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    How menopause and ageing affect the vagina, with Dr Shirin Lakhani

    enFebruary 17, 2023

    Podcast Summary

    • Menopause affects women's vaginal health1 in 4 women experience vaginal issues during menopause, including incontinence, UTIs, dryness, atrophy, and lichen sclerosis. Healthcare professionals should ask about these symptoms to improve overall health.

      Menopause affects women in various ways beyond just hot flushes and anxiety, including vaginal health issues which are often underreported. Approximately 25% of women experience problems with their vaginas and pelvic floors, such as incontinence, recurrent UTIs, vaginal dryness, vaginal atrophy, and lichen sclerosis. Healthcare professionals should ask about these symptoms as they may not always be volunteered. Dr. Shireen Nakani, a former GP and aesthetic physician, emphasizes the importance of addressing these issues and reassures women that they are not alone. The aging process, according to Dr. Nakani, should be viewed as an opportunity to manage and improve overall health, rather than focusing on anti-aging. By shifting the narrative towards age management, we can adopt a more positive perspective on aging and maintain our wellness throughout our lives.

    • Changes in women's genitals during menopauseMenopause causes collagen and elastin loss, resulting in changes like labia deflation, elongated labia minora, discomfort, bladder/bowel prolapse, reduced lubrication, and increased infection risk. Seeking help for these symptoms is vital for overall well-being.

      As women age and go through menopause, they experience various changes in their genitals that are often underreported and underdiscussed. These changes include the loss of collagen and elastin, leading to deflation of labia majora, elongation of labia minora, and symptoms such as discomfort during walking, exercise, and intercourse. Additionally, the vaginal canal can lose support, leading to conditions like bladder and bowel prolapse. These changes can also result in reduced lubrication, dryness, and thinning of tissue, causing pain, frequent urinary tract infections, and sexual dysfunction. The reduction in estrogen levels during menopause contributes to these changes by making the vagina less acidic, which can lead to cellular changes, increased infection risk, and discomfort. It's essential for healthcare professionals to ask about these symptoms and for women to seek help when needed, as these issues can significantly impact daily life. While the appearance of the genital area may not be a concern for many women, addressing the physical symptoms and discomfort is crucial for overall well-being.

    • Menopause symptoms and overlooked solutionsDuring menopause, women may experience uncomfortable symptoms like UTIs, vaginal dryness, and atrophy. Local estrogen replacement or PRP therapy can effectively alleviate these issues without increasing breast cancer risk.

      During menopause, decreased estrogen levels can lead to various issues such as recurrent UTIs, vaginal dryness, and atrophy. These problems are often overlooked by healthcare professionals and women themselves, leading to unnecessary discomfort and fear of hormone replacement therapy (HRT). However, local estrogen replacement using vaginal pessaries or creams does not increase breast cancer risk and can effectively alleviate these symptoms. Another solution for those unwilling or unable to use hormones is platelet-rich plasma (PRP) therapy, which utilizes the body's own healing capacity to regenerate and repair affected tissue. PRP has been proven effective in over 80% of cases, making it a promising alternative for treating vaginal atrophy and related conditions.

    • Misdiagnosis of Lichen Sclerosis as ThrushLichen Sclerosis, an autoimmune disease causing intense itching and discomfort, is often misdiagnosed as Thrush. Seek proper diagnosis from a healthcare professional, as untreated Lichen Sclerosis can lead to significant pain and even cancer.

      Lichen Sclerosis, a condition that affects the genital tissue, is often misdiagnosed and under-recognized, particularly in women around menopause. This autoimmune disease, which can also impact men, is characterized by intense itching and can lead to significant discomfort, pain during sexual intercourse, and even vulvar cancer if left untreated. Despite its potential severity, there is a lack of research and information available, leading to misdiagnosis as recurrent thrush. Thrush, on the other hand, is treatable with antifungals and characterized by thick discharge and white patches on the skin. If you're experiencing persistent symptoms, it's crucial to be examined by a healthcare professional and ask for a referral to a specialist if necessary. The condition can be managed with various techniques, but current treatment on the NHS is limited to steroids for flare-ups. It's essential to advocate for your health and push for proper diagnosis and care.

    • Women's shame keeps them from addressing genital conditions like lichen sclerosisDespite being common and often treatable, women's embarrassment and shame prevent them from seeking help for genital conditions like lichen sclerosis, which can cause discomfort and itching, and recurrent UTIs, affecting pelvic floor and bladder health. Speak up about symptoms and prioritize medical care.

      Women's embarrassment and shame surrounding genital conditions, particularly lichen sclerosis, prevent them from seeking help. This condition, which can cause discomfort and itching, is not contagious or a sexually transmitted disease. While there are no consistent triggers, stress can exacerbate symptoms. There is no cure for lichen sclerosis, but treatments like steroids and platelet rich plasma can help manage flare-ups and prevent disease progression. It's important for women to speak up about their symptoms and not let shame or stigma keep them from getting the medical care they need. Additionally, recurrent UTIs are a common issue, and addressing pelvic floor and bladder health is crucial for overall urinary tract health.

    • Addressing women's hormonal health issues as they ageLocalized estrogen therapies like Vagifem, Intrarosa, and pessaries can effectively alleviate symptoms of vaginal dryness, UTIs, and incontinence in older women, improving their quality of life, even during breast cancer treatment.

      As women age, they may experience various health issues related to hormonal changes, such as vaginal dryness, urinary tract infections (UTIs), and incontinence. Estrogen plays a significant role in these issues, and using localized estrogen therapies like Vagifem, Intrarosa, or pessaries can help alleviate symptoms without the risks associated with systemic hormone replacement therapy. These therapies are safe and effective, even for women undergoing breast cancer treatment. It's crucial to address these issues and overcome the fear of using hormone replacement therapies to improve the quality of life for older women. Unfortunately, misconceptions and fear, both from the public and the healthcare profession, prevent many women from receiving the necessary help.

    • Transdermal estrogen: A safer alternative to systemic HRTTransdermal estrogen is effective and safe for treating menopause, improving quality of life. Pelvic floor health is crucial, learn Kegel exercises from a professional to maintain strength and prevent incontinence, practice regularly from a young age.

      Transdermal estrogen, a localized form of hormone replacement therapy (HRT), has a much safer and different risk profile compared to systemic HRT. Despite this, misinformation persists, and women should be informed that this form of HRT is safe and effective in treating menopause and can significantly improve quality of life. Another important topic discussed was pelvic floor health and the effectiveness of Kegel exercises. These exercises are crucial for maintaining pelvic floor strength and preventing incontinence, but most women do not know how to do them correctly. It is recommended that women learn these exercises from a pelvic floor physiotherapist to ensure proper technique and prevent potential issues. Regular practice starting at a young age is also essential for optimal pelvic floor health and preventing future problems.

    • Addressing urinary incontinence in older womenHRT can prevent incontinence and dementia, normalization of incontinence can hinder seeking treatment, pelvic floor exercises are crucial, and various treatments are available to improve vaginal health and treat incontinence.

      Urinary incontinence is a common issue among older women, often leading them to care homes, and it's important to address this issue through prevention and proper care. Hormone Replacement Therapy (HRT) can help prevent urinary incontinence and dementia in older women, improving their quality of life. The normalization of incontinence through advertising and societal expectations leads many women to believe it's a normal part of aging and to purchase pads instead of seeking treatment. It's crucial to understand that the vagina cleans itself and no douching or intimate washes are necessary. Pelvic floor exercises should be started early, and women should not accept abnormal symptoms as normal. A variety of treatments, including vaginal tightening and the Emsella chair, are available to help improve vaginal health and treat incontinence. These treatments can be life-changing, and it's essential to seek help if you're experiencing symptoms.

    • Advocating for women's health during menopauseTools like pelvic floor chairs, support groups, and open discussions with GPs can help women navigate menopause and improve their quality of life.

      There is a significant health inequality between genders when it comes to menopause-related issues, and women need to be more vocal in advocating for their health needs. The use of tools like pelvic floor chairs can help women reconnect with their bodies and improve their Kegel exercises' effectiveness. It's crucial to bring these issues to light and encourage informed discussions between women and their GPs. Additionally, resources like support groups on social media can provide valuable information and community for those dealing with menopause-related conditions such as lichen sclerosis. Menopause brings about various changes, and seeking knowledge and support can lead to a better quality of life. As one listener shared, HRT can be a game-changer for women experiencing perimenopause symptoms. It's essential to remember that menopause doesn't mean the end of joy and vitality but an opportunity to regain our mojo and feel better than ever.

    • Maintaining joy receptors, pet health, Mother's Day gifts, and high-quality sheetsInvest in joy, prioritize pet health, celebrate Mother's Day, and upgrade to better sheets for improved well-being

      Our mental and physical well-being is crucial, and addressing our needs can lead to significant improvements. Lizziell emphasized the importance of maintaining joy receptors in our brain cells, which can be achieved by replacing estrogen. Daniel introduced Pretty Litter, a health monitoring litter that helps detect early signs of cat illness, emphasizing the significance of keeping tabs on our pets' health. This Mother's Day, 1-800-Flowers encourages us to give back to the moms who have given us so much, offering handmade bouquets, sweet treats, and one-of-a-kind gifts with discounts. Lastly, investing in high-quality organic cotton sheets from Boll and Branch can lead to a better night's sleep, as they get softer with every wash. These small actions can lead to significant improvements in our daily lives and the lives of those we care about.

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    Looking forward to connecting with you! Here are some ways to connect with me!

    THE FLEXIBLE NEUROTIC SHOW NOTES: https://www.theflexibleneurotic.com/episodes/65

    THE FLEXIBLE NEUROTIC INSTAGRAM: https://www.instagram.com/theflexibleneurotic/ 

    THE FLEXIBLE NEUROTIC WEBSITE: https://www.theflexibleneurotic.com/ 

    THE FLEXIBLE NEUROTIC EMAIL: sarah@theflexibleneurotic.com

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    Here’s to happy private parts!

    Thanks again to Dr. Susie for her expert information on how to keep or regain your healthy pelvic floor. You can find more from Dr. Susie on her website.

    Have you had professional help and training to regain pelvic floor function? We’d love to hear about it and how it helped you get your quality of life back. Please share with us in the comments below (you’re welcome to comment anonymously), email us at info@genneve.com, or let us know on genneve’s Facebook page or in Midlife & Menopause Solutions, genneve’s closed Facebook group. 

    Next up on the genneve podcast calendar, Jill talks with acupuncturist and owner of Vitamin Chi, Jennifer Mason, about your fabulous fascia – what it is and how to keep it happy. Stay tuned!

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    Sharon is an NHS nurse practitioner and runs a private practice to support women going through menopause. You can find her online here.

    Please do subscribe to the podcast, you can find it on all platforms and if you'd like to subscribe to the blog as well, head over to Women What Whistle website.