Vaginal Estrogen Explained: The Often Overlooked Menopause Option - Episode 303

I break the silence around vaginal atrophy, share the research behind local estrogen, and explain why systemic HRT often misses this common, under-treated problem. I compare a couple of creams, DHEA, and low-dose estradiol inserts, and share practical steps for personalized care.

• defining vaginal atrophy and why it accelerates after menopause
• how estrogen loss drives dryness, pain, urgency, and infections
• why systemic HRT often fails to restore vaginal tissue
• estriol versus estradiol: forms, dosing, and convenience
• safety and systemic absorption with low-dose vaginal estrogen
• UTI risk reduction and pelvic floor benefits
• off-label DHEA and testosterone: where they may fit
• finding knowledgeable clinicians and tailoring therapy
• personal outcomes with estradiol inserts and symptom relief

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Chapters

• 0:00 Setting The Stage On Menopause
• 2:27 What Vaginal Atrophy Really Is
• 4:20 Credentials And A Listener’s Question
• 7:10 Estrogen Types And Skin Changes
• 10:56 How Common And Under-Treated It Is
• 13:36 Why Systemic HRT Isn’t Enough
• 16:43 DHEA, Testosterone, And Estriol Trials
• 20:37 Switching To Estradiol Inserts

Transcript

Sandy Kruse: 0:01

Hi everyone, it's me, Sandy Cruz of Sandy K Nutrition, Health and Lifestyle Queen. For years now, I've been bringing to you conversations about wellness from experts from all over the world. Whether it be suggestions in how you can age better, biohacking, alternative wellness, these are conversations to help you live your best life. I want to live a long, healthy, vibrant life. Never mind all those stigmas that as we reach midlife and beyond, we're just gonna shrivel up and die with some horrible disease. Always remember, balanced living works. Today I'm gonna talk all about vaginal estrogen. I'm gonna provide you with a lot of information that is not like publicly okay, I shouldn't say it's not publicly available. It's all publicly available. It's just that you have to dig deep, you have to find the research just to understand how important this topic is for a woman in menopause. So I'm gonna talk all about it from what's out there in the research as well as my personal perspective. I'm 55 years old and I entered menopause officially. It would be in March of 2025, where I hit the one year of no periods. It's this magical one year. Apparently, they they started doing this way back when, just to be able to identify when there's absolutely no chance of conception. Anyway, the fact is that early stages of menopause starts way before that. Um, and I began having symptoms at age 52, officially entered official menopause at age 55. So the one thing that, you know, everyone talks about is the hot flashes and you know, the mood issues, depression, anxiety, all of that. But what's not talked about is supporting the vaginal tissue. It's typically more after you reach menopause. And again, I'm speaking from a personal perspective. When you're in the latter stages of perimenopause, you might have like vaginal dryness here and there, you may have UTIs now and again, you may have yeast infections, all these kinds of things that you're like, what? Like, why is this happening? I never really had a problem. It is all related to not always, but you know, a lot of the reasons this is happening is because the vaginal tissues are beginning to atrophy. So I'm gonna be looking at some of my notes here because it's really important to get this right for you. So, what is atrophy? Atrophy is basically the thinning of the vaginal and urethral tissues, and those tissues are very, very high in estrogen receptors. So, this is why when you get closer to menopause, you'll notice more of the dryness, more of these symptoms. And I'm gonna preface this also just by saying I am a registered holistic nutritionist. I am the podcast host of Sandy K Nutrition Health and Lifestyle Queen. It's been around for almost six years, February. I'll hit six years. I am not a doctor. And anything that I talk about here is for you to take this information to your own practitioner. Okay. And I have to read this to you. And this really just made me, it made me realize that I've got to record about this because it was enough just to make my skin crawl. So I'm gonna read this to you. This is from my podcast, Sandy K Nutrition, Health and Lifestyle Queen. Hi, Ms. Cruz. I am just listening to the episode 282. I live in Canada, so this may alter your answers. My question is with vaginal estrogen. I was just prescribed primer vaginal estrogen cream. Is this safe? The doctor on your podcast just said don't put horse urine into your body. That's what primerin is, okay? It comes from like a conjugated or something, horse urine. I have asked my pharmacist if there is a biosimilar vaginal cream, and she said no. But maybe that's just her saying that because she isn't very nice. Ha ha, please help if you can. So right there, that's enough for me to call that pharmacist out either by lying or by not simply stating, I'm not sure. If you don't know the answer, say I'm not sure. Check with your doctor, your prescriber, whoever it is, because that kind of misinformation is what causes women to just send random messages to podcasters like me because they don't know where to go. As you can see, I'm really passionate about this because vaginal atrophy is a very big topic, especially once a woman reaches full menopause, post-menopause, even elderly. I'm gonna break down some of the research. You're gonna be shocked. So before I begin, I'm gonna say there's three different types of estrogen, the main estrogens. There's estriol, that's the one that I use on my face. I've I've had some of my reels and TikToks go viral because I've talked about this. And I started talking about this at age 52. It's been many years that I've been using it. That's why I have the glow. That's why I don't have the crisscross crepey skin that you see. I call it estrogen skin, no offense to anybody, but it happens. It's when that, it's like your skin becomes so thin and it's like tissue paper, and it looks like there's little tiny crisscrosses. That is a drop in estrogen, my friends. And while we can't, you know, we can't avoid all the wrinkles. I mean, we're gonna we're gonna age and we choose how we want to age, but um, good skin is something that you know I want to have forever. Anyway, so there's estriol, that's the weaker, there's estradiol, and then there's estrone. So when we look to vaginal estrogens, we kind of have we have a few choices. We can go with the horse urine, um, or we can go with biosimilar estrogen or estriol. So that when it comes to symptoms, vaginal atrophy symptoms of menopause, the symptoms are up to 90% in women. Okay, and 50% are clinically significant. And then the problem is that less than 25% of the women actually get help. Many don't even report it if they've got symptoms, if it's not bad enough. Some will just assume it's just part of aging, and you know, that's an answer I just don't really accept personally. Um, you know, some of the symptoms are the dryness, the burning, itching, painful sex, um, urinary urgency, and incontinence. Yes, ladies, a lot of you who go and get the bladder sling surgery, you know, because you can't do a jumping jack without peeing yourself, or you're like, you know, thinking that depends is where you're gonna be at as you age post-menopause. I'm not saying I know what your situation is, and this isn't to shame anyone, but what I am saying is that vaginal estrogen might help you. So I don't have any issues of incontinence, however, I do have urgency issues, which means I just gotta pee a lot, you know, but then I drink a lot of water too. So there's that. But by 10 years post-menopause, so closer to ages um 60 and up, 100% have objective signs of atrophy. And this is according to a 2018 review, which basically indicates the signs are progressive and chronic. So, my whole point is you might be in perimenopause and you're like, eh, it's not so bad, just occasional dryness, not a big deal. You know, we can use lube, it's fine, but then you get to a point where the lube isn't good enough, you start to experience the burning, you start to get UTIs, you start to have issues with, you know, yeast infections because the microbiome, the pH, everything's off. And that's what happens when estrogen declines severely in the vaginal tissues. So then you might go, okay, that's fine. You know, um, I don't need to worry about that because I plan to take bioidentical hormone replacement therapy. Well, my beauties, that does not usually, in most cases, address the issues of vaginal atrophy. So basically, it might help you with the hot flashes, it might help you with the mood and the depression and the anxiety, but and the and the bones. We can't forget the bones and all the other good stuff that can happen when you start taking HRT, bioidentical. The vaginal atrophy is a separate issue because remember what I said at the beginning, we have a lot of estrogen receptors in our vagina. And when that declines, um, taking a systemic bioidentical hormone replacement therapy will likely not address that. So, to recap, this thinning of tissues weakens the pelvis. So you could have, you know, pelvic floor, more pelvic floor issues, is it weakens the pelvic supports, it raises pH and creates a fertile environment for bacterial invasion as well. So UTIs, BV, bacterial vaginosis, um, yeast, urinary issues, all of those things can happen. It can get worse and worse the farther away from you know how far out you are from menopause. So there's a few issues. Now, I'm gonna this is where I'm gonna talk about there. There is DHEA. Some will use DHEA. Um and what I will say is that I think that's off-label use. I don't think it's common, but it can help in some areas. Some will even use topical testosterone. Um, I've also heard of this as well, but you know, these are off-label. I have I have used vaginal DHEA, and personally, I didn't notice enough from it. And remember, I started off with this about a year ago. So, what this is, is this is a cream. It's bioidentical, and it is estriol. The one that I have here is 0.4 percent. You know, you just use it as needed, but and it was fine about a year before that one year magical, I am finally an estro, uh, sorry, menopause mark. It was fine until then. And then more recently, what I found I had to use it more often, it's kind of messy, it's you know, it's just not cutting it. Because what I feel is with this, there's no actual restoration. Fact is, is that I do not want to be dried up. And here I'm gonna tell you guys a story, and you guys might be like, oh god, I went to one event once, and and I was only young, like I I think I was like 35, and some older man who had clearly had too much to drink, he came up to me and we just started chatting. I thought, okay, we're just having a good chat. Then he starts telling me that, you know, once you get older, your vagina dries up and closes off. I'm not kidding you. I'm like, oh my god, this dude had too much to drink. I was so like, I was taken aback, but I'm like, why is this guy telling me about his wife's vagina? Like it was just so weird and so off-putting. And then I and then of course I was like 35. I'm like, does that really happen, or is this guy just drunk? So I have known some women who can't even have a pap done because it's so excruciatingly painful. So um it does happen. I think you know, everybody has different extremes. I think that it depends on so many different factors, but it does happen. And getting to that point is somewhere where I'm just not interested in going to. Talked about the topical estriol. I have tried DHEA topically, and you know, like these things, I feel like they're just temporary, like they don't actually fix. Like, I keep having it put the cream, I keep, and I'm like, just give me something that's gonna actually restore the tissue so it doesn't feel dry. So I started using this one. This is called, this is, I think it's available in North America. You can check wherever you are. It's called Invexy. And what the the dose that I have is 10 micrograms. This is estradiol. It's the more potent of the three estrogens, and nobody ever uses estrone. That's not one. So, what this is, is they're tiny, tiny little like suppositories. They look like the top of an eraser. You use this for 10 days, and and then you only use it twice a week for maintenance, and that's it. No like really messy creams, it does dissolve overnight, but basically, what it's doing is it's kind of restoring the area, and then you got to kind of keep it up. So I am quite frankly amazed. I feel like it really does what you want it to do. Now, I know that there's um estradyl rings and things like that you can look into. You can check with your practitioner, but you want bioidentical estrogen. Now, whether you're at that point of using just estriol, and if that's enough for you, um, you know, for me, it was fine until I entered full menopause, then I needed to up, I needed to level up. So a big thing that women ask is does this absorb into the bloodstream? And I think that's an important question because some women may choose to not do hormone replacement, some can't, for whatever your reasons are. I don't know. But the fact of the matter is, is you might say, okay, well, I don't want to take systemic hormone replacement therapy, but I know that estrogen will help with incontinence and urgency and all of that. And by the way, it's amazing how much this has helped me with urgency, which is what I was saying. So I didn't have incontinence, but I just constantly would have to pee. So I can hold my pee better and longer. That that's an absolute for sure. So if you're worried about systemic absorption, I can tell you the research shows that very little is absorbed systemically. Again, you would have to see with your own practitioner if you know what's right for you and what you choose. The estriol cream will absorb less than the estradiol vaginal um inserts, but both definitely don't absorb the same way as hormone replacement therapy. Now I I want to talk about UTIs. So recurrent UTIs can be a massive problem for women. I personally have never really had that, but when I started to dig into the research, I was like, oh my God. Like the elderly, you know, like over 90, like 305 per 100,000 die of UTIs. We know that vaginal estrogen users had a 58% lower risk of recurrent UTIs. I don't really understand this. I don't understand the whole medical system on why a practitioner who knows you would not prescribe vaginal estrogen unless you have your own personal contraindication for not doing so. My aunt died of uterine cancer and colon. By the time they found it, they couldn't tell where it began. I believe that there is a safe way to do hormones, and one of the safest ways is to have a practitioner who knows you. Not only who knows you, but who is educated in hormone replacement therapy. So in Canada, we did not have this until pretty recently. We have an institution they're called Science and Humans. I have a nurse practitioner that I work with. She checks my blood work every three months and checks for anomalies, symptoms, everything, and really works to customize my hormone replacement therapy, which is key. We are not robots, we are humans. So I think this is very, very important. And I hope that this helped. Please, if it did, I would love for you to share this, but it's that important because as you know, I'm always about passion over profit. I want people to learn so that they ask the right questions. And I'm not telling you or giving you advice. I'm giving you information for you to take to a practitioner who is A qualified and B who knows you personally. Anyway, I hope that helps. Thank you, thank you, thank you. Leave me some comments, likes, whatever if you find that it helps, and share this with a friend. Have a good day. And always remember when you rate, review, subscribe, you help to support my content and help me to keep going and bring these conversations to you each and every week. Join me next week for a new topic, new guest, new exciting conversations to help you live your fastest life.