A happy V, delving into articles, and my first 21-day challenge
March midlife roundup [2024]
A couple of years ago, I had to see a gynecologist in order to be referred to a menopause specialist.
I am not fond of having to jump through those hoops, but what choice did I have?
This male physician went on (without me asking) about how I can go through menopause naturally, like he recommended, or I can use hormones.
When I brought up vaginal estrogen, he said I could do it but that I’d need to take progesterone. I knew he was wrong, and that local estrogen is not systemic.
Did I correct him? Nah. I just got the needed appointment over so I could talk to the knowledgeable doctor. But this and many other healthcare experiences taught me that educating myself is key.
Vaginal estrogen is something I later advocated for and felt very confident that it not only was beneficial for me, but safe. I know because I’ve read the studies.
In this round-up, we have new research studies supporting vaginal estrogen, exploring other potential options, in-depth articles, and my upcoming 21-day challenge.
New vaginal estrogen studies
A recent comprehensive study looked at 49, 237 women between the ages of 40-79 years old newly diagnosed with breast cancer in Scotland and Wales from 2006 to 2016. Five percent took vaginal estrogen, and the rest did not.
Those who used vaginal estrogen did not experience higher breast cancer mortality rates compared to those not taking it.
Another recent study looked at vaginal estrogen and breast cancer in Denmark following women 50-60 years old for 18 years. There was no correlation found between vaginal estrogen and breast cancer. This is true even in women who used vaginal estrogen more frequently.
Despite this and other studies, black box cancer warnings on vaginal estrogen products remains. In fact, since 2014, organizations such as the Menopause Society (previously North American Menopause Society) have been asking the FDA and drug companies to consider changing it.
I recently heard of a woman who spent years getting expensive laser surgery and work done down there when all she needed was vaginal estrogen.
Other options
It’s nice that we have vaginal estrogen (and other options like vaginal DHEA and ospemifene medication). But I can’t help but wonder about probiotics.
Estrogen increases glycogen in the vagina, which produces mostly lactobacillus communities including Lactobacillus (L. crispatus, L. gasseri, L. jensenii and L. iners).
As estrogen decreases, the count of lactobacilli also decreases. In fact, only half of postmenopausal women had detectable lactobacilli. This increases the vagina’s PH and thins the lining, which creates symptoms that negatively affect quality of life. It also creates a vulnerability to infections and bladder issues.
It’s not just estrogen per se but the good lactobacilli bacteria it helps feed and grow. There is some research that taking oral probiotics of these strains can increase the bacteria in the vagina, but we need more research. But what about probiotics delivered vaginally?
In one 2018 randomized control trial, researchers administered estrogen with and without probiotics. The women who got both estrogen and probiotics had better improvements in vaginal health scores, vaginal dryness, and pain during intercourse.
“In addition to local use of estrogen, oral or vaginal use of probiotics in postmenopausal women is also very effective in reducing menopausal symptoms caused by GSM. This provides a new choice for improving the quality of life of postmenopausal women.”
-May and Dandan, Front Cell Infect Microbiol. 2022; 12: 963868
Then I ran across a pilot study with the use of vaginal hygiene products such as soap and gel with lactobacilli probiotics. There were 35 pre-menopausal women and 35 post menopause. Over a period of 4 weeks, participants were divided into groups - some used soap and cream, others used a gel, while some used no products.
Those using the probiotic feminine products had lower Ph and pathogenic bacteria. Vaginal symptoms improved in 60% premenopausal women and 81% of post menopause.
Of course, this is a small study, but wow! I tried to track down these products, but they don’t seem available in the US. I came across the VagiBiom products including a probiotic suppository which in a very recent study showed it helped pre and perimenopausal women increase lactobacilli, decrease pH, and improve vaginal scores after 4 weeks.
Vaginal microbiota disruption occurs in more than just menopausal women, as premenopausal women commonly experience bacterial vaginosis, UTIs, and yeast infections.
Nutrition may also make a difference as diets that are high in micronutrients A, C, D, E, b-carotene, calcium, and zinc positively affect vaginal health. High sugar, high fat and stress may have negative impacts (see graphic below).
I’ll keep following this research to help you understand the options to ensure a happy V.
Articles of interest
I ran across this Time article on how menopause is finally going mainstream. Menopause is having its moment and there’s much good to come from it. As with everything, there are unintended consequences.
There’s a thoughtful review by Dr. Carla Digirolamo at Athletic Aging on Menopausal Hormone therapy and Breast Cancer Survivors. The perception that menopausal hormone therapy is off-limits for breast cancer survivors is shifting as this topic gains attention.
On social media there has been a theme that statins don’t work for midlife women. The research summarized by Dr. Jen Gunter at The Vajenda supports statin use for midlife women who require it. I also think that we need more research on women in this area!
Just a reminder that last week I posted about my call for universal ferritin screening for women. This is yet another way we can help women get the care that they need. Iron deficiency without anemia truly affects the lives of so many women.
Take a moment to sign the petition and spread the word among your friends.
21-day challenge
I’m going to start my first challenge next Monday and through the month of March, making it 21 days (started smaller than 30 days). I will provide straightforward tips for optimizing gut health during midlife. Expect a somewhat brief education (ha, ha…I’ll try), a printable PDF, and a challenge for the week.
Just a reminder that the purpose of this is not to replace medical advice, but to aid you in effectively communicating with medical providers.
I hope you have an amazing week. And a happy March.
This is something I have wondered about as well! Such a fascinating concept, the more I understand how the microbiomes within impact our wellbeing - and how hormones impact bacteria vice versa, the more I want to know.🧠