Full Transcript Introduction to Vaginal Estrogen 0:01 when the estrogen's going up and down, 0:01 when the estrogen's going up and down, and definitely post menopause. And then 0:03 and definitely post menopause. And then 0:03 and definitely post menopause. And then they can become more dry, they don't 0:05 they can become more dry, they don't 0:05 they can become more dry, they don't have the resiliency, the elasticity, the 0:07 have the resiliency, the elasticity, the 0:07 have the resiliency, the elasticity, the moisture. And when those tissues thin, 0:16 vaginal estrogen, how much do you need? 0:16 vaginal estrogen, how much do you need? Hi, I'm Dr. Valarie Davidson from the 0:18 Hi, I'm Dr. Valarie Davidson from the 0:18 Hi, I'm Dr. Valarie Davidson from the Progressive Health Podcast. 0:20 Progressive Health Podcast. 0:20 Progressive Health Podcast. >> I'm Dr. Mackey from the Progressive 0:21 >> I'm Dr. Mackey from the Progressive 0:21 >> I'm Dr. Mackey from the Progressive Health Podcast. Uh so, this topic comes 0:23 Health Podcast. Uh so, this topic comes 0:23 Health Podcast. Uh so, this topic comes up all the time. Uh it's all over the 0:26 up all the time. Uh it's all over the 0:26 up all the time. Uh it's all over the interwebs. Um 0:27 interwebs. Um 0:27 interwebs. Um but yeah, nonetheless, there's always 0:29 but yeah, nonetheless, there's always 0:29 but yeah, nonetheless, there's always something to learn. So, why don't we 0:31 something to learn. So, why don't we 0:31 something to learn. So, why don't we kind of dive into um 0:33 kind of dive into um 0:33 kind of dive into um what and how to use vaginal estrogen?
How Vaginal Estrogen Supports Vaginal Tissue 0:36 what and how to use vaginal estrogen? 0:36 what and how to use vaginal estrogen? >> So, vaginal estrogen we've used with 0:37 >> So, vaginal estrogen we've used with 0:37 >> So, vaginal estrogen we've used with patients since 2000 me 2004. It's a 0:40 patients since 2000 me 2004. It's a 0:40 patients since 2000 me 2004. It's a great way to add estrogen to those 0:43 great way to add estrogen to those 0:43 great way to add estrogen to those tissues, especially in perimenop- late 0:45 tissues, especially in perimenop- late 0:45 tissues, especially in perimenop- late perimenopause, when the estrogen's going 0:47 perimenopause, when the estrogen's going 0:47 perimenopause, when the estrogen's going up and down, and also in menopause, and 0:49 up and down, and also in menopause, and 0:49 up and down, and also in menopause, and definitely post menopause, cuz those 0:52 definitely post menopause, cuz those 0:52 definitely post menopause, cuz those tissues don't have the estrogen, and 0:54 tissues don't have the estrogen, and 0:54 tissues don't have the estrogen, and then they can become more dry, they 0:55 then they can become more dry, they 0:56 then they can become more dry, they don't have the resiliency, the 0:57 don't have the resiliency, the 0:57 don't have the resiliency, the elasticity, the moisture. And when those 1:00 elasticity, the moisture. And when those 1:00 elasticity, the moisture. And when those tissues thin, just cuz we're nerdy and I 1:02 tissues thin, just cuz we're nerdy and I 1:02 tissues thin, just cuz we're nerdy and I love the science, is the tissues can't 1:05 love the science, is the tissues can't 1:05 love the science, is the tissues can't release glycogen, which is the fuel 1:06 release glycogen, which is the fuel 1:06 release glycogen, which is the fuel source or the food for the lactobacillus 1:09 source or the food for the lactobacillus 1:09 source or the food for the lactobacillus or the lactobacillus species that pre- 1:11 or the lactobacillus species that pre- 1:11 or the lactobacillus species that pre- that predominate the vaginal vault. So, 1:14 that predominate the vaginal vault. So, 1:14 that predominate the vaginal vault. So, the vaginal microbiome, yes, it has its 1:16 the vaginal microbiome, yes, it has its 1:16 the vaginal microbiome, yes, it has its own microbiome, just like a gut 1:17 own microbiome, just like a gut 1:17 own microbiome, just like a gut microbiome, but the vaginal microbiome 1:19 microbiome, but the vaginal microbiome 1:19 microbiome, but the vaginal microbiome loves this lactobacillus species, and 1:22 loves this lactobacillus species, and 1:22 loves this lactobacillus species, and that keeps the pH nice and low, more
Estriol vs. Estradiol Basics 1:24 that keeps the pH nice and low, more 1:24 that keeps the pH nice and low, more acidic, so it can prevent, you know, 1:26 acidic, so it can prevent, you know, 1:26 acidic, so it can prevent, you know, different infections, which we'll go 1:27 different infections, which we'll go 1:27 different infections, which we'll go into in another podcast. But when that 1:30 into in another podcast. But when that 1:30 into in another podcast. But when that when that lactobacillus species goes 1:32 when that lactobacillus species goes 1:32 when that lactobacillus species goes down, the pH changes, the the tissues 1:35 down, the pH changes, the the tissues 1:35 down, the pH changes, the the tissues start to get really thin, you don't have 1:37 start to get really thin, you don't have 1:37 start to get really thin, you don't have that resiliency, and then you can have 1:38 that resiliency, and then you can have 1:38 that resiliency, and then you can have pain with intercourse. You can even have 1:40 pain with intercourse. You can even have 1:40 pain with intercourse. You can even have pain and chapping just going for a walk 1:42 pain and chapping just going for a walk 1:42 pain and chapping just going for a walk or working out. 1:44 or working out. 1:44 or working out. >> Uh uh well, 1:46 >> Uh uh well, 1:46 >> Uh uh well, now, this is uh you know, like I said, 1:49 now, this is uh you know, like I said, 1:49 now, this is uh you know, like I said, something that is 1:50 something that is 1:50 something that is when we started in practice a long time 1:52 when we started in practice a long time 1:52 when we started in practice a long time ago, I mean, this really never got 1:54 ago, I mean, this really never got 1:54 ago, I mean, this really never got talked about. It seemed pretty obvious 1:56 talked about. It seemed pretty obvious 1:56 talked about. It seemed pretty obvious for you and I, um, but now, um, talking 1:59 for you and I, um, but now, um, talking 1:59 for you and I, um, but now, um, talking about vaginal estrogens everywhere, 2:01 about vaginal estrogens everywhere, 2:01 about vaginal estrogens everywhere, okay, which is good. I mean, uh, it 2:02 okay, which is good. I mean, uh, it 2:02 okay, which is good. I mean, uh, it really it really needs to be a sort 2:04 really it really needs to be a sort 2:04 really it really needs to be a sort >> we always had to bring like in a patient 2:06 >> we always had to bring like in a patient 2:06 >> we always had to bring like in a patient consult. I remember you two, um, would 2:08 consult. I remember you two, um, would 2:08 consult. I remember you two, um, would always have to we'd bring it up. Do are 2:10 always have to we'd bring it up. Do are 2:10 always have to we'd bring it up. Do are you having vaginal dryness? Oh, yeah, 2:11 you having vaginal dryness? Oh, yeah, 2:11 you having vaginal dryness? Oh, yeah, yeah, yeah, I am. 2:12 yeah, yeah, I am. 2:12 yeah, yeah, I am. >> Well, well, me talking to a female 2:14 >> Well, well, me talking to a female 2:14 >> Well, well, me talking to a female patient it was always a little bit 2:16 patient it was always a little bit 2:16 patient it was always a little bit awkward, uh, you know, but then I 2:18 awkward, uh, you know, but then I 2:18 awkward, uh, you know, but then I realized that they all wanted to ask it. 2:21 realized that they all wanted to ask it. 2:21 realized that they all wanted to ask it. They were just a little bit, at least to 2:22 They were just a little bit, at least to 2:22 They were just a little bit, at least to me anyways, they tell you everything, 2:24 me anyways, they tell you everything, 2:24 me anyways, they tell you everything, um, but they're a little bit 2:25 um, but they're a little bit 2:25 um, but they're a little bit apprehensive and rightly so, uh, but 2:27 apprehensive and rightly so, uh, but 2:27 apprehensive and rightly so, uh, but then once we talked about it, then it's, 2:29 then once we talked about it, then it's, 2:29 then once we talked about it, then it's, you know, then like 2:31 you know, then like 2:31 you know, then like >> Sounds like we got this. Yeah, we can 2:32 >> Sounds like we got this. Yeah, we can 2:32 >> Sounds like we got this. Yeah, we can absolutely take care of that because 2:33 absolutely take care of that because 2:33 absolutely take care of that because vaginal estrogen can be really safe and 2:36 vaginal estrogen can be really safe and 2:36 vaginal estrogen can be really safe and extremely effective for vaginal dryness. 2:38 extremely effective for vaginal dryness. 2:38 extremely effective for vaginal dryness. Um, what is it? GSM, genitourinary 2:40 Um, what is it? GSM, genitourinary 2:40 Um, what is it? GSM, genitourinary syndrome of menopause. 2:41 syndrome of menopause. 2:41 syndrome of menopause. >> Yeah, so today we're just talking about 2:43 >> Yeah, so today we're just talking about 2:43 >> Yeah, so today we're just talking about the the genital side, the vagina side. 2:45 the the genital side, the vagina side. 2:45 the the genital side, the vagina side. The next episode we're going to talk 2:47 The next episode we're going to talk 2:47 The next episode we're going to talk about, um, the urinary side of it, um, 2:50 about, um, the urinary side of it, um, 2:50 about, um, the urinary side of it, um, because it does, you know, one solution 2:52 because it does, you know, one solution 2:52 because it does, you know, one solution actually does cover a lot of bases. Now, 2:55 actually does cover a lot of bases. Now, 2:55 actually does cover a lot of bases. Now, we just did one on estriol for the face, 2:57 we just did one on estriol for the face, 2:57 we just did one on estriol for the face, um, which you can find the link up here 2:59 um, which you can find the link up here 2:59 um, which you can find the link up here somewhere. 3:00 somewhere. 3:00 somewhere. Uh, you know, so they all three sort of 3:02 Uh, you know, so they all three sort of 3:02 Uh, you know, so they all three sort of go together and the best part about that 3:04 go together and the best part about that 3:04 go together and the best part about that is now that one was about estriol.
Dosing and Application Guidance 3:07 is now that one was about estriol. 3:07 is now that one was about estriol. Um, you can use that estriol for 3:09 Um, you can use that estriol for 3:09 Um, you can use that estriol for basically all three things. Um, you're 3:11 basically all three things. Um, you're 3:11 basically all three things. Um, you're using you're using basically one 3:13 using you're using basically one 3:13 using you're using basically one prescription for three different 3:15 prescription for three different 3:15 prescription for three different solutions. 3:16 solutions. 3:16 solutions. >> Well, of course, if you're going to use 3:17 >> Well, of course, if you're going to use 3:17 >> Well, of course, if you're going to use any kind of estrogen vaginally, you're 3:19 any kind of estrogen vaginally, you're 3:19 any kind of estrogen vaginally, you're going to want to use a nice, uh, safe 3:22 going to want to use a nice, uh, safe 3:22 going to want to use a nice, uh, safe base that's not going to irritate the 3:23 base that's not going to irritate the 3:23 base that's not going to irritate the tissues like a VersaBase. Now, when 3:25 tissues like a VersaBase. Now, when 3:25 tissues like a VersaBase. Now, when you're using vaginal estrogen, there's 3:27 you're using vaginal estrogen, there's 3:27 you're using vaginal estrogen, there's vaginal estradiol, so E2, that's the 3:29 vaginal estradiol, so E2, that's the 3:29 vaginal estradiol, so E2, that's the strongest estrogen, and then there's 3:30 strongest estrogen, and then there's 3:30 strongest estrogen, and then there's also you can use it vaginally as 3:32 also you can use it vaginally as 3:32 also you can use it vaginally as estriol, which is E3, which which is 3:34 estriol, which is E3, which which is 3:34 estriol, which is E3, which which is very gentle. 3:36 very gentle. 3:36 very gentle. Typically, I probably use more estriol 3:39 Typically, I probably use more estriol 3:39 Typically, I probably use more estriol with patients for vaginal dryness than 3:41 with patients for vaginal dryness than 3:41 with patients for vaginal dryness than estradiol cuz you have a little more 3:43 estradiol cuz you have a little more 3:43 estradiol cuz you have a little more versatility. You can increase up the 3:45 versatility. You can increase up the 3:46 versatility. You can increase up the dose really well cuz estriol is very 3:47 dose really well cuz estriol is very 3:47 dose really well cuz estriol is very gentle. It doesn't have as much of an 3:50 gentle. It doesn't have as much of an 3:50 gentle. It doesn't have as much of an effect on thickening the endometrial 3:52 effect on thickening the endometrial 3:52 effect on thickening the endometrial uterine lining like estradiol does. Now, 3:55 uterine lining like estradiol does. Now, 3:55 uterine lining like estradiol does. Now, estradiol when you're applying it 3:56 estradiol when you're applying it 3:56 estradiol when you're applying it vaginally, you know, you might use it 3:58 vaginally, you know, you might use it 3:58 vaginally, you know, you might use it one to three times a week, it's going to 4:00 one to three times a week, it's going to 4:00 one to three times a week, it's going to be very minimal what's going to go into 4:01 be very minimal what's going to go into 4:02 be very minimal what's going to go into the bloodstream as long as you're using 4:03 the bloodstream as long as you're using 4:03 the bloodstream as long as you're using a particular dose. But when you're using 4:05 a particular dose. But when you're using 4:05 a particular dose. But when you're using the estriol, you can go a little bit 4:07 the estriol, you can go a little bit 4:07 the estriol, you can go a little bit higher, which I'll go into a little bit 4:09 higher, which I'll go into a little bit 4:09 higher, which I'll go into a little bit more when we talk about the urinary 4:10 more when we talk about the urinary 4:10 more when we talk about the urinary tract. But with vaginal dryness, we can 4:12 tract. But with vaginal dryness, we can 4:12 tract. But with vaginal dryness, we can kind of separate them. So, if you're 4:14 kind of separate them. So, if you're 4:14 kind of separate them. So, if you're going to use estradiol, which is more 4:16 going to use estradiol, which is more 4:16 going to use estradiol, which is more easily accessible for most people in our 4:18 easily accessible for most people in our 4:18 easily accessible for most people in our country in the United States, is it's 4:20 country in the United States, is it's 4:20 country in the United States, is it's easier to get, um it's probably a little 4:22 easier to get, um it's probably a little 4:22 easier to get, um it's probably a little bit more affordable than estriol, and 4:24 bit more affordable than estriol, and 4:24 bit more affordable than estriol, and but it can be effective, but you want to 4:26 but it can be effective, but you want to 4:26 but it can be effective, but you want to definitely use a very low dose 4:27 definitely use a very low dose 4:27 definitely use a very low dose vaginally. 4:29 vaginally. 4:29 vaginally. In my practice, you know, I've been 4:30 In my practice, you know, I've been 4:30 In my practice, you know, I've been doing this for since 2004, is I 4:34 doing this for since 2004, is I 4:34 doing this for since 2004, is I I do I have had people use too much 4:36 I do I have had people use too much 4:36 I do I have had people use too much vaginal estradiol. I've tested their 4:38 vaginal estradiol. I've tested their 4:39 vaginal estradiol. I've tested their blood, and it shows up in their 4:40 blood, and it shows up in their 4:40 blood, and it shows up in their bloodstream even if they're not taking 4:42 bloodstream even if they're not taking 4:42 bloodstream even if they're not taking any HRT systemically. So, it can go into 4:45 any HRT systemically. So, it can go into 4:45 any HRT systemically. So, it can go into your bloodstream depending on what dose 4:47 your bloodstream depending on what dose 4:47 your bloodstream depending on what dose it is. Now, with the estradiol, I'll use 4:49 it is. Now, with the estradiol, I'll use 4:49 it is. Now, with the estradiol, I'll use more like maybe 0.5 mg. That's pretty 4:53 more like maybe 0.5 mg. That's pretty 4:53 more like maybe 0.5 mg. That's pretty That's a pretty good dose one to three 4:55 That's a pretty good dose one to three 4:55 That's a pretty good dose one to three times a week, as long as they're not 4:57 times a week, as long as they're not 4:57 times a week, as long as they're not having any spotting and they're getting, 4:59 having any spotting and they're getting, 4:59 having any spotting and they're getting, you know, positive results on that. Now, 5:01 you know, positive results on that. Now, 5:01 you know, positive results on that. Now, with the estriol, I have a little bit 5:03 with the estriol, I have a little bit 5:03 with the estriol, I have a little bit more um versatility with it. I'll 5:05 more um versatility with it. I'll 5:05 more um versatility with it. I'll actually go up a lot higher with 5:07 actually go up a lot higher with 5:07 actually go up a lot higher with estriol, even go up anywhere between, 5:09 estriol, even go up anywhere between, 5:09 estriol, even go up anywhere between, you know, 2 mg one to three times a week 5:13 you know, 2 mg one to three times a week 5:13 you know, 2 mg one to three times a week of estriol vaginally, even up to five 5:15 of estriol vaginally, even up to five 5:15 of estriol vaginally, even up to five with some women. 5:17 with some women. 5:17 with some women. >> Yeah. Now, you you you certainly got to 5:19 >> Yeah. Now, you you you certainly got to 5:19 >> Yeah. Now, you you you certainly got to talk to your practitioners. Don't just 5:20 talk to your practitioners. Don't just 5:20 talk to your practitioners. Don't just use those doses on your own. 5:22 use those doses on your own. 5:22 use those doses on your own. >> for medical advice. What is our What do 5:23 >> for medical advice. What is our What do 5:23 >> for medical advice. What is our What do our attorneys say? Not for medical
Perimenopause, Safety, and Clinical Use Cases 5:24 our attorneys say? Not for medical 5:24 our attorneys say? Not for medical advice. 5:25 advice. 5:25 advice. Education. 5:26 Education. 5:26 Education. >> we're yeah, we're just uh we're just for 5:28 >> we're yeah, we're just uh we're just for 5:28 >> we're yeah, we're just uh we're just for educational purposes. 5:29 educational purposes. 5:29 educational purposes. >> to help. 5:30 >> to help. 5:30 >> to help. >> Um because this is where, you know, this 5:32 >> Um because this is where, you know, this 5:32 >> Um because this is where, you know, this is where where the rubber meets the 5:33 is where where the rubber meets the 5:33 is where where the rubber meets the road, and what everyone's sort of 5:35 road, and what everyone's sort of 5:35 road, and what everyone's sort of wondering about, uh and they are two 5:37 wondering about, uh and they are two 5:37 wondering about, uh and they are two different hormones. So, they have to be 5:38 different hormones. So, they have to be 5:38 different hormones. So, they have to be sort of used I mean, technically, 5:40 sort of used I mean, technically, 5:41 sort of used I mean, technically, they're both estrogen, right? But uh you 5:43 they're both estrogen, right? But uh you 5:43 they're both estrogen, right? But uh you know, especially on a vaginal 5:44 know, especially on a vaginal 5:44 know, especially on a vaginal application, they're going to have 5:46 application, they're going to have 5:46 application, they're going to have different effects. And that's all we're 5:47 different effects. And that's all we're 5:47 different effects. And that's all we're trying to do. So, we prefer to use 5:49 trying to do. So, we prefer to use 5:49 trying to do. So, we prefer to use estriol, um but we know estradiol is a 5:52 estriol, um but we know estradiol is a 5:52 estriol, um but we know estradiol is a lot more, like you said, a lot more 5:53 lot more, like you said, a lot more 5:53 lot more, like you said, a lot more accessible. This is just a way to, uh 5:56 accessible. This is just a way to, uh 5:56 accessible. This is just a way to, uh kind of decide. You got access to a good 5:58 kind of decide. You got access to a good 5:58 kind of decide. You got access to a good compounding pharmacy. Every compounding 6:00 compounding pharmacy. Every compounding 6:00 compounding pharmacy. Every compounding pharmacy is going to have a vaginal 6:03 pharmacy is going to have a vaginal 6:03 pharmacy is going to have a vaginal formulation for estriol. Um pretty much 6:05 formulation for estriol. Um pretty much 6:05 formulation for estriol. Um pretty much every one of them. 6:06 every one of them. 6:06 every one of them. >> I do like both. I think, you know, if 6:07 >> I do like both. I think, you know, if 6:07 >> I do like both. I think, you know, if you if your only option is maybe using 6:09 you if your only option is maybe using 6:09 you if your only option is maybe using the estradiol, absolutely. You know, 6:11 the estradiol, absolutely. You know, 6:12 the estradiol, absolutely. You know, that can definitely help with the 6:13 that can definitely help with the 6:13 that can definitely help with the vaginal dryness. The 6:15 vaginal dryness. The 6:15 vaginal dryness. The you know, 6:16 you know, 6:16 you know, with the estriol and the and the 6:18 with the estriol and the and the 6:18 with the estriol and the and the estradiol, a lot of women will say, 6:19 estradiol, a lot of women will say, 6:19 estradiol, a lot of women will say, "Well, if I insert that vaginally, do I 6:21 "Well, if I insert that vaginally, do I 6:21 "Well, if I insert that vaginally, do I insert it or do I put it around the 6:23 insert it or do I put it around the 6:23 insert it or do I put it around the opening of the vaginal vault?" Now, you 6:25 opening of the vaginal vault?" Now, you 6:25 opening of the vaginal vault?" Now, you can do both. So, that's where it comes 6:27 can do both. So, that's where it comes 6:27 can do both. So, that's where it comes down to the actual individual. If you're 6:29 down to the actual individual. If you're 6:29 down to the actual individual. If you're having a lot of atrophy, like some women 6:31 having a lot of atrophy, like some women 6:31 having a lot of atrophy, like some women I've had, they can't even have a 6:33 I've had, they can't even have a 6:33 I've had, they can't even have a penetration there, you know, 6:35 penetration there, you know, 6:35 penetration there, you know, vaginally. So, we might go a little more 6:38 vaginally. So, we might go a little more 6:38 vaginally. So, we might go a little more frequently and do a little bit of a 6:39 frequently and do a little bit of a 6:39 frequently and do a little bit of a higher dose. If somebody's having, you 6:42 higher dose. If somebody's having, you 6:42 higher dose. If somebody's having, you know, just more and I'll and I'll 6:43 know, just more and I'll and I'll 6:43 know, just more and I'll and I'll usually have them put it around the 6:45 usually have them put it around the 6:45 usually have them put it around the opening of the vaginal canal, and later, 6:47 opening of the vaginal canal, and later, 6:47 opening of the vaginal canal, and later, as they're able to have a little bit 6:49 as they're able to have a little bit 6:49 as they're able to have a little bit more resiliency with that vaginal vault, 6:51 more resiliency with that vaginal vault, 6:51 more resiliency with that vaginal vault, then we can insert it. So, if someone's 6:53 then we can insert it. So, if someone's 6:53 then we can insert it. So, if someone's having more atrophy, I definitely like 6:55 having more atrophy, I definitely like 6:55 having more atrophy, I definitely like the vaginal application, uh whether it's 6:57 the vaginal application, uh whether it's 6:57 the vaginal application, uh whether it's estradiol or estriol. Now, if they're 7:00 estradiol or estriol. Now, if they're 7:00 estradiol or estriol. Now, if they're just having some dryness, maybe some 7:02 just having some dryness, maybe some 7:02 just having some dryness, maybe some chafing, but not really any super pain 7:04 chafing, but not really any super pain 7:05 chafing, but not really any super pain with intercourse, is then I might just 7:07 with intercourse, is then I might just 7:07 with intercourse, is then I might just have them just apply it to the vaginal 7:09 have them just apply it to the vaginal 7:09 have them just apply it to the vaginal the vaginal opening. It's one big mucous 7:11 the vaginal opening. It's one big mucous 7:11 the vaginal opening. It's one big mucous membrane, and then it'll matriculate 7:13 membrane, and then it'll matriculate 7:13 membrane, and then it'll matriculate throughout the entire vaginal vault. I 7:15 throughout the entire vaginal vault. I 7:15 throughout the entire vaginal vault. I do say, if you're going to apply vaginal 7:17 do say, if you're going to apply vaginal 7:17 do say, if you're going to apply vaginal estrogen, 7:18 estrogen, 7:18 estrogen, but, you know, it is it can be really 7:20 but, you know, it is it can be really 7:20 but, you know, it is it can be really great for that microbiome is put it on 7:22 great for that microbiome is put it on 7:22 great for that microbiome is put it on at night. Just cuz it can be a little 7:23 at night. Just cuz it can be a little 7:23 at night. Just cuz it can be a little messy, you know, put it on at night, 7:25 messy, you know, put it on at night, 7:25 messy, you know, put it on at night, have a little panty liner. And also, 7:26 have a little panty liner. And also, 7:27 have a little panty liner. And also, while you're sleeping, then it can 7:28 while you're sleeping, then it can 7:28 while you're sleeping, then it can really permeate into those tissues. 7:30 really permeate into those tissues. 7:30 really permeate into those tissues. >> I mean, honestly, um this is something 7:32 >> I mean, honestly, um this is something 7:32 >> I mean, honestly, um this is something that women even in their late 30s can 7:34 that women even in their late 30s can 7:34 that women even in their late 30s can even start using because, you know, even 7:36 even start using because, you know, even 7:36 even start using because, you know, even after pregnancy, um things like that, 7:38 after pregnancy, um things like that, 7:38 after pregnancy, um things like that, where maybe intercourse maybe is a 7:40 where maybe intercourse maybe is a 7:40 where maybe intercourse maybe is a little bit more painful, which can be a 7:42 little bit more painful, which can be a 7:42 little bit more painful, which can be a very often first sign or first symptom 7:44 very often first sign or first symptom 7:45 very often first sign or first symptom of perimenopause. Um you don't really 7:47 of perimenopause. Um you don't really 7:47 of perimenopause. Um you don't really feel much different or maybe you start 7:48 feel much different or maybe you start 7:48 feel much different or maybe you start to notice a couple things all of a 7:49 to notice a couple things all of a 7:49 to notice a couple things all of a sudden now, you know, um uh it can be 7:52 sudden now, you know, um uh it can be 7:52 sudden now, you know, um uh it can be easily used very safely and gently um at 7:55 easily used very safely and gently um at 7:55 easily used very safely and gently um at those younger ages all the way through 7:58 those younger ages all the way through 7:58 those younger ages all the way through as a woman is transitioning into 7:59 as a woman is transitioning into 7:59 as a woman is transitioning into menopause and then the postmenopause. 8:01 menopause and then the postmenopause. 8:01 menopause and then the postmenopause. >> Now, for for um a perimenopausal female, 8:04 >> Now, for for um a perimenopausal female, 8:05 >> Now, for for um a perimenopausal female, now this is just in my clinical 8:06 now this is just in my clinical 8:06 now this is just in my clinical experience, is I may only use estriol 8:09 experience, is I may only use estriol 8:09 experience, is I may only use estriol vaginally with them just cuz in some 8:11 vaginally with them just cuz in some 8:11 vaginally with them just cuz in some women that I come across in 8:12 women that I come across in 8:12 women that I come across in perimenopause, they have these huge 8:14 perimenopause, they have these huge 8:14 perimenopause, they have these huge spikes in estradiol and they go down and 8:16 spikes in estradiol and they go down and 8:16 spikes in estradiol and they go down and I don't want anything to really mess 8:18 I don't want anything to really mess 8:18 I don't want anything to really mess with their levels of their own levels of 8:21 with their levels of their own levels of 8:21 with their levels of their own levels of estradiol that they're making. I know 8:22 estradiol that they're making. I know 8:23 estradiol that they're making. I know those are really low doses of estro- 8:24 those are really low doses of estro- 8:24 those are really low doses of estro- estrogen vaginally or estradiol 8:26 estrogen vaginally or estradiol 8:26 estrogen vaginally or estradiol vaginally can be very minimal, but I 8:28 vaginally can be very minimal, but I 8:28 vaginally can be very minimal, but I still want I'm just really anal and 8:30 still want I'm just really anal and 8:30 still want I'm just really anal and really particular about you know, 8:31 really particular about you know, 8:31 really particular about you know, people's doses. Same with um you know, 8:34 people's doses. Same with um you know, 8:34 people's doses. Same with um you know, I started practicing in 2004 is that was 8:37 I started practicing in 2004 is that was 8:37 I started practicing in 2004 is that was when a lot of practitioners were not 8:39 when a lot of practitioners were not 8:39 when a lot of practitioners were not happy with me giving 8:41 happy with me giving 8:41 happy with me giving giving HRT to women, but I'm like, these 8:43 giving HRT to women, but I'm like, these 8:43 giving HRT to women, but I'm like, these women need their hormones. 8:44 women need their hormones. 8:44 women need their hormones. >> Oh, yeah. 8:44 >> Oh, yeah. 8:44 >> Oh, yeah. >> Hormones are what keep us youthful and 8:46 >> Hormones are what keep us youthful and 8:46 >> Hormones are what keep us youthful and healthy and prevent long-term disease 8:48 healthy and prevent long-term disease 8:48 healthy and prevent long-term disease and chronic illnesses is women need 8:51 and chronic illnesses is women need 8:51 and chronic illnesses is women need their hormones, you know, it needs to be 8:53 their hormones, you know, it needs to be 8:53 their hormones, you know, it needs to be done right, of course, but so I would I 8:55 done right, of course, but so I would I 8:55 done right, of course, but so I would I would even have you know, just for 8:57 would even have you know, just for 8:57 would even have you know, just for transparency here, you know, women with 8:59 transparency here, you know, women with 8:59 transparency here, you know, women with you know, that have had cancer is I 9:01 you know, that have had cancer is I 9:01 you know, that have had cancer is I would you and they would have terrible 9:02 would you and they would have terrible 9:02 would you and they would have terrible vaginal dryness and it was very painful 9:05 vaginal dryness and it was very painful 9:05 vaginal dryness and it was very painful for intimacy and and whatnot is you 9:08 for intimacy and and whatnot is you 9:08 for intimacy and and whatnot is you know, I would use estriol cuz I felt 9:10 know, I would use estriol cuz I felt 9:10 know, I would use estriol cuz I felt like estriol is very safe. Their other 9:12 like estriol is very safe. Their other 9:12 like estriol is very safe. Their other practitioners or oncologists were 9:14 practitioners or oncologists were 9:14 practitioners or oncologists were semi okay with that cuz it wasn't 9:16 semi okay with that cuz it wasn't 9:16 semi okay with that cuz it wasn't estradiol, but that's where I was kind
Partner Safety and Closing Remarks 9:18 estradiol, but that's where I was kind 9:18 estradiol, but that's where I was kind of you know, I started off using more 9:20 of you know, I started off using more 9:20 of you know, I started off using more estriol E3 using it vaginally and I've 9:23 estriol E3 using it vaginally and I've 9:23 estriol E3 using it vaginally and I've had really great effects with it, but 9:25 had really great effects with it, but 9:25 had really great effects with it, but you know, the estradiol vaginally being 9:27 you know, the estradiol vaginally being 9:27 you know, the estradiol vaginally being available as estradiol cuz it can be 9:29 available as estradiol cuz it can be 9:29 available as estradiol cuz it can be more available for you know, for women 9:31 more available for you know, for women 9:31 more available for you know, for women in this country is I do think it's you 9:33 in this country is I do think it's you 9:33 in this country is I do think it's you know, it both can be very effective. 9:35 know, it both can be very effective. 9:35 know, it both can be very effective. >> Yeah, well, they you just need a little 9:37 >> Yeah, well, they you just need a little 9:37 >> Yeah, well, they you just need a little bit of a distinction there 9:39 bit of a distinction there 9:39 bit of a distinction there uh and maybe like you said a little bit 9:41 uh and maybe like you said a little bit 9:41 uh and maybe like you said a little bit um you know, different dosing for those 9:43 um you know, different dosing for those 9:43 um you know, different dosing for those two applications. 9:44 two applications. 9:45 two applications. Uh anything else you want to say about 9:46 Uh anything else you want to say about 9:46 Uh anything else you want to say about this? 9:47 this? 9:47 this? >> See, I wrote a couple little notes down 9:49 >> See, I wrote a couple little notes down 9:49 >> See, I wrote a couple little notes down to make sure I didn't miss it. Yeah, the 9:50 to make sure I didn't miss it. Yeah, the 9:50 to make sure I didn't miss it. Yeah, the dosing, where to put it, the base, and 9:53 dosing, where to put it, the base, and 9:53 dosing, where to put it, the base, and how often. Oh, um 9:55 how often. Oh, um 9:55 how often. Oh, um I do get questions from patients about 9:57 I do get questions from patients about 9:57 I do get questions from patients about their male partners about it getting I 9:59 their male partners about it getting I 9:59 their male partners about it getting I don't know if I mentioned this earlier 10:00 don't know if I mentioned this earlier 10:00 don't know if I mentioned this earlier if it you know 10:01 if it you know 10:01 if it you know Hey, I applied my vaginal estrogen and 10:04 Hey, I applied my vaginal estrogen and 10:04 Hey, I applied my vaginal estrogen and spontaneously we had intercourse. Their 10:07 spontaneously we had intercourse. Their 10:07 spontaneously we had intercourse. Their male partners might say, "Oh my 10:08 male partners might say, "Oh my 10:08 male partners might say, "Oh my goodness, is this a bad for me? Is 10:10 goodness, is this a bad for me? Is 10:10 goodness, is this a bad for me? Is something going to happen?" I No, no, 10:12 something going to happen?" I No, no, 10:12 something going to happen?" I No, no, either way nothing bad is going to 10:13 either way nothing bad is going to 10:13 either way nothing bad is going to happen to their male partner. Some of 10:15 happen to their male partner. Some of 10:15 happen to their male partner. Some of that estrogen that you inserted 10:16 that estrogen that you inserted 10:17 that estrogen that you inserted vaginally may have been um might have 10:18 vaginally may have been um might have 10:18 vaginally may have been um might have not gotten absorbed, so you might want 10:20 not gotten absorbed, so you might want 10:20 not gotten absorbed, so you might want to just do a second dose that night, but 10:22 to just do a second dose that night, but 10:22 to just do a second dose that night, but it's really okay um in that respect. 10:24 it's really okay um in that respect. 10:24 it's really okay um in that respect. >> Men are terrified of any any tiny little 10:27 >> Men are terrified of any any tiny little 10:27 >> Men are terrified of any any tiny little smudge of estrogen. They'll be fine. Uh 10:30 smudge of estrogen. They'll be fine. Uh 10:30 smudge of estrogen. They'll be fine. Uh yeah, that's not going to hurt them. The 10:31 yeah, that's not going to hurt them. The 10:31 yeah, that's not going to hurt them. The kind of doses that women are using, 10:33 kind of doses that women are using, 10:33 kind of doses that women are using, especially in such a localized area, 10:36 especially in such a localized area, 10:36 especially in such a localized area, aren't going to really affect the men 10:37 aren't going to really affect the men 10:37 aren't going to really affect the men whatsoever. Now, if a man's using a 10:39 whatsoever. Now, if a man's using a 10:39 whatsoever. Now, if a man's using a transdermal testosterone cream, that's a 10:41 transdermal testosterone cream, that's a 10:41 transdermal testosterone cream, that's a whole 'nother story, which we talked 10:43 whole 'nother story, which we talked 10:43 whole 'nother story, which we talked about that in a couple of episodes ago, 10:45 about that in a couple of episodes ago, 10:45 about that in a couple of episodes ago, testosterone one. Uh you know, 10:48 testosterone one. Uh you know, 10:48 testosterone one. Uh you know, women, kids, and pets 10:50 women, kids, and pets 10:50 women, kids, and pets uh you know, they have to be worried 10:52 uh you know, they have to be worried 10:52 uh you know, they have to be worried about the men's testosterone dose, not 10:54 about the men's testosterone dose, not 10:54 about the men's testosterone dose, not necessarily the other way around. 10:56 necessarily the other way around. 10:56 necessarily the other way around. >> Yeah. Okay, yeah, and I think I got 10:57 >> Yeah. Okay, yeah, and I think I got 10:57 >> Yeah. Okay, yeah, and I think I got through Well, gosh, if anybody has their 10:59 through Well, gosh, if anybody has their 10:59 through Well, gosh, if anybody has their own experience, I'd love to hear it or 11:01 own experience, I'd love to hear it or 11:01 own experience, I'd love to hear it or if you have any questions or comments, 11:03 if you have any questions or comments, 11:03 if you have any questions or comments, please um 11:04 please um 11:04 please um we love to read them. 11:05 we love to read them. 11:05 we love to read them. >> Yeah, write them down down in the 11:06 >> Yeah, write them down down in the 11:06 >> Yeah, write them down down in the comments below. Um lately we've been 11:08 comments below. Um lately we've been 11:08 comments below. Um lately we've been giving getting a lot of um views and a 11:10 giving getting a lot of um views and a 11:11 giving getting a lot of um views and a lot of comments and likes. We 11:12 lot of comments and likes. We 11:12 lot of comments and likes. We We do appreciate all of the attention. 11:15 We do appreciate all of the attention. 11:15 We do appreciate all of the attention. Um you know, keep asking questions and 11:17 Um you know, keep asking questions and 11:17 Um you know, keep asking questions and we'll we'll keep making videos for you. 11:19 we'll we'll keep making videos for you. 11:19 we'll we'll keep making videos for you. So, till next time I'm Dr. Maki. 11:21 So, till next time I'm Dr. Maki. 11:21 So, till next time I'm Dr. Maki. >> And I'm Dr. Valerie. 11:22 >> And I'm Dr. Valerie. 11:22 >> And I'm Dr. Valerie. >> Take care. Bye-bye.
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