Full Transcript 0:01 couple of patients I've even gone up to 0:01 couple of patients I've even gone up to 12 to help with that urinary stress 0:03 12 to help with that urinary stress 0:03 12 to help with that urinary stress incontinence. That's really nice. So,
Introduction to Vaginal Estrogen 0:06 incontinence. That's really nice. So, 0:06 incontinence. That's really nice. So, but if somebody's having the UTIs or 0:08 but if somebody's having the UTIs or 0:08 but if somebody's having the UTIs or they like they have to go to the 0:10 they like they have to go to the 0:10 they like they have to go to the bathroom 0:16 >> Vaginal estrogen for UTIs and urinary 0:16 >> Vaginal estrogen for UTIs and urinary symptoms. Hi, I'm Dr. Valerie Davidson 0:18 symptoms. Hi, I'm Dr. Valerie Davidson 0:18 symptoms. Hi, I'm Dr. Valerie Davidson from the Progressive Health podcast. 0:20 from the Progressive Health podcast. 0:20 from the Progressive Health podcast. >> And I'm Dr. Magu from the Progressive 0:21 >> And I'm Dr. Magu from the Progressive 0:21 >> And I'm Dr. Magu from the Progressive Health podcast. Uh so, the last one we 0:23 Health podcast. Uh so, the last one we 0:23 Health podcast. Uh so, the last one we did, you find the link up here 0:24 did, you find the link up here 0:24 did, you find the link up here somewhere, we talked about uh as- 0:27 somewhere, we talked about uh as- 0:27 somewhere, we talked about uh as- estrogen for vaginal dryness. Um that's 0:30 estrogen for vaginal dryness. Um that's 0:30 estrogen for vaginal dryness. Um that's the GSM, genital urinary syndrome of 0:34 the GSM, genital urinary syndrome of 0:34 the GSM, genital urinary syndrome of menopause. I think I say symptoms all 0:36 menopause. I think I say symptoms all 0:36 menopause. I think I say symptoms all the time. So, we just talked about the 0:38 the time. So, we just talked about the 0:38 the time. So, we just talked about the genital side, now we're going to talk 0:39 genital side, now we're going to talk 0:39 genital side, now we're going to talk about the urinary side. 0:40 about the urinary side. 0:40 about the urinary side. >> So, like we talked about on the previous
Estradiol vs Estriol for Urinary Symptoms 0:42 >> So, like we talked about on the previous 0:42 >> So, like we talked about on the previous podcast, uh estradiol, vaginal 0:45 podcast, uh estradiol, vaginal 0:45 podcast, uh estradiol, vaginal estradiol, and vaginal estriol are both 0:47 estradiol, and vaginal estriol are both 0:48 estradiol, and vaginal estriol are both really well tolerated and very healthy 0:50 really well tolerated and very healthy 0:50 really well tolerated and very healthy for the vaginal microbiome and also for 0:52 for the vaginal microbiome and also for 0:52 for the vaginal microbiome and also for you the urinary tract. Now, estradiol, 0:55 you the urinary tract. Now, estradiol, 0:55 you the urinary tract. Now, estradiol, you have to be a little bit more careful 0:56 you have to be a little bit more careful 0:56 you have to be a little bit more careful cuz it is the stronger estrogen. Estriol 0:59 cuz it is the stronger estrogen. Estriol 0:59 cuz it is the stronger estrogen. Estriol is much gentler, but estradiol you just 1:01 is much gentler, but estradiol you just 1:01 is much gentler, but estradiol you just have to be a little careful with the 1:03 have to be a little careful with the 1:03 have to be a little careful with the dosing if somebody has a uterus, 1:05 dosing if somebody has a uterus, 1:05 dosing if somebody has a uterus, especially if their uterus is very 1:06 especially if their uterus is very 1:06 especially if their uterus is very sensitive to estrogen cuz estradiol can 1:08 sensitive to estrogen cuz estradiol can 1:08 sensitive to estrogen cuz estradiol can thicken the endometrial lining um easier 1:11 thicken the endometrial lining um easier 1:11 thicken the endometrial lining um easier than the estriol. The estriol doesn't 1:13 than the estriol. The estriol doesn't 1:13 than the estriol. The estriol doesn't have quite as much of a of that effect. 1:15 have quite as much of a of that effect. 1:15 have quite as much of a of that effect. Now, estradiol vaginally, estradiol can 1:17 Now, estradiol vaginally, estradiol can 1:18 Now, estradiol vaginally, estradiol can be very minimal into the bloodstream. It 1:19 be very minimal into the bloodstream. It 1:19 be very minimal into the bloodstream. It can have a very little effect. You're 1:21 can have a very little effect. You're 1:21 can have a very little effect. You're not using it every day, twice a day. So, 1:23 not using it every day, twice a day. So, 1:23 not using it every day, twice a day. So, it is well tolerated. I do find with 1:26 it is well tolerated. I do find with 1:26 it is well tolerated. I do find with estriol when I'm working on the urinary 1:28 estriol when I'm working on the urinary 1:28 estriol when I'm working on the urinary tract that I like the estriol in a way 1:30 tract that I like the estriol in a way 1:30 tract that I like the estriol in a way because I can go really higher with 1:33 because I can go really higher with 1:33 because I can go really higher with those doses because the urinary tract,
How Vaginal Estrogen Helps the Urinary Tract 1:35 those doses because the urinary tract, 1:35 those doses because the urinary tract, especially women that are having more 1:37 especially women that are having more 1:37 especially women that are having more frequent urinary tract infections after 1:39 frequent urinary tract infections after 1:39 frequent urinary tract infections after menopause, that you can go higher on the 1:41 menopause, that you can go higher on the 1:41 menopause, that you can go higher on the doses and I'm going to go over the doses 1:43 doses and I'm going to go over the doses 1:43 doses and I'm going to go over the doses of the estriol. Where with the 1:44 of the estriol. Where with the 1:44 of the estriol. Where with the estradiol, I really don't go too much 1:46 estradiol, I really don't go too much 1:46 estradiol, I really don't go too much higher than 0.5 mg, sometimes 1 mg. 1:51 higher than 0.5 mg, sometimes 1 mg. 1:51 higher than 0.5 mg, sometimes 1 mg. Um you know, if we're using it vaginally 1:53 Um you know, if we're using it vaginally 1:53 Um you know, if we're using it vaginally as estradiol. Now, Now, somebody doesn't 1:55 as estradiol. Now, Now, somebody doesn't 1:55 as estradiol. Now, Now, somebody doesn't have a uterus, that's a little bit of a 1:57 have a uterus, that's a little bit of a 1:57 have a uterus, that's a little bit of a different story, but if someone has a 1:59 different story, but if someone has a 1:59 different story, but if someone has a uterus, I want to be more careful. But, 2:01 uterus, I want to be more careful. But, 2:01 uterus, I want to be more careful. But, when you're looking at GSMs 2:04 when you're looking at GSMs 2:04 when you're looking at GSMs the syndrome, you know, but symptoms of 2:06 the syndrome, you know, but symptoms of 2:06 the syndrome, you know, but symptoms of GSM for the urinary tract is women can 2:08 GSM for the urinary tract is women can 2:08 GSM for the urinary tract is women can have more frequent urinary tract 2:09 have more frequent urinary tract 2:10 have more frequent urinary tract infections. They can even have it where 2:12 infections. They can even have it where 2:12 infections. They can even have it where it feels like you have this sort of 2:14 it feels like you have this sort of 2:14 it feels like you have this sort of um like you just feel like you have to 2:16 um like you just feel like you have to 2:16 um like you just feel like you have to go to the bathroom. You're you're it 2:18 go to the bathroom. You're you're it 2:18 go to the bathroom. You're you're it feels like it's uncomfortable, almost 2:19 feels like it's uncomfortable, almost 2:19 feels like it's uncomfortable, almost like you feel like you're getting an 2:20 like you feel like you're getting an 2:20 like you feel like you're getting an infection, but you don't have an 2:22 infection, but you don't have an 2:22 infection, but you don't have an infection. Also, too, another symptom, 2:24 infection. Also, too, another symptom, 2:24 infection. Also, too, another symptom, and you see this also in perimenopause, 2:26 and you see this also in perimenopause, 2:26 and you see this also in perimenopause, especially when the estrogen is starting 2:27 especially when the estrogen is starting 2:27 especially when the estrogen is starting to dive, is waking up a lot to go to the 2:29 to dive, is waking up a lot to go to the 2:30 to dive, is waking up a lot to go to the bathroom. Even if you don't have a full 2:32 bathroom. Even if you don't have a full 2:32 bathroom. Even if you don't have a full bladder, it's like, "Oh, I feel like I 2:33 bladder, it's like, "Oh, I feel like I 2:33 bladder, it's like, "Oh, I feel like I have to go." You go, and maybe it's a 2:35 have to go." You go, and maybe it's a 2:35 have to go." You go, and maybe it's a quarter or a half a bladder. So, using 2:37 quarter or a half a bladder. So, using 2:37 quarter or a half a bladder. So, using any kind of estrogen vaginally can be 2:39 any kind of estrogen vaginally can be 2:39 any kind of estrogen vaginally can be really really incredible for that. And 2:42 really really incredible for that. And 2:42 really really incredible for that. And then, on another flip side that vaginal 2:44 then, on another flip side that vaginal 2:44 then, on another flip side that vaginal estrogen can be helpful for is if you 2:46 estrogen can be helpful for is if you 2:46 estrogen can be helpful for is if you have urinary stress incontinence. Now,
Dosing Strategies for UTIs and Incontinence 2:48 have urinary stress incontinence. Now, 2:48 have urinary stress incontinence. Now, there's so many different reasons for 2:49 there's so many different reasons for 2:49 there's so many different reasons for having urinary stress incontinence, but 2:52 having urinary stress incontinence, but 2:52 having urinary stress incontinence, but if it's that urethra because of the lack 2:54 if it's that urethra because of the lack 2:54 if it's that urethra because of the lack of estrogen, it's a little bit lax, 2:56 of estrogen, it's a little bit lax, 2:56 of estrogen, it's a little bit lax, sometimes it's easier to have like a 2:58 sometimes it's easier to have like a 2:58 sometimes it's easier to have like a little leakage if you're coughing, or if 3:00 little leakage if you're coughing, or if 3:00 little leakage if you're coughing, or if you have to go, but you're holding it, 3:01 you have to go, but you're holding it, 3:01 you have to go, but you're holding it, all of a sudden you're leaking before 3:03 all of a sudden you're leaking before 3:03 all of a sudden you're leaking before you get to the toilet. So, that can be 3:05 you get to the toilet. So, that can be 3:05 you get to the toilet. So, that can be really tremendous for that. 3:07 really tremendous for that. 3:07 really tremendous for that. >> Yeah, I mean, uh we've been using uh 3:09 >> Yeah, I mean, uh we've been using uh 3:09 >> Yeah, I mean, uh we've been using uh we prefer estriol. Um and granted, we 3:12 we prefer estriol. Um and granted, we 3:12 we prefer estriol. Um and granted, we have used estriol 3:13 have used estriol 3:13 have used estriol >> back back and forth cuz I know estradiol 3:15 >> back back and forth cuz I know estradiol 3:15 >> back back and forth cuz I know estradiol is very easily available. The cost of it 3:18 is very easily available. The cost of it 3:18 is very easily available. The cost of it is pretty is pretty well, you know, for 3:20 is pretty is pretty well, you know, for 3:20 is pretty is pretty well, you know, for the general but at least in the United 3:21 the general but at least in the United 3:21 the general but at least in the United States here. Uh you know, women have 3:23 States here. Uh you know, women have 3:23 States here. Uh you know, women have access to estradiol much more easily 3:26 access to estradiol much more easily 3:26 access to estradiol much more easily than estriol. 3:26 than estriol. 3:26 than estriol. >> Yeah, estriol is only going to come from 3:28 >> Yeah, estriol is only going to come from 3:28 >> Yeah, estriol is only going to come from a compounding pharmacy. 3:29 a compounding pharmacy. 3:29 a compounding pharmacy. >> And and you know, it might be a little 3:30 >> And and you know, it might be a little 3:30 >> And and you know, it might be a little bit more pricey, so you're looking at 3:31 bit more pricey, so you're looking at 3:31 bit more pricey, so you're looking at affordability there. So, if it's a 3:33 affordability there. So, if it's a 3:34 affordability there. So, if it's a difference between you know, no estrogen 3:36 difference between you know, no estrogen 3:36 difference between you know, no estrogen and estrogen, take estrogen. 3:37 and estrogen, take estrogen. 3:37 and estrogen, take estrogen. >> Yeah, sure, sure. Yeah. Um one of the uh 3:39 >> Yeah, sure, sure. Yeah. Um one of the uh 3:39 >> Yeah, sure, sure. Yeah. Um one of the uh um some versus none, you know, take the 3:41 um some versus none, you know, take the 3:41 um some versus none, you know, take the some, and that's better than having 3:43 some, and that's better than having 3:43 some, and that's better than having nothing. And honestly, we've seen quite 3:45 nothing. And honestly, we've seen quite 3:45 nothing. And honestly, we've seen quite quite a few miracles over the years 3:46 quite a few miracles over the years 3:46 quite a few miracles over the years using vaginal estrogen, um whether it's 3:48 using vaginal estrogen, um whether it's 3:49 using vaginal estrogen, um whether it's for dryness or incontinence, or I've 3:51 for dryness or incontinence, or I've 3:51 for dryness or incontinence, or I've even had a a few patients that have had 3:53 even had a a few patients that have had 3:53 even had a a few patients that have had improvement in their prolapse. 3:55 improvement in their prolapse. 3:55 improvement in their prolapse. Um their their bladder and uterine 3:57 Um their their bladder and uterine 3:57 Um their their bladder and uterine prolapse by using estrogen and where 3:59 prolapse by using estrogen and where 3:59 prolapse by using estrogen and where they didn't require surgery. 4:01 they didn't require surgery. 4:01 they didn't require surgery. >> [snorts] 4:01 >> [snorts] 4:01 >> [snorts] >> Uh now granted, the problem wasn't 4:03 >> Uh now granted, the problem wasn't 4:03 >> Uh now granted, the problem wasn't completely solved by using uh you know 4:05 completely solved by using uh you know 4:05 completely solved by using uh you know um some estriol cream, um but it made it 4:08 um some estriol cream, um but it made it 4:08 um some estriol cream, um but it made it where it was tolerable uh and they 4:11 where it was tolerable uh and they 4:11 where it was tolerable uh and they really weren't really looking to have 4:12 really weren't really looking to have 4:12 really weren't really looking to have surgery anyways. 4:14 surgery anyways. 4:14 surgery anyways. Uh you know anyway uh you know whatever. 4:15 Uh you know anyway uh you know whatever. 4:15 Uh you know anyway uh you know whatever. So it just gives a lot of uh a lot of 4:18 So it just gives a lot of uh a lot of 4:18 So it just gives a lot of uh a lot of options 4:19 options 4:19 options and it can be, you know, pretty profound 4:21 and it can be, you know, pretty profound 4:21 and it can be, you know, pretty profound in the in in in a lot of cases. 4:23 in the in in in a lot of cases. 4:23 in the in in in a lot of cases. >> Yeah, and just, you know, from you know, 4:25 >> Yeah, and just, you know, from you know, 4:25 >> Yeah, and just, you know, from you know, we've dealt with lots of patients, so 4:26 we've dealt with lots of patients, so 4:26 we've dealt with lots of patients, so we've heard lots of experiences and just
Vaginal pH, Microbiome, and Infection Prevention 4:28 we've heard lots of experiences and just 4:28 we've heard lots of experiences and just my own, I remember when I was going 4:30 my own, I remember when I was going 4:30 my own, I remember when I was going through menopause, I was doing some 4:31 through menopause, I was doing some 4:31 through menopause, I was doing some static dosing, you know, I try 4:33 static dosing, you know, I try 4:33 static dosing, you know, I try everything um before I went on the 4:34 everything um before I went on the 4:34 everything um before I went on the rhythmic dosing cuz I have and I'm sure 4:37 rhythmic dosing cuz I have and I'm sure 4:37 rhythmic dosing cuz I have and I'm sure all you ladies might have this habit too 4:38 all you ladies might have this habit too 4:38 all you ladies might have this habit too where it's like, oh, I have to go to the 4:40 where it's like, oh, I have to go to the 4:40 where it's like, oh, I have to go to the bathroom, I have to go urinate, I have 4:42 bathroom, I have to go urinate, I have 4:42 bathroom, I have to go urinate, I have to go pee, but I just want to do one 4:43 to go pee, but I just want to do one 4:43 to go pee, but I just want to do one more thing or let me tidy this thing up 4:45 more thing or let me tidy this thing up 4:45 more thing or let me tidy this thing up real quick or let me just check this 4:46 real quick or let me just check this 4:46 real quick or let me just check this real quick and then I remember when by 4:48 real quick and then I remember when by 4:49 real quick and then I remember when by the time I was getting the bladder, I 4:50 the time I was getting the bladder, I 4:50 the time I was getting the bladder, I actually peed my pants. 4:52 actually peed my pants. 4:52 actually peed my pants. >> [laughter] 4:53 >> [laughter] 4:53 >> [laughter] >> And and and I've always been, you know, 4:55 >> And and and I've always been, you know, 4:55 >> And and and I've always been, you know, I've always kind of felt like I had a 4:56 I've always kind of felt like I had a 4:56 I've always kind of felt like I had a small bladder, you always know that I 4:57 small bladder, you always know that I 4:57 small bladder, you always know that I have to go to the bathroom a lot. 4:58 have to go to the bathroom a lot. 4:59 have to go to the bathroom a lot. >> Like a Like a kindergarten 5:00 >> Like a Like a kindergarten 5:00 >> Like a Like a kindergarten >> notice it was like I had to go more and 5:03 >> notice it was like I had to go more and 5:03 >> notice it was like I had to go more and more when I went through menopause, not 5:04 more when I went through menopause, not 5:04 more when I went through menopause, not because I was, you know, I was holding 5:06 because I was, you know, I was holding 5:06 because I was, you know, I was holding on to water, I was letting go of water, 5:08 on to water, I was letting go of water, 5:08 on to water, I was letting go of water, it was just like it just felt like I had 5:09 it was just like it just felt like I had 5:09 it was just like it just felt like I had to go. So using that vaginal estrogen 5:12 to go. So using that vaginal estrogen 5:12 to go. So using that vaginal estrogen was really nice to kind of tonify that 5:15 was really nice to kind of tonify that 5:15 was really nice to kind of tonify that up that urethra, um like you said, the 5:17 up that urethra, um like you said, the 5:17 up that urethra, um like you said, the pelvic, you know, the pelvic floor 5:18 pelvic, you know, the pelvic floor 5:18 pelvic, you know, the pelvic floor muscles can also get tonified. One thing 5:21 muscles can also get tonified. One thing 5:21 muscles can also get tonified. One thing that vaginal estrogen can help with is 5:23 that vaginal estrogen can help with is 5:23 that vaginal estrogen can help with is when it thickens the lining of the 5:25 when it thickens the lining of the 5:25 when it thickens the lining of the vaginal mucosa, the tissue, the tissue 5:27 vaginal mucosa, the tissue, the tissue 5:27 vaginal mucosa, the tissue, the tissue can put out um glyc- um glycogen. So 5:30 can put out um glyc- um glycogen. So 5:30 can put out um glyc- um glycogen. So glycogen is basically like sugar, like 5:32 glycogen is basically like sugar, like 5:32 glycogen is basically like sugar, like food or fuel for the lactobacillus, 5:34 food or fuel for the lactobacillus, 5:34 food or fuel for the lactobacillus, which is the predominant species in your 5:36 which is the predominant species in your 5:36 which is the predominant species in your vaginal vault microbiome. So the more 5:39 vaginal vault microbiome. So the more 5:39 vaginal vault microbiome. So the more lactobacillus you have, the lower the pH 5:42 lactobacillus you have, the lower the pH 5:42 lactobacillus you have, the lower the pH it is in your vaginal vault and then 5:43 it is in your vaginal vault and then 5:44 it is in your vaginal vault and then it's a nice beautiful symbiotic 5:46 it's a nice beautiful symbiotic 5:46 it's a nice beautiful symbiotic ecosystem. But when that lactobacillus 5:48 ecosystem. But when that lactobacillus 5:48 ecosystem. But when that lactobacillus goes down because the estrogen went 5:50 goes down because the estrogen went 5:50 goes down because the estrogen went down, then they they don't get their 5:51 down, then they they don't get their 5:51 down, then they they don't get their fuel source sources, less lactobacillus, 5:54 fuel source sources, less lactobacillus, 5:54 fuel source sources, less lactobacillus, higher pH, it makes you much more prone 5:57 higher pH, it makes you much more prone 5:57 higher pH, it makes you much more prone to the E. coli, 5:59 to the E. coli, 5:59 to the E. coli, which is a predominant bacteria that's 6:01 which is a predominant bacteria that's 6:01 which is a predominant bacteria that's going to cause urinary tract infections 6:03 going to cause urinary tract infections 6:03 going to cause urinary tract infections for the baddies to come in. Those E. 6:05 for the baddies to come in. Those E. 6:05 for the baddies to come in. Those E. coli, the baddies, you know, the lacto 6:06 coli, the baddies, you know, the lacto 6:06 coli, the baddies, you know, the lacto go down, and the baddies come in, it can 6:08 go down, and the baddies come in, it can 6:08 go down, and the baddies come in, it can crawl up that urethra, cause a bladder 6:10 crawl up that urethra, cause a bladder 6:10 crawl up that urethra, cause a bladder infection, cause a urinary tract 6:12 infection, cause a urinary tract 6:12 infection, cause a urinary tract infection, can also make you more 6:14 infection, can also make you more 6:14 infection, can also make you more predisposed to having bacterial 6:15 predisposed to having bacterial 6:15 predisposed to having bacterial vaginosis as well. 6:17 vaginosis as well. 6:17 vaginosis as well. >> Well, one thing that we don't want is we 6:19 >> Well, one thing that we don't want is we 6:19 >> Well, one thing that we don't want is we don't want women having to run to the 6:21 don't want women having to run to the 6:21 don't want women having to run to the doctor to get antibiotics, 6:23 doctor to get antibiotics, 6:23 doctor to get antibiotics, uh or just have too much exposure to 6:25 uh or just have too much exposure to 6:25 uh or just have too much exposure to them in general. So, this is a very
Reducing Antibiotic Use for Recurrent UTIs 6:27 them in general. So, this is a very 6:27 them in general. So, this is a very great sort of seems obvious to us, but 6:30 great sort of seems obvious to us, but 6:30 great sort of seems obvious to us, but out of the box kind of a thought process 6:33 out of the box kind of a thought process 6:33 out of the box kind of a thought process of cuz a woman is not supposed to get 6:35 of cuz a woman is not supposed to get 6:35 of cuz a woman is not supposed to get just a random UTI, right? Just casually 6:39 just a random UTI, right? Just casually 6:39 just a random UTI, right? Just casually living their life. I just had a patient 6:41 living their life. I just had a patient 6:41 living their life. I just had a patient the other day, and she was um traveling 6:43 the other day, and she was um traveling 6:43 the other day, and she was um traveling internationally, um um did not have any 6:46 internationally, um um did not have any 6:46 internationally, um um did not have any intercourse, and developed a UTI. That's 6:49 intercourse, and developed a UTI. That's 6:49 intercourse, and developed a UTI. That's not really supposed to happen. And women 6:51 not really supposed to happen. And women 6:51 not really supposed to happen. And women in their 20s and 30s, and also women 6:52 in their 20s and 30s, and also women 6:52 in their 20s and 30s, and also women very much are prone to them, and there's 6:54 very much are prone to them, and there's 6:54 very much are prone to them, and there's a lot of factors that can go into what 6:56 a lot of factors that can go into what 6:56 a lot of factors that can go into what makes them prone. We're trying to make 6:58 makes them prone. We're trying to make 6:58 makes them prone. We're trying to make sure we don't create that vicious cycle, 7:01 sure we don't create that vicious cycle, 7:01 sure we don't create that vicious cycle, antibiotic infection, infection 7:03 antibiotic infection, infection 7:03 antibiotic infection, infection antibiotic, infection antibiotic, cuz 7:05 antibiotic, infection antibiotic, cuz 7:05 antibiotic, infection antibiotic, cuz the more exposure you have, the more 7:07 the more exposure you have, the more 7:07 the more exposure you have, the more susceptible you are to those recurring 7:08 susceptible you are to those recurring 7:08 susceptible you are to those recurring infections. 7:09 infections. 7:09 infections. >> Yeah, so one, you know, everybody's 7:11 >> Yeah, so one, you know, everybody's 7:11 >> Yeah, so one, you know, everybody's men have longer urethras, that's why 7:13 men have longer urethras, that's why 7:13 men have longer urethras, that's why they don't get urinary tract infections 7:15 they don't get urinary tract infections 7:15 they don't get urinary tract infections as frequently or ever. And women have 7:17 as frequently or ever. And women have 7:17 as frequently or ever. And women have shorter, and some women have shorter, 7:18 shorter, and some women have shorter, 7:18 shorter, and some women have shorter, you know, shorter urethras, so they're 7:20 you know, shorter urethras, so they're 7:20 you know, shorter urethras, so they're going to be more prone. When they go 7:22 going to be more prone. When they go 7:22 going to be more prone. When they go through menopause, that urethra gets a 7:24 through menopause, that urethra gets a 7:24 through menopause, that urethra gets a little bit lax, like I said, the pH 7:25 little bit lax, like I said, the pH 7:26 little bit lax, like I said, the pH changes, the E. coli can crawl up there. 7:28 changes, the E. coli can crawl up there. 7:28 changes, the E. coli can crawl up there. So, when you're using the vaginal 7:29 So, when you're using the vaginal 7:29 So, when you're using the vaginal estrogen, you want to you can for the 7:32 estrogen, you want to you can for the 7:32 estrogen, you want to you can for the year people that are having were more 7:34 year people that are having were more 7:34 year people that are having were more maintenance for UTIs, like they haven't 7:36 maintenance for UTIs, like they haven't 7:36 maintenance for UTIs, like they haven't had one, but they've maybe gotten a few 7:38 had one, but they've maybe gotten a few 7:38 had one, but they've maybe gotten a few in the last few years, and they've never 7:40 in the last few years, and they've never 7:40 in the last few years, and they've never had them before, then I might have them 7:42 had them before, then I might have them 7:42 had them before, then I might have them do the estriol vaginally or estradiol 7:45 do the estriol vaginally or estradiol 7:45 do the estriol vaginally or estradiol like once a week. If it's just for 7:47 like once a week. If it's just for 7:47 like once a week. If it's just for urinary tract infections prevention as 7:50 urinary tract infections prevention as 7:50 urinary tract infections prevention as maintenance. Now, if somebody's having 7:52 maintenance. Now, if somebody's having 7:52 maintenance. Now, if somebody's having more bacterial um or if they're having 7:55 more bacterial um or if they're having 7:55 more bacterial um or if they're having more like BV issues, I'll probably have 7:57 more like BV issues, I'll probably have 7:57 more like BV issues, I'll probably have them maybe do it, you know, one to two 7:59 them maybe do it, you know, one to two 7:59 them maybe do it, you know, one to two times a week. Maybe you can even add in, 8:02 times a week. Maybe you can even add in, 8:02 times a week. Maybe you can even add in, which is another classic, is this is 8:04 which is another classic, is this is 8:04 which is another classic, is this is from education, not for medical advice, 8:07 from education, not for medical advice, 8:07 from education, not for medical advice, is you can do boric acid vaginal 8:09 is you can do boric acid vaginal 8:09 is you can do boric acid vaginal capsules are really nice. 300 Usually 8:11 capsules are really nice. 300 Usually 8:11 capsules are really nice. 300 Usually 600 mg is the magic number. That's 8:14 600 mg is the magic number. That's 8:14 600 mg is the magic number. That's sometimes used 300 in people, but 600 is 8:16 sometimes used 300 in people, but 600 is 8:16 sometimes used 300 in people, but 600 is usually the magic number as you can do 8:18 usually the magic number as you can do 8:18 usually the magic number as you can do that once a week to maintain that 8:19 that once a week to maintain that 8:19 that once a week to maintain that vaginal pH. That's a nice thing to go in 8:22 vaginal pH. That's a nice thing to go in 8:22 vaginal pH. That's a nice thing to go in co-in, you know, sort of in in 8:24 co-in, you know, sort of in in 8:24 co-in, you know, sort of in in conjunction with your vaginal estrogen.
When Vaginal Estrogen Is Most Beneficial 8:26 conjunction with your vaginal estrogen. 8:27 conjunction with your vaginal estrogen. But when I'm using estriol for the just 8:30 But when I'm using estriol for the just 8:30 But when I'm using estriol for the just the urinary tract, where you know, the 8:31 the urinary tract, where you know, the 8:31 the urinary tract, where you know, the the vaginal dryness was the episode 8:32 the vaginal dryness was the episode 8:32 the vaginal dryness was the episode before, is I can even go up higher to 8:36 before, is I can even go up higher to 8:36 before, is I can even go up higher to like 5 mg. Sometimes I'll even go closer 8:39 like 5 mg. Sometimes I'll even go closer 8:39 like 5 mg. Sometimes I'll even go closer to 10 mg of estriol. I would never do 8:41 to 10 mg of estriol. I would never do 8:41 to 10 mg of estriol. I would never do that as estradiol vaginally, never. 8:43 that as estradiol vaginally, never. 8:43 that as estradiol vaginally, never. That's way too high. But estriol you can 8:45 That's way too high. But estriol you can 8:45 That's way too high. But estriol you can go a little bit higher, even up I've 8:47 go a little bit higher, even up I've 8:47 go a little bit higher, even up I've even a couple of patients I've even gone 8:49 even a couple of patients I've even gone 8:49 even a couple of patients I've even gone up to 12 to help with that urinary 8:51 up to 12 to help with that urinary 8:51 up to 12 to help with that urinary stress incontinence. That's really nice. 8:54 stress incontinence. That's really nice. 8:54 stress incontinence. That's really nice. So, but if somebody's having the UTIs or 8:57 So, but if somebody's having the UTIs or 8:57 So, but if somebody's having the UTIs or they feel like they have to go to the 8:58 they feel like they have to go to the 8:58 they feel like they have to go to the bathroom, a lot of times I'll use 9:00 bathroom, a lot of times I'll use 9:00 bathroom, a lot of times I'll use anywhere between 2 mg of estriol up to 4 9:03 anywhere between 2 mg of estriol up to 4 9:03 anywhere between 2 mg of estriol up to 4 mg of estriol through one to three times 9:06 mg of estriol through one to three times 9:06 mg of estriol through one to three times a week 9:07 a week 9:07 a week vaginally. We'll either put it around 9:09 vaginally. We'll either put it around 9:09 vaginally. We'll either put it around the introitus, around the opening of the 9:11 the introitus, around the opening of the 9:11 the introitus, around the opening of the vaginal vault, or use an applicator to 9:13 vaginal vault, or use an applicator to 9:13 vaginal vault, or use an applicator to insert it into the vaginal vault, and I 9:15 insert it into the vaginal vault, and I 9:15 insert it into the vaginal vault, and I have them to of course do that at night. 9:17 have them to of course do that at night. 9:17 have them to of course do that at night. Do it at night and put a little panty 9:18 Do it at night and put a little panty 9:18 Do it at night and put a little panty liner in. 9:19 liner in. 9:19 liner in. >> Yeah. I I it's a really we've been using 9:21 >> Yeah. I I it's a really we've been using 9:21 >> Yeah. I I it's a really we've been using it for years, really good solution. Uh 9:23 it for years, really good solution. Uh 9:23 it for years, really good solution. Uh it almost always works. Sometimes, like 9:26 it almost always works. Sometimes, like 9:26 it almost always works. Sometimes, like you said, you got to play with the 9:27 you said, you got to play with the 9:27 you said, you got to play with the dosing in some respects. And now maybe 9:29 dosing in some respects. And now maybe 9:29 dosing in some respects. And now maybe on the leakage side, uh like I said, the 9:31 on the leakage side, uh like I said, the 9:31 on the leakage side, uh like I said, the stress incontinence, 9:33 stress incontinence, 9:33 stress incontinence, uh I mean, that just seems like it's 9:35 uh I mean, that just seems like it's 9:35 uh I mean, that just seems like it's almost like a like every woman is going 9:36 almost like a like every woman is going 9:37 almost like a like every woman is going to experience that. It's a big deal, all 9:38 to experience that. It's a big deal, all 9:39 to experience that. It's a big deal, all right? And very common, happens to 9:40 right? And very common, happens to 9:40 right? And very common, happens to everyone. Now, maybe it doesn't uh maybe 9:42 everyone. Now, maybe it doesn't uh maybe 9:42 everyone. Now, maybe it doesn't uh maybe it doesn't solve the problem completely. 9:44 it doesn't solve the problem completely. 9:44 it doesn't solve the problem completely. Like a really hard sneeze, okay, maybe 9:46 Like a really hard sneeze, okay, maybe 9:46 Like a really hard sneeze, okay, maybe you have a little bit. 9:47 you have a little bit. 9:47 you have a little bit. >> Only if there's some mechanics going on. 9:48 >> Only if there's some mechanics going on. 9:48 >> Only if there's some mechanics going on. It's not It's not a be-all end-all for 9:51 It's not It's not a be-all end-all for 9:51 It's not It's not a be-all end-all for urinary um stress incontinence. Truly 9:54 urinary um stress incontinence. Truly 9:54 urinary um stress incontinence. Truly no. 9:54 no. 9:54 no. >> But you can still get you know 50, 70, 9:57 >> But you can still get you know 50, 70, 9:57 >> But you can still get you know 50, 70, 80% uh improvement, maybe sometimes even
Practical Use and Closing Remarks 10:00 80% uh improvement, maybe sometimes even 10:00 80% uh improvement, maybe sometimes even up to 90% improvement. 10:01 up to 90% improvement. 10:01 up to 90% improvement. >> If it's from GSM. 10:02 >> If it's from GSM. 10:02 >> If it's from GSM. >> Yeah, yeah. Uh uh it's just that those a 10:05 >> Yeah, yeah. Uh uh it's just that those a 10:05 >> Yeah, yeah. Uh uh it's just that those a few exceptions where it might not go 10:06 few exceptions where it might not go 10:06 few exceptions where it might not go away completely. 10:08 away completely. 10:08 away completely. >> And then using that like I'd mentioned 10:09 >> And then using that like I'd mentioned 10:09 >> And then using that like I'd mentioned about waking up in the middle of the 10:10 about waking up in the middle of the 10:10 about waking up in the middle of the night going to the bathroom, it can help 10:13 night going to the bathroom, it can help 10:13 night going to the bathroom, it can help you not have to go up go to the bathroom 10:14 you not have to go up go to the bathroom 10:15 you not have to go up go to the bathroom as much. Now, we're girls, a lot of us 10:16 as much. Now, we're girls, a lot of us 10:16 as much. Now, we're girls, a lot of us wake up at least once a night to maybe 10:17 wake up at least once a night to maybe 10:17 wake up at least once a night to maybe go to the bathroom or if you drink a lot 10:19 go to the bathroom or if you drink a lot 10:19 go to the bathroom or if you drink a lot of water during the day, I drink a lot 10:20 of water during the day, I drink a lot 10:20 of water during the day, I drink a lot of water in the evening. So, of course, 10:23 of water in the evening. So, of course, 10:23 of water in the evening. So, of course, but I have noticed if you're waking up 10:25 but I have noticed if you're waking up 10:25 but I have noticed if you're waking up several times at night to go to the 10:27 several times at night to go to the 10:27 several times at night to go to the bathroom, but it's not a full bladder 10:28 bathroom, but it's not a full bladder 10:28 bathroom, but it's not a full bladder and you don't have a UTI, then vaginal 10:30 and you don't have a UTI, then vaginal 10:31 and you don't have a UTI, then vaginal estrogen can definitely be beneficial. 10:34 estrogen can definitely be beneficial. 10:34 estrogen can definitely be beneficial. >> Uh yeah, that's Sorry in the 10:36 >> Uh yeah, that's Sorry in the 10:36 >> Uh yeah, that's Sorry in the >> We bring our dogs here and one of them's 10:37 >> We bring our dogs here and one of them's 10:38 >> We bring our dogs here and one of them's kind of hot and panting. 10:39 kind of hot and panting. 10:39 kind of hot and panting. >> Yeah, yeah. 10:39 >> Yeah, yeah. 10:39 >> Yeah, yeah. >> He's a panter. 10:40 >> He's a panter. 10:40 >> He's a panter. >> They're the uh 10:41 >> They're the uh 10:41 >> They're the uh they're the production crew and uh right 10:43 they're the production crew and uh right 10:43 they're the production crew and uh right now he's uh it's um August here and uh 10:46 now he's uh it's um August here and uh 10:46 now he's uh it's um August here and uh it's a little hot. 10:47 it's a little hot. 10:47 it's a little hot. >> Do you feel 10:48 >> Do you feel 10:48 >> Do you feel >> No, no, it's it's fine. He's he's just a 10:49 >> No, no, it's it's fine. He's he's just a 10:49 >> No, no, it's it's fine. He's he's just a little bit of a baby sometimes and he 10:51 little bit of a baby sometimes and he 10:51 little bit of a baby sometimes and he hates this office. 10:53 hates this office. 10:53 hates this office. Um anyways, uh 10:55 Um anyways, uh 10:55 Um anyways, uh sorry for the digression. 10:57 sorry for the digression. 10:57 sorry for the digression. Um but he's like panting right in our 10:59 Um but he's like panting right in our 10:59 Um but he's like panting right in our ears we're trying to do this. 11:01 ears we're trying to do this. 11:01 ears we're trying to do this. >> cute. 11:02 >> cute. 11:02 >> cute. >> Yeah, he's adorable. 11:02 >> Yeah, he's adorable. 11:03 >> Yeah, he's adorable. >> let's see. I I took a little notes here 11:05 >> let's see. I I took a little notes here 11:05 >> let's see. I I took a little notes here to just kind of talk about Okay, we did 11:06 to just kind of talk about Okay, we did 11:06 to just kind of talk about Okay, we did the vaginal one. Yeah, the stress um 11:08 the vaginal one. Yeah, the stress um 11:08 the vaginal one. Yeah, the stress um urinary irritation. Of course, 11:11 urinary irritation. Of course, 11:11 urinary irritation. Of course, always get yourself checked. Make sure I 11:12 always get yourself checked. Make sure I 11:13 always get yourself checked. Make sure I do I have a UTI? Is it BV? Is it yeast? 11:15 do I have a UTI? Is it BV? Is it yeast? 11:15 do I have a UTI? Is it BV? Is it yeast? So, make sure you get yourself checked, 11:16 So, make sure you get yourself checked, 11:16 So, make sure you get yourself checked, but know that vaginal estrogen can be 11:18 but know that vaginal estrogen can be 11:18 but know that vaginal estrogen can be really beneficial for the urinary tract. 11:20 really beneficial for the urinary tract. 11:20 really beneficial for the urinary tract. >> Now, we're going to do another episode 11:21 >> Now, we're going to do another episode 11:21 >> Now, we're going to do another episode on UTIs in general, but one thing I 11:23 on UTIs in general, but one thing I 11:23 on UTIs in general, but one thing I would like to say about limiting 11:25 would like to say about limiting 11:25 would like to say about limiting exposure to antibiotics, 11:27 exposure to antibiotics, 11:27 exposure to antibiotics, uh if you uh 11:29 uh if you uh 11:29 uh if you uh don't have symptoms, but show positive 11:33 don't have symptoms, but show positive 11:33 don't have symptoms, but show positive on a, you know, on a, you know, UTI 11:35 on a, you know, on a, you know, UTI 11:36 on a, you know, on a, you know, UTI dipstick, we don't recommend treatment 11:38 dipstick, we don't recommend treatment 11:38 dipstick, we don't recommend treatment in that respect. Um, because now you're 11:40 in that respect. Um, because now you're 11:40 in that respect. Um, because now you're giving, um, antibiotics for, 11:43 giving, um, antibiotics for, 11:43 giving, um, antibiotics for, you know, for no symptoms. And women do 11:45 you know, for no symptoms. And women do 11:45 you know, for no symptoms. And women do not have silent UTIs. 11:47 not have silent UTIs. 11:47 not have silent UTIs. >> Well, some some do, especially over the, 11:49 >> Well, some some do, especially over the, 11:49 >> Well, some some do, especially over the, you know, 11:50 you know, 11:50 you know, um, women that are older, maybe in their 11:52 um, women that are older, maybe in their 11:52 um, women that are older, maybe in their 70s or 80s, especially 11:54 70s or 80s, especially 11:54 70s or 80s, especially >> True. No, granted, we don't have a lot 11:56 >> True. No, granted, we don't have a lot 11:56 >> True. No, granted, we don't have a lot in that category, um, right? We don't 11:58 in that category, um, right? We don't 11:58 in that category, um, right? We don't have a lot in the women that we do have 12:00 have a lot in the women that we do have 12:00 have a lot in the women that we do have in their 70s are not elderly yet. 12:02 in their 70s are not elderly yet. 12:02 in their 70s are not elderly yet. >> No, no, they're in great shape. They're 12:04 >> No, no, they're in great shape. They're 12:04 >> No, no, they're in great shape. They're good. But some some women, I mean, just 12:06 good. But some some women, I mean, just 12:06 good. But some some women, I mean, just to speak to that, um, like, especially 12:08 to speak to that, um, like, especially 12:08 to speak to that, um, like, especially in like nursing homes or whatnot, 12:10 in like nursing homes or whatnot, 12:10 in like nursing homes or whatnot, sometimes they exhibit more behavioral 12:12 sometimes they exhibit more behavioral 12:12 sometimes they exhibit more behavioral issues when they have a UTI rather than 12:14 issues when they have a UTI rather than 12:14 issues when they have a UTI rather than showing that they have pain. And once 12:16 showing that they have pain. And once 12:16 showing that they have pain. And once you correct their UTI, then those 12:18 you correct their UTI, then those 12:18 you correct their UTI, then those behavioral or mood issues, you know, 12:20 behavioral or mood issues, you know, 12:20 behavioral or mood issues, you know, diminish completely. So, that is one 12:21 diminish completely. So, that is one 12:21 diminish completely. So, that is one thing. So, I don't want to say don't 12:23 thing. So, I don't want to say don't 12:23 thing. So, I don't want to say don't ever use antibiotics. Please, you don't 12:25 ever use antibiotics. Please, you don't 12:25 ever use antibiotics. Please, you don't want to get a kidney infection. You 12:26 want to get a kidney infection. You 12:26 want to get a kidney infection. You don't want Bladder infections are the 12:28 don't want Bladder infections are the 12:28 don't want Bladder infections are the worst. I mean, that 12:30 worst. I mean, that 12:30 worst. I mean, that Not everybody I'm sure somebody's had a 12:32 Not everybody I'm sure somebody's had a 12:32 Not everybody I'm sure somebody's had a UTI that's watching this and know that 12:33 UTI that's watching this and know that 12:33 UTI that's watching this and know that No, I they're not fun. So, if you have 12:36 No, I they're not fun. So, if you have 12:36 No, I they're not fun. So, if you have to use antibiotics, absolutely. Our goal 12:38 to use antibiotics, absolutely. Our goal 12:38 to use antibiotics, absolutely. Our goal here is to try to minimize the use of 12:40 here is to try to minimize the use of 12:40 here is to try to minimize the use of antibiotics so you don't become 12:41 antibiotics so you don't become 12:41 antibiotics so you don't become antibiotic resistant. 12:42 antibiotic resistant. 12:42 antibiotic resistant. >> Yeah, yeah. And that's And just limiting 12:44 >> Yeah, yeah. And that's And just limiting 12:44 >> Yeah, yeah. And that's And just limiting exposure, so over the course of a year, 12:47 exposure, so over the course of a year, 12:47 exposure, so over the course of a year, uh, and over time, you're just not 12:49 uh, and over time, you're just not 12:49 uh, and over time, you're just not accumulating, especially for the women, 12:52 accumulating, especially for the women, 12:52 accumulating, especially for the women, this really, uh, 12:53 this really, uh, 12:53 this really, uh, bodes to the women that are having 12:55 bodes to the women that are having 12:55 bodes to the women that are having reoccurring infections. We're trying to 12:56 reoccurring infections. We're trying to 12:56 reoccurring infections. We're trying to break that cycle because those are the 12:58 break that cycle because those are the 12:58 break that cycle because those are the ones that are going to end up with some 12:59 ones that are going to end up with some 13:00 ones that are going to end up with some problems. You're going to trade one 13:01 problems. You're going to trade one 13:01 problems. You're going to trade one problem for another. You get a, you 13:03 problem for another. You get a, you 13:03 problem for another. You get a, you know, you take one antibiotic a year for 13:05 know, you take one antibiotic a year for 13:05 know, you take one antibiotic a year for UTI, no big deal, right? And honestly, I 13:07 UTI, no big deal, right? And honestly, I 13:07 UTI, no big deal, right? And honestly, I think what's the average? I haven't 13:08 think what's the average? I haven't 13:08 think what's the average? I haven't looked this up in a while. Like, 1.3 13:10 looked this up in a while. Like, 1.3 13:10 looked this up in a while. Like, 1.3 UTIs a year or something like that. I'm 13:12 UTIs a year or something like that. I'm 13:12 UTIs a year or something like that. I'm not 13:12 not 13:12 not >> I'd have to look that up. But I do feel 13:14 >> I'd have to look that up. But I do feel 13:14 >> I'd have to look that up. But I do feel with GSM, 13:15 with GSM, 13:16 with GSM, because it is the result of the lack of 13:17 because it is the result of the lack of 13:18 because it is the result of the lack of estrogen, you know, in the vaginal 13:19 estrogen, you know, in the vaginal 13:19 estrogen, you know, in the vaginal [clears throat] tissues, that you can 13:21 [clears throat] tissues, that you can 13:21 [clears throat] tissues, that you can really 13:22 really 13:22 really do, like I was saying, the different If 13:23 do, like I was saying, the different If 13:24 do, like I was saying, the different If you're going to have estrogen, take the 13:25 you're going to have estrogen, take the 13:25 you're going to have estrogen, take the estrogen in the, you know, vagina. Do it 13:28 estrogen in the, you know, vagina. Do it 13:28 estrogen in the, you know, vagina. Do it because it can be really beneficial for 13:29 because it can be really beneficial for 13:29 because it can be really beneficial for women that are getting UTIs frequently 13:31 women that are getting UTIs frequently 13:31 women that are getting UTIs frequently from GSM. 13:32 from GSM. 13:32 from GSM. >> Absolutely. 13:33 >> Absolutely. 13:33 >> Absolutely. Uh yeah, so um 13:36 Uh yeah, so um 13:36 Uh yeah, so um I'm not sure if there's anything else to 13:37 I'm not sure if there's anything else to 13:37 I'm not sure if there's anything else to talk about on this one. 13:38 talk about on this one. 13:38 talk about on this one. Um 13:39 Um 13:39 Um >> Yeah, so if anybody has some questions 13:41 >> Yeah, so if anybody has some questions 13:41 >> Yeah, so if anybody has some questions about this, like I'm sure we could go on 13:42 about this, like I'm sure we could go on 13:43 about this, like I'm sure we could go on honestly, we're very verbose. I could 13:44 honestly, we're very verbose. I could 13:44 honestly, we're very verbose. I could talk forever. But if anybody has any 13:46 talk forever. But if anybody has any 13:46 talk forever. But if anybody has any questions, concerns, or your own story, 13:48 questions, concerns, or your own story, 13:48 questions, concerns, or your own story, please write it in the comments or you 13:50 please write it in the comments or you 13:50 please write it in the comments or you can write it on our website if you don't 13:51 can write it on our website if you don't 13:51 can write it on our website if you don't feel comfortable. Um on the website, we 13:53 feel comfortable. Um on the website, we 13:53 feel comfortable. Um on the website, we always change everybody's names if we 13:55 always change everybody's names if we 13:55 always change everybody's names if we talk about you. 13:55 talk about you. 13:55 talk about you. >> Yeah, until next time, I'm Dr. Mackey. 13:57 >> Yeah, until next time, I'm Dr. Mackey. 13:57 >> Yeah, until next time, I'm Dr. Mackey. >> And I'm Dr. Valerie. 13:58 >> And I'm Dr. Valerie. 13:58 >> And I'm Dr. Valerie. >> Take care. Bye-bye.
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