Feb 24 • 10M

My Ten Year Journey to Treating Menopause

Estrogen creams to the rescue!

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My Ten Year Journey to Treating Menopause

It was December 4, 2009, when I first heard the words no one wants to hear. “You have breast cancer,” my friend and breast cancer surgeon Gayle told me, “This was caught very early, so you have a good prognosis.” I was 47, and like anyone in that situation, I had a host of emotions that I could not identify in the moment. I also, of course, had a lot of questions. As I went through treatment over the next two years, my doctors answered many of them. But no one talked to me about what being thrown into menopause immediately (as a result of the chemotherapy) would be like. It was an omission that affected my life until a year ago when I visited a gynecologist specializing in menopause. 

When I went to my primary care doctor over the years and reported symptoms, I was told to use more lube, which really wasn’t all that helpful. It was akin to putting an ill-fitting Bandaid on a problem.  It was only when I started following @DrJenGunter and then @DrRachelRubin on Twitter that I realized there was treatment available that no one was telling me about. I purchased Dr. Gunter’s books, The Vagina Bible and The Menopause Manifesto, and learned that there were safe treatments available beyond lube. That was when I started looking for a doctor specializing in treating menopause. When I went to my first appointment, I was struggling. But with some guidance from the doctor and some exercises and most importantly, estrogen cream, things improved over two months and my symptoms subsided. I couldn’t believe it! But then I was mad that it had taken so long, 10 years, to get proper treatment! While I recognize that there were changes in guidelines over those 10 years, I also know that the primary care and oncology doctors with whom I spoke were not keeping up with the literature.

While there are many physiological changes that happen when women enter menopause, the most significant is the lack of estrogen and androgens in her body. The PH levels in her vagina change, losing collagen and elastin, the blood supply is reduced leading to a lack of lubrication. The more recent medical name for this cluster of symptoms is ​​genitourinary syndrome of menopause or GSM. These changes can lead to chronic urinary tract infections (UTIs), painful sex, and urinary leakage. 

In 2019, the American Urological Association (AUA) issued guidance to include vaginal estrogen as prophylaxis for peri- and postmenopausal women with recurrent UTIs to reduce future UTI risk. While many consider UTIs to be a nuisance, they can lead to sepsis and then death if not treated promptly. In fact, according to the European Association of Urology, up to 31 percent of sepsis cases start as UTIs, representing 2.8 million to 9.8 million cases in the U.S. and Europe, leading to as many as 1.6 million deaths. Now that there is an effective and safe treatment,  the issue is getting the word out to the public and all doctors, especially those practicing in primary care. 

This treatment should not be confused with Hormone Replacement Therapy (HRT) pills which are systemic in nature. Treatment for GSM involves creams, rings, or suppositories. The estrogen stays in the vaginal area and does not enter the bloodstream, and therefore does not contribute to cancer or other side effects of HRT. It is safe for former breast cancer patients like me.

And for those who are concerned about cost, Mark Cuban’s new prescription drug website, Cost Plus Drug Company, covers many types of vaginal estrogen products. As of this date, however, those of us who live in North Carolina cannot order drugs from the website due to some licensing issues. 

I am sharing this incredibly personal story in the hopes that it will help other women. If the content in this article is news to you, please consider sharing it widely among your female friends. Information is knowledge and knowledge is power. 


For Inspiration

I saw this beautiful piece of embroidery on Twitter this week and thought I’d share it. Talk about a visual journal, the level of detail is off the charts!

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