Is vaginal estrogen the same as menopause hormone therapy.
Hey everybody it’s kelly casperson i am a urologist and today i wanted to show you vaginal estrogen so this is a tube of estradiol cream this is the generic it is estradiol 0.01 is the only percentage that you can get i am a practicing neurologist in the united states of america so everything i say is american based some countries don’t carry the generic some
Countries it’s over the counter wouldn’t that be great a girl can dream but currently in the united states of america this is a prescription the reason is because it’s a hormone which is regulated by the fda and it is prescription only so you need a doctor nurse practitioner physician’s assistant etc this is one tube of 42 grams it really only comes in one one size
One percentage it’s kind of easy now you can get vaginal estrogen in other formulations you can get it in tabs vagifem you can also get it in a ring called s string or you can get it in the cream there’s two options in america brand name premarin which is conjugated estrogen cream sometimes that’s cheaper but a lot of times it’s more expensive then there’s the brand
Name estrace which is just estradiol but brand name i don’t recommend it it’s very expensive and then number three my favorite is the generic estradiol so when you go to see your doctor or provider make sure it’s the generic it’s going to be the cheapest next thing to do is to go on your phone and to get the good rx app the goodrx app shows you what cash price is
In your town you have to type in estradiol vaginal cream the 42.5 gram tube and then you type in your zip code it’ll tell you the cheapest there’s no reason to be paying over a hundred dollars for this ever again it is generic and cheap but you might have to go to your pharmacist and say i want to pay cash here’s my coupon on the goodrx don’t charge my insurance
It’s yesterday when we thought that insurance was going to give you the best price for your pharmaceuticals it is not that case anymore oftentimes cash based not using your insurance is going to give you the cheapest it’s pretty rare these days that you have to get it compounded at a compounding pharmacy in order to get the price lower now i really do recommend the
Fda approved comp component of the vaginal estrogen the only reason that you’d want this compounded is if you’re sensitive to the base it is an alcohol base and it for especially for really dry skin or sensitive skin pretty common to have a couple of weeks of sensitivity especially if your skin is very sensitive but that does go away as the skin heals and you i
Tell people you literally grow healthier skin this is like skin care in your face except for it’s in your vulva and your vagina so if you are noticing that it’s a severe burn and just does not get better after a couple weeks try the compounded they can oftentimes take that alcohol base out and put it either in like an olive oil base or something that is a little
More natural or at least get the alcohol out of it versa base v-e-r-s-a is a nice base that can be compounded with the estradiol cream for people with really sensitive skin now you say what do you like i like the cream the best because you can put the cream on the vulva that six o’clock area of the vulva tends to get very tight torn tender especially with sexual
Intercourse you can rub the cream there as well as the top of the volvo where the clitoris and the clitoral hood is to help decrease adhesions to help keep good blood flow and collagen to the skin surrounding the clitoris that’s why i love the cream i don’t think you’re going to get that as much if you use a tab just in the vagina but certainly if all you’re trying
To do is get a healthy vagina to possibly decrease your risk of urinary tract infections remember vaginal estrogen post menopause in some studies decreases uti by 68 percent it’s awesome everybody with recurrent utis rebalance uh the ph and the microbiome of your pelvic health with vaginal estrogen after you take those antibiotics it’s a nice preventative medicine
Really i want to start seeing it as level one evidence for recurrent uti we’re almost there certainly in the guidelines now for urology for recurrent uti which is awesome so now i want to show you the applicator you can use this just on your finger like this for your vulva clitoris vulva just use this is like a pea size amount but the actual prescription is one
Gram per vagina twice a week a lot of people will do the loading dose which is once a day for two weeks then backing off to two times a week i think that’s officially how the prescription is written i think it’s hard for people to understand that i think it’s too much too soon for people especially if they have that sensitive skin you want them to kind of not
Have a lot of side effects so they continue to use this i don’t love using the loading dose for those two reasons i just tell people twice a week until you die and they say can i ever stop using this and i say yes if you want your symptoms to return so now i gotta find my applicator this is an applicator if your prescription didn’t come with an applicator for
Whatever reason or you threw it out because you didn’t want to use it i wasn’t having people use applicators a couple years ago and the reason for that is because the product was so expensive i just wanted them to like use as little as possible for what they needed now that the prices really come down i’m seeing a lot of these people back and they’re still getting
Utis they’re still having pain with sex and i’m like go back up on the on the standard dose again one gram per vagina twice a week i just think they were under dosing when i was telling them to use a pea-sized amount so i certainly have changed that recommendation um over time but so it’s an applicator and it can come apart what you can see on here is gram one
Gram two gram three gram four gram you’re going to fill it up to the one gram line i don’t know why they have more than that um because it’s rare that i see something unless you’re you’re doing something specially so what you can do is you can put it on there and you just squeeze gently as you pull back to the one gram on here so you can see it’s kind of like
To there it is a very small amount put it in like a tampon at the top of the vagina you put it up in the top of the vagina and especially right before bed um it tends to not be very goopy if it is goopy the next day i’d say are you not putting it up high enough are you using too much maybe back off a little bit certainly i would rather have you troubleshoot this
Than just stop right because we know that genital urinary syndrome menopause gsm formerly known as volvo vaginal atrophy is a progressive disease it will continue to get worse with age it’ll continue so if you don’t take good skin care it’ll just get worse and worse how common is this gsm fifty to eighty percent of women post menopause really starts kicking in five
To ten years after the start of menopause again defined as one year of no menstrual periods but certainly a lot of perimenopause around menopause i’m still getting my period every once in a while but i have pain with sex or dryness or itchiness or increased bladder urinary urgency frequency you can use it in that perimenopause i see it very commonly so i would
Put this up in the vagina squirt this like a little uh tampon and then do a little bit more or just take what’s around the excess for clitoris and vulva use a mirror for a while till you get the hang of like where all these structures are no shame in making sure you do this right skincare is a billion dollar industry this is just skin care pelvic health bladder
Health vulva vaginal health i see a lot of women they’re like i’m not sexually active do i have to use this i’m like you’re not doing this for your partner you’re doing it for you you might be sexually active in the future who knows maintain great skin but it does really help decrease your recurrent uti risk dryness dysuria skin thinning irritation sensitivity
With wiping it’s again just skin care so i don’t really care if you’re sexually active or not i don’t think vaginal estrogen is just for the sexually active population another important question about vaginal estrogen vaginal estrogen is not considered hrt or hormone replacement therapy in the way we think about systemic hormones but full body hormones oral or
Patch estrogen hormones so if you’re just using vaginal estrogen you do not need to be on a progestin to protect the uterine lining like you do if you have a uterus and you’re taking systemic estrogen vaginal estrogen a whole year’s worth is equivalent to one pill of oral hormone menopause therapy so it’s incredibly low dose the association with breast cancer
Is zero the association with any other cancer or badness is zero it is mislabeled on the packaging the packaging does have the same uh concern and risk that systemic estrogen so same reading as if you were on birth control pills or if you’re on hormone menopause replacement therapy again the data does not support any risk of breast cancer or any other of those
Risks with estrogen with vaginal estrogen so much so that acog and cancer survivorships fully authorize vaginal estrogen use even after treatment with breast cancer even with treatment if you’re currently undergoing treatment for breast cancer i would say consult with your doctor and your oncologist but more and more we realize quality of life and survivorship is
Very important and the risk of vaginal estrogen is incredibly low another question i get especially with the sexually active people is ideally you’re not going to get this on a male partner it’s still really really low dose if you are but i’d say this is twice a week see if you can spread out those sexual activities and events just so you’re not putting direct
Vaginal estrogen cream on a male partner um that’s an ideal world uh but don’t be afraid you can still be sexually active i just wouldn’t directly apply it right before any vaginal sexual activity so how long does this take to kick in and work takes about six to eight weeks for maximum benefit remember this is not a band-aid this is literally creating new skin
Getting you the healthier skin that you had when you had a good amount of estrogen in your body so it might be a little irritating you might have some side effects in the beginning those should back off as that skin becomes more resilient and healthy and then you shouldn’t have any side effects if you do ask your doctor do you need to go on a different lower dose
Do you need to get a compounded product um but really effective is going to be about six to eight weeks after you start and you do need to continue it for life i always say it’s like it’s like sunscreen like doctor i need to keep wearing sunscreen like well only as long as you don’t want to have sunburn right only as long as you don’t want to have the bothersome
Side effects of genital urinary syndrome of menopause again 50 to 80 of women vulva owners who are past menopause will experience this i think vaginal estrogen you should turn 50 you should just say it here’s your mammogram here’s your colonoscopy here’s your vaginal estrogen western medicine is very bad at preventative health we only want to treat disease we aren’t
As good at preventing disease we don’t have a lot of data to say that this should be a preventative medicine but certainly what i do with my job every day and seeing over and over and over genital urinary syndrome of menopause women don’t even know that’s what it is usually they’re treated with anti-yeast meds a lot antibiotics over and over until they come to
See me and i say this is a because of estrogen deficiency so that is my vaginal estrogen episode i’ve been dying to do this for you guys because i get questions all the time and now i have a great resource for you all so love you so much god bless go get your vaginal estrogen pay cash it might be cheaper than insurance and you do not need to take a progestin or
A progesterone product when you’re just taking vaginal estrogen hope it helps love you see you next time
Transcribed from video
Vaginal Estrogen Show and Tell By Pacific Northwest Urology Specialists PLLC
