getting better, but I'm not
totally sure that it is. The Glenmark generic version of
vagafem is likely made in India, the UVAFM might be,
(18:41):
and the Tiva could be, but might not be. As
Tiva makes drugs in Israel, Europe, Australia and South America.
The generic for s trace creams seem to be less
likely to be made in India. Pradagus brand is made
in Israel. Prasco says they manufacture in Ohio, and Alvagen
is in Romania, Korea and Taiwan, so just a little
(19:02):
food for thought there. There also exists Premarin vaginal cream
made of horse estrogen, and it's about two hundred and
fifty dollars a tube. I would say never use that
when you have bioidentical human estrogen options, because that's just stupid.
There is also a prescription called string, which is a
vaginal ring you insert and leave it there for ninety days.
(19:23):
That's also a good option. It contains two milligrams of
bioidentical estradiol that releases at an approximate rate of seven
point five micrograms per day for ninety days. It's a
ring that you insert vaginally and just stays there. You
don't feel it. You just have to remember to change
it every ninety days. The only rail downside to estring
is that it's still brand name only, so it's about
(19:45):
two hundred and fifty dollars for one ring, but there's
a good chance your insurance might help pay for part
of it. And to make things more confusing, there's a
different vaginal ring called femring that it's not bioidentical estradyle
and it is for whole body menopause symptoms, not just
genitourinary symptoms. There's also neuverring, which is totally different except
(20:05):
for that it's also an estrogen containing hormonal vaginal ring,
but neuverring is for birth control. Themorng and estring are
from enopause, but only es string is for vaginal genitourinary help.
There's something else interesting which is relatively new, called intrarosa.
It's a DHA vaginal insert kind of like a suppository
(20:26):
to be used vaginally. It has DHA in it. Maybe
we can talk more about DHA in the future, but
it's a steroid hormone that is often, but not always
included in bioidentical hormone replacement therapy. Send me have a
message at Healthcourage Collective at gmail dot com if you
want to know more about the hormone cascade or DHA.
Dha is upstream in the cascade, so it's the precursor
(20:48):
to testosterone and estrogen. So when you insert DHA vaginally,
it is converted to both testosterone and potentially multiple types
of estrogen, which is kind of cool. It's a prescription
only product approved for painful intercourse due to vaginal dryness
from menopause. Doctor Rachel Rubin published a study just a
(21:09):
couple months ago in March of twenty twenty five in
a journal called Menopause, showing that the DHA insert intra
rosa reduces the risk of UTIs by more than half,
same as estrogen does. But your vagina, vulvar, vestibule, clitoris,
and bladder all have androgen receptors in addition to estrogen receptors.
(21:33):
Androgens are testosterone related hormones, so while estrogen is good
for the genitourinary system of women, so is a little
bit of testosterone, which is why the precursor to both
of them, DHA, seems to be a great option. While
both BAGIFM and estrace are dosed twice a week, the
DHA insert intrarosa is recommended to be used every night
(21:57):
at bedtime. It's six point five miligrams of DA in
palm oil, so it's also moisturizing. My only problem with
intra Rosa is that DHA is super cheap, and we've
been compounding with it at my pharmacy forever, and you
can buy oral DHA over the counter very economically, but
intra Rosa is three hundred and thirty dollars for twenty
(22:18):
eight inserts and there's no generic yet and it's not
even approved for anything other than pain with intercourse. I've
never filled a prescription for it for someone, so I
don't know for sure, but I'd be surprised to see
an insurance company pay for it, at least not without
some kind of prior authorization. Mother may I process since
DHA is over the counter well in the US, but
(22:41):
not in Canada. In Canada, it's a tightly controlled prescription
only controlled substance. It looks like there are a couple
of over the counter DHA things you can buy on Amazon,
Jewelva vaginal cream and Bezwecan DHA inserts. I have no
idea if there are any, or they actually have any
(23:01):
DHA in them, or if they contain lead or grass
clippings or what the joys of the supplement world, but
it's possible that they're good. Now. I know that I'm
biased as a compounding pharmacist, but I really do believe
that getting a prescription for a compounded product would be
a great option. Here. There can be some sketchy, fly
(23:22):
by night compounding pharmacies, especially internet pharmacies, which is too
bad because it's really sad to have to have your
guard up trying to utilize what should be a trustworthy, honest,
and highly regulated healthcare establishment. It makes me crazy because
the pharmacies that I work out care a whole heck
of a lot about providing the best possible products to
(23:44):
their patients. If you had a good compounding pharmacy, a
compounded vaginal product could be really great. A little estra dial,
maybe even a little estreol, a different kind of younger
woman's estrogen, a bit of testosterone, maybe some DHA, and
it's special non irritating cream or suppository base. I think
it could be really great, and it would probably only
(24:06):
cost around forty or fifty dollars ISSH, depending on how
much you buy. Your insurance would almost certainly not pay
for it, though you'd also have to have a prescriber
willing to explore some unconventional options, which isn't always as
easy as it should be. Maybe we'll talk about the
benefits of vaginal testosterone or even systemic testosterone for life
(24:26):
women some other time. To sum up, I think vaginal
estrogen is a good thing, Vaginal DHA is good, and
vaginal estrogen and testosterone together plus or minus DHA is great.
I think almost every woman should eventually be on something
that provides estrogen vaginally. Every woman is unique, so there
might be someone somewhere who shouldn't take vaginal estrogen, but
(24:50):
I'm not quite sure who. There's likely something I'm overlooking,
But since tiny doses really don't get absorbed systemically, even
hormone positive breast cancer and other things that would give
us pause. In the realm of hormone replacement therapy doesn't apply.
Some questions you might have are when should I start
vaginal estrogen. I would say it's up to you and
(25:11):
your doctor, But if you're noticing vaginal dryness, it's probably
time to start. If you're in your late forties or older,
probably time to start. What about if you take systemic
hormone replacement therapy, You're getting estrogen progesteron a testosterone systemically
throughout your whole body and bloodstream. I'm a fan of that.
I have a you to me course teaching the basics
(25:33):
of biodentical hormone replacement therapy if you're interested. Even with
systemic treatment, though, there's a good chance that you might
still need a bit of vaginal estrogen and or a testosterone.
An extra ten micrograms of estradile placed vaginally twice a
week is not going to alter your estrogen levels, So
there's no kind of risk of overdosing on estrogen if
(25:53):
you already take it, and there's a good chance that
the hormone replacement you're on isn't going to be enough
to counter the effects of decreased estrogen and testosterone presence
in your bladder and genito urinary system. If you have
other questions, always send me a message at Healthcourage Collective
at gmail dot com and I will do my best
to answer you. Thank you so much for being here today.
(26:14):
I really care about you being able to give more
to the world as you get older and wiser, and
I think vaginal estrogen plus or minus testosterone and our
DHA is something that can help you to be stronger
and more independent as your estrogen levels naturally decrease. It
might seem like a small thing, but being more comfortable
reducing your risk of developing life changing urinary incontinence while
(26:38):
also avoiding life threatening infections and the resilience destroying consequences
of having to take antibiotics is huge. And I don't
think it's on most women's radar, but now it's on yours,
which is fantastic. Next week we're going to talk about
the problem with trying to fix your problems. Until then,
remember the importance of locally delivered estrogen to your genito
(27:01):
urinary health and it don't be normal. Thank you so
much for tuning into the Health Courage Collective podcast. I
am truly honored that you have paid me the enormous
compliment of your time and attention. I would be so
grateful if you would share this podcast with someone you
know and subscribe so you never miss an episode. This
podcast is for entertainment and information purposes only. Statements and
(27:24):
views on this podcast are not medical advice. This podcast, including.
Speaker 2 (27:28):
Christina Hackett and producers, disclaim responsibility for any possible adverse
events by use of information contained hearing. If you think
you have a medical problem, consult a licensed decision
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