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Welcome to The Modern Midlife Collective—where midlife isn’t a crisis, it’s a rebirth. Hosted by Dr. Ade Akindipe, DNP, and Dr. Jillian Woodruff, MD, this is the podcast for women ready to unapologetically own their power, thrive through the ups and downs of hormones, weight, and self-care, and show the world that thriving at 40 and beyond isn’t just possible—it’s your birthright.
Biweekly, we bring you science-backed insights on hormones, menopause, longevity, and sexual health—real tools to empower women in midlife and beyond. With a fearless blend of functional medicine, real-life wisdom, and no-nonsense empowerment, we’re here to challenge the norms, break through the barriers, and help you step into a life of vitality, confidence, and unstoppable strength.
Ready to rise? Let’s do this.
Ade Akindipe, DNP, APRN, NP-C (00:25)
All right, welcome to another episode of the Modern Midlife Collective. And this topic is most women what we whisper about, about bladder leaks, dryness, painful sex, and all of those unspoken things, things we don't naturally come out and tell our doctors about, especially after the age of 45. So honestly, these shifts can appear out of nowhere.
and we're not connecting it to what's really happening with these changes. So today we're going to dive all into this.
Jillian Woodruff MD (00:54)
Yeah, and maybe people would feel more comfortable coming out and talking about this if they were confident that there would be a solution or that the person would be listening to them and they would have help for it, right?
Ade Akindipe, DNP, APRN, NP-C (01:06)
Exactly. So we are going to break down the silence today and give language to what's really going on because just because you're getting older doesn't mean that has to be the full story. So hopefully when we break down the physiology of this and the real root cause behind this, this will make sense and you're going to get some answers. Okay. So Dr. Jill, let's talk about what's happening in the woman's body in your OB-GYN practice. I'm sure you see this.
Jillian Woodruff MD (01:24)
Right?
Yes.
Ade Akindipe, DNP, APRN, NP-C (01:33)
all the time when women come in with, know, sometimes maybe even vague symptoms, dryness, leakiness, maybe even recurrent UTIs. We know that there's a lot of hormonal things happening, but what are you seeing happening and tell us what's really going on?
Jillian Woodruff MD (01:47)
Right, absolutely. There is a name for this. It's called Genitourinary Syndrome of Menopause. And, you know, as you know, it encompasses so many different signs and symptoms, and you don't have to have all of these signs and symptoms. And some people may just have a few issues and other people may run the full gamut of what we see with this. But it's really ⁓ far reaching in terms of what you experience. The important thing is there are
⁓ Treatments for this, it's a very, very treatable thing if only it were diagnosed and then it could be discussed. So it does start with dryness as one of them, but some people may not experience dryness. Some people may only experience dryness with sexual intercourse. And others, may not have sexual intercourse, so they may not come to you and say, I have dryness, but it could be that they're having itchiness. They're feeling itchy down there.
and there may not physically be a problem that we can see like a skin issue, but that dryness can be from, or that itchiness can be from dryness, which could be from genitourinary syndrome of menopause. Many of the issues are connected. Most of these issues are related to low estrogen in the vagina. And we can start seeing this before...
menopause, so in those perimenopause years, know, five years before menopause, 10 years before menopause. And another time I do see this quite often is after childbirth because you've had such a huge decline in hormone levels or even their breastfeeding, which changes the hormonal makeup of the vagina. And they have these symptoms of dryness or painful intercourse. And the treatment is actually the same. And somebody who is after childbirth versus
Minute pause.
Ade Akindipe, DNP, APRN, NP-C (03:37)
I love that you mentioned that it's not just women who are in menopause, but some other people that might experience this during childbirth and things like that. And it's also not just about sex, right? It's about bladder health, tissue integrity. I know some women that will probably have issues with even their pelvic floor, pelvic floor support, microbiome balance. So,
It also can affect the urethral sphincter, which is pretty much like the gatekeeper to keep the urine in. So women will have trouble with bladder leakage and things like that. But when you go cough and sneeze or you go to the gym and you're leaking, unfortunately, those are the symptoms that are not so pretty that we experience. also one of those things that I see with women is with the whole gut health issue where
Jillian Woodruff MD (04:16)
Absolutely.
Ade Akindipe, DNP, APRN, NP-C (04:24)
if you already don't have a good gut health and then you're having these issues, you have things like maybe low good bacteria in that vaginal area that doesn't support a good microbiome. So you're getting urinary tract infections and yeast infections and coming from where I used to work in the acute care setting or the minute clinics, you're coming in with the same symptoms of recurrent UTIs but
We test you and you're negative. You don't have a UTI, you don't have a yeast infection, but there's vaginal dryness. And unfortunately you're exposing yourself to more issues by giving you more antibiotics, further causing more problems. So it's like a chain reaction of things that happens with tissue breakdown, collagen breakdown, and then your immune system is even more weakened, right?
Jillian Woodruff MD (05:13)
Yes, you brought up so many really important facts and really discussed the profound.
reach of low estrogen in vet and the vagina. The estrogen loss leads to the thinning of the vaginal tissues and the urethral tissues. So we're looking at the bladder and the tube that brings the urine from the bladder to the outside, that urethra. When you lose the integrity around this, it can change the way that you pee. The loss of the tissues in the vagina,
like the tissue strength of that vagina really changed the way that you, the sensations you have with intercourse, but not just that. They can also change the integrity of the vagina and how other organs are held up and not kind of falling in or prolapsing into the vagina. Also, the lower estrogen level decreases your collagen.
And collagen is really important for the integrity of that tissue and also for the production of elastin. So if you like pinch your skin up and if your skin goes back, you have elastin. But you know how when you get older and you pinch up, it just stays and it sags there. That same thing happens in the vagina and the tissue is more friable, more thin friable, meaning any sort of friction can cause bleeding and pain and paper cut feelings.
So the more severe that estrogen loss, the more severe those symptoms can be. And the bladder lining is really sensitive. So the inner portion of the bladder, very sensitive to estrogen and to testosterone actually. And so with you have that loss, it not only affects the vagina, but it affects the bladder. And actually they started writing more about this in urology literature.
even before they were writing about it in our gynecology literature because they're urologists who are really understanding the importance of local estrogen to the vagina for your bladder health. One of the things I know that you've experienced in your patients is urinary frequency. They just pee a lot, you know, and they're waking up more throughout the night to pee. And they may be...
getting tested for urinary tract infections, UTIs, and they never have them and they're like, but I have these symptoms and they can have pain too, you know, because they're bladder spasming. When you have low estrogen, your bladder is angry. It just, it's irritated and just squeezes. And when it's squeezing, you just have that feeling like I've got to get to the bathroom. And you may have more urgency and overactive bladder and it all may come back just to maybe some estrogen in your vagina.
But what happens is they're treated over and over with antibiotics, and then they're getting yeast infections, and they're getting other issues that come from overuse of antibiotics, right? The thought is that they have interstitial cystitis, like an inflammatory bladder issue. And so maybe they're put on pain medications, maybe something like gabapentin. They're having procedures where you're looking in the bladder. And then at the end, they don't have these things. They just need some estrogen because there's a loss. Your bladder's like, I needed you.
You kept me calm. You kept my tissues thick and smooth and working well. And now it's gone and I'm feeling it. I'm just trying to tell you with these symptoms that I need some help, right? Yeah. and the pH, the pH change of the vagina. That's a big one too, right? People start having recurrent yeast infections. You mentioned vaginal infections in general and urinary tract infections. Sometimes it is an infection. So sometimes it may.
Ade Akindipe, DNP, APRN, NP-C (08:31)
Yeah.
Absolutely.
Yeah.
Jillian Woodruff MD (08:51)
feel like one and it isn't, but sometimes it is because your pH changes. So the acidity of your vagina changes, right? When you don't have that estrogen and when that changes, you get rid of the good bacteria. It can't survive if it's not acidic. It can't survive in the new vagina you've got. And so when you lose your good bacteria that's keeping the bad bacteria away, hey, here come the bad bacteria. And then you add in some
Ade Akindipe, DNP, APRN, NP-C (08:56)
Yeah.
Exactly.
Jillian Woodruff MD (09:18)
high blood sugar, diabetes, microbiome of the GI system in there, right? And then yeast come to play with the sugar and it's a big old mess. We can fix it though.
Ade Akindipe, DNP, APRN, NP-C (09:27)
It's a big old
mess. Yes, we can. And if those tiny microfibers or those micro tears that happen just keep happening and you're wiping or you're riding a bike and ladies, this is what it shows up like. You you're trying to use a tampon and the thing that didn't used to hurt now hurts or, you know, the narrowing or tightness of that area. You know, just those little things that you may not.
necessarily tie it to, maybe this is hormonal changes. Maybe you were, I don't know, I know one lady that was just putting on jeans and every time she would try to put on the jeans, it would hurt leggings or trying to ride a bike or spotting after sex. Things like that are due to the, you know, the pH changes and the recurrent issues that are having the vaginal dryness, the BV. Sometimes you might even have discharge, even an odor, change in odor of what that looks
Jillian Woodruff MD (10:18)
yes.
Ade Akindipe, DNP, APRN, NP-C (10:18)
right? Thinking of your microbiome is changing. of course, that'll impact your whatever's happening in your gut definitely impacts your vagina area. you know, women are quietly adapting to this and thinking that the symptoms are okay to live with. But we know that estrogen decline starts and it can happen even before you even turn 40 or 45, right? We can start to see this a lot earlier. So
educating you and letting you know that if you start to have these symptoms, maybe this is what it is and you need to go get checked.
Jillian Woodruff MD (10:52)
Right, absolutely. And I think also Dr. Day is that sometimes they are saying something, but they're getting, you know, a little run around, right? Because we didn't know these things until we looked for these answers. Yes.
Ade Akindipe, DNP, APRN, NP-C (11:05)
or prescribed antibiotics, even if urine
culture was negative.
Jillian Woodruff MD (11:09)
Right, yes, yes. ⁓
Ade Akindipe, DNP, APRN, NP-C (11:11)
Yeah, yeah. You know, the emotional impact
is huge. You know, when you feel like you're not being heard and you're telling them, hey, I think something is wrong and you're not being heard. Like you mentioned earlier, there was a woman that kept having the same issue come to find out she had already had been diagnosed with type two diabetes and already had all of those repercussions from that. So estrogen decline comes with, you know,
insulin resistance too if you're not careful and changing your diet and watching those hormonal changes that happens.
Jillian Woodruff MD (11:42)
Right, and we did discuss in a previous episode that whole interplay between the estradiol and insulin resistance and blood sugar and that's a really interesting one to go back and listen to. And as we get more into talking about these things and we bring up all of these interconnections, to me it's very exciting. I know to you it's really exciting to really understand how everything really is connected.
but we treat them so separately in traditional medicine and it makes it tough. So it's good to share this, I think, so that people can see how connected it is, but no one person's gonna have all your answers, right? We're really good at the things that we're talking about, but there's other things that I depend on, many other things that I would depend on colleagues to help with, but that's the thing we need to really continue to build that up and work with.
Ade Akindipe, DNP, APRN, NP-C (12:17)
Yeah.
Yes.
Jillian Woodruff MD (12:36)
other people, right? Because our bodies are awesome and amazing and complicated. It's lot to learn.
Ade Akindipe, DNP, APRN, NP-C (12:38)
Absolutely.
Absolutely,
very, very complicated. But I think that's what's great about things like this, that ⁓ we have this episode and we already know how much information people are already getting. Somebody said the other day, like, I didn't know that this is what causes that. I didn't chuck it off to hormones. So if you're listening to this, this is why we're here. So all right, Dr.
Jillian Woodruff MD (13:02)
That's right. Let's go through those
top 10. Can you like, let's start us off with like just our top 10 symptoms and then let's talk about some myths.
Ade Akindipe, DNP, APRN, NP-C (13:10)
So top 10 symptoms, I mean, what I see in practice, I see a lot of urinary symptoms, dryness, painful sex, recurrent urinary tract infections, BV, or they have gone to minute clinics. Most times they can't get into their doctor's office and the only place they can get into is urgent care where they have to see multiple patients throughout the day and they're given something maybe to relieve it.
Jillian Woodruff MD (13:18)
Okay.
Ade Akindipe, DNP, APRN, NP-C (13:36)
You know, like I mentioned before, just getting on a bike. know, sometimes I just, I was able to ride bikes, but now it's so painful for me to even do that. Or even just looking at the skin. When you do an exam, everything looks very dry. There's a lot of chafing. There's a lot of soreness down there. One woman, it was so bad that she was already having wounds that we had to actually treat the wound here. Turns out it was estrogen. Once we put her, you know, put her in just some local estrogen, she started to recover. started to feel good.
So those are the ones that I see most commonly. Sometimes even pelvic discomfort, some of them will say they have to brace themselves because they're afraid of it hurting or it feels very loose down there for some reason. And of course, we know that there's estrogen receptors pretty much everywhere. So you can imagine everything, the elasticity loss in your joints and things like that, even due to loss of testosterone too, could probably be some of the-
Jillian Woodruff MD (14:13)
Hmm
Ade Akindipe, DNP, APRN, NP-C (14:30)
costs of that.
Jillian Woodruff MD (14:31)
Yeah, I think it's a cycle too because you mentioned BV being one of the issues and we know recurrent vaginal infections can occur. And then when people are peeing and they're bracing themselves, when that urine stream touches those raw areas, that's painful. So it could even be it's not the estrogen that caused that, but in a roundabout way, yes, it did. I guess to add to that, other things I see are just that.
paper cuts or shards of glass feeling, that's hard. And sometimes there are physical paper cuts and sometimes it's from recurrent yeast infections. Another time just due to loss of integrity of that skin and just being so fragile that it tears with any sore and it's not always intercourse. It could be just movement, right? Cause you're always moving in that area. The bladder spasms and just that feeling of ⁓ needing to pee a lot, urinary.
urgency and then leakage with that urgency. So urgency is like I feel like I need to get to the bathroom. I got to go right now. I'm not going to make it and they're rushing and then they may have some leak along the way and both the urgency and the leakage I see increased with genitourinary syndrome of menopause. And yes, leakage with stress like jump, cough, sneeze, anything that increases that pressure on the abdomen can also be, you know, increased in those with
estrogen, estrogen loss. And yes, and I think all the other things you said definitely in my top 10. Myths, I think one of them is that if you're on hormone replacement with estrogen, estradiol, hormone replacement like with a patch or a pill or a cream or a pellet, you know, something that
you've taken in order to decrease hot flashes or help with brain fog that you can't or shouldn't be on vaginal estrogen. That's definitely a myth. I think of estrogen for the vagina as skincare for the vagina. It's some really good expensive skincare. And so absolutely you should be treating it right down there where you need it, even if you're on systemic hormones. And sometimes that systemic hormone is not enough to
Ade Akindipe, DNP, APRN, NP-C (16:28)
Uh-uh.
Jillian Woodruff MD (16:47)
take care of the symptoms that you experience.
Ade Akindipe, DNP, APRN, NP-C (16:50)
Absolutely. Yeah.
So let's talk treatment, Dr. Jill, because what actually helps, because a lot of women, the first thing is they're probably not going to go straight to you right away to talk about stuff like this. So they're probably already trying things on their own. So they might have tried lubricants, coconut oil, boric acid, or random things people find, cranberry supplements, anything that will
hopefully remove all of these symptoms. So while we know that estrogen is one of those things, what, and you probably already mentioned it, what is your go-to first thing?
Jillian Woodruff MD (17:24)
Okay, well, you know that you brought up lube, which is another myth that if I have vaginal dryness, I'm just going to use lubricant. That's right, lube it up, lube it up. For intercourse, yes, you should use lubricant. That's wonderful. However, it's not going to fix the problem, right? We're just trying to avoid some symptoms that you may have from intercourse.
Ade Akindipe, DNP, APRN, NP-C (17:31)
gonna lube it up.
Jillian Woodruff MD (17:46)
So which means that even if you're not having intercourse, you should take care of your vagina. Even if you never plan to have anything in your vagina at all, you should still take care of your vagina and your bladder. And with some of these things we'll discuss. So my go-to is definitely estrogen, a vaginal estradiol. So either a cream form or a pill form or a ring. And I'm talking about a systemic ring. Not a system.
Ade Akindipe, DNP, APRN, NP-C (17:56)
Bye.
Jillian Woodruff MD (18:10)
I'm not talking about a systemic ring, Dr. Day, I'm not. talking about there is a ring that releases just estradiol locally to the vagina that you can leave in for three months. I quite like this, especially for people who may not be as consistent with doing something each day. I think this works really well. Typically, if you are having penetrative sex, you probably need to remove it. You could leave it in.
It just depends on the size of your vagina and how comfortable you are. There's no problem with leaving it in. There's not going to be a problem to your partner. You know, especially even if it's a male partner in his penis, it's not going to cause an issue. So you could leave it in, but it is thicker than the birth control ring is. So sometimes people may be more comfortable just to remove it, set it aside and put it back in afterwards. Vaginal estradiol pills are probably the thing that are the most common. They go in the vagina.
And these are nice because it's very, very easy to use. Some of them come on little inserters. I hate that there's such a waste of plastic because there's a separate inserter for every teeny tiny little pill where you could just stick your finger, you know, and stick it up in the vagina. But, and then there's ⁓ a cream and the vaginal estradiol cream is nice because it can be soothing and it also can be rubbed on the outside to help with that tissue on the outside that may be dry or itchy or, and,
and need improvement, need collagen. And also you can use it on other areas. I put vaginal estradiol around my eyes and I put it around my lip because it can help to prevent, you know, wrinkles. And, you know, I like the aesthetic part of it. But to use it in the vagina, I think it's too messy personally for me. But other people find it quite soothing to use. And you do have to kind of put it in a little insert or like a little syringe to put the cream in there.
I wish I, I think I showed, I didn't show the cream last time, but you put it in there and then you insert it like a tampon would be. Those are my favorite things for really most everyone. can there's, it's really safe for really most everyone.
Ade Akindipe, DNP, APRN, NP-C (20:01)
or it's pretty easy to do.
definitely is very safe, easy to use. mean, once you get into a routine of it, it definitely is very safe. And then just, you know, on the lifestyle part, I mean, of course, hormone replacement locally and even systemically can really add to that, can really help. But hydration, right? The simple back to basic things, making sure that you're hydrating, not...
you know, washing with harsh soaps and making it even worse. Because sometimes people feel like they just need to clean and use all kinds of douches over the counter things to kind of clean down there. You're actually making the matters worse. But the biggest story also lies in making sure that you are not chronically stressed, right? You are not inflamed. You are sleeping very well because all of these little things matter. Insulin resistance is a huge part of that.
So if your blood sugars are already on the rise, that can cause more urinary symptoms and more vaginal irritation. So eating good, eating, yes, exactly. So low omega-3 intake can also lead to problems that affects the tissue. You need omega-3 for those tissues. Gut health, cannot emphasize that enough because your gut and your vagina, they kind of talk to each other. So the bacteria there can also impact
Jillian Woodruff MD (21:06)
more infections.
Ade Akindipe, DNP, APRN, NP-C (21:25)
how your vaginal flora, the lactobacilli, which is that good stuff that your vaginal area needs to prevent you from getting those yeast infections and BV and UTI. So keeping the pH of that area balanced, making sure that it's not super high. You need it to be lower so that you avoid those, so that the good bacteria can thrive and you're not feeding the gut with stuff that's going to make you get sick.
Jillian Woodruff MD (21:38)
Yes.
Ade Akindipe, DNP, APRN, NP-C (21:52)
Just that transitional phase, think, even though the local, like you talked about, is really great, I think even the systemic also, right? Dr. Jill can help with those other symptoms that might creep up with perimenopause, but can also help too. So like you said, that myth, just because you're on systemic doesn't mean you can't do the local as well. So getting a little bit of both is absolutely possible, not just one without the other, right?
Jillian Woodruff MD (22:18)
Yes, and you know, Dr. Day, you brought up the GI system and the flora that's there naturally. In women, we're quite unique in that everything is pretty close together, right? So your urethra, your urine comes out in the vagina. And so you can find when you're having an infection, if you have a vaginal infection, you could carry that in your urine and vice versa. Urine infection you can carry in the vagina. The same with the
Ade Akindipe, DNP, APRN, NP-C (22:33)
Mm-hmm.
Jillian Woodruff MD (22:44)
we find GI bugs in the vagina. And they can cause symptoms that are even more severe than would typically be experienced from a vaginal infection. The area between the vagina and the anus is called the perineum, and it shortens, especially if you had vaginal deliveries. You may have had cuts or tears during delivery. That area shortens, so you can...
it becomes closer and closer together. So then when your poop comes out, you know, there is just a lot more risk of the things that should remain in your intestines now in the bladder and or in the blood now in the bladder or in the vagina. And so that's a huge problem that is somewhat caused by physical changes that happen with a procedure or childbirth, but also estrogen as that.
Ade Akindipe, DNP, APRN, NP-C (23:28)
Exactly.
Jillian Woodruff MD (23:40)
Tissues change, thin, they become smaller, thinner, friable, easily terrible, you know, and then they're closer together because of that too. The separation between these areas, that tissue even inside the vagina, the tissue between the bladder and between the rectum is also quite thin. Aside from, there's some women who just do not want to use estrogen, and so there are things to do even if you're not doing estrogen.
for that tissue. Hyaluronic acid is something that helps with lubricating dry tissues and so that and it comes in different forms that is something to do. DHEA is a protestosterone, right? It metabolizes into testosterone. There are over-the-counter inserts that can go in the vagina that have that. It has vitamin E, has beeswax.
Ade Akindipe, DNP, APRN, NP-C (24:15)
Great.
Jillian Woodruff MD (24:27)
really lubricating things so it feels nice and also can lead to long-term benefits. So that and then there's great devices. I love this device. That's a red light device that you put in the vagina and there's red light and heat associated with it. And red light, we, I don't know if we've actually gone into red light and all of the many numerous benefits, but red light is really great for decreasing inflammation, increasing collagen.
Increasing, even slight increases of skin thickness, decreasing of bloating. Anyway, right there in the vagina can help to stimulate collagen production, which is tissues, right? So this can decrease pain and decrease risk of infections. It's a really good thing. And then, like you said, with the hygiene, like these, I think when people have odor changes, then they automatically think it's something they're doing, you know, and...
Ade Akindipe, DNP, APRN, NP-C (25:00)
Absolutely. Yeah.
Jillian Woodruff MD (25:17)
So they try to reach for more, clean more, do this more. But sadly, the odor changes from the pH changes is from estrogen loss. So it's not, can't hygiene that away. And hygiene, know, all of the cleaning with all these stringent soaps and things does make it worse because they just get rid of really good things that are there.
Ade Akindipe, DNP, APRN, NP-C (25:24)
Yes.
Absolutely, estrogen
has such a huge, huge function with us. And you lose the glycogen stores that's feeding the good bacteria too. And then that causes problems, which is why I really love to recommend probiotics for those women as well. Probiotics specifically that replace the lactobacillus. There are two, and I'm not sure if I can remember this, lactobacillus sc...
Jillian Woodruff MD (25:48)
Yes.
Yes.
Ade Akindipe, DNP, APRN, NP-C (25:57)
I think it is, and there's another one that I really love those two. They just really help with just restoring the normal flora. And we could probably put it in the show notes if I remember this, but they're just found to be really good, high quality probiotics. help just lower that vaginal pH, support bladder health, and just overall just kind of help everything much better. Or just even fixing your...
your diet as well, making sure that you're eating foods that are probiotic rich, like kombucha, yogurts, there's some yogurts you find now that'll say they've got rich pre and probiotics that can help target and help improve the bacteria in that area too.
Jillian Woodruff MD (26:37)
⁓ absolutely. I've had patients that have started on oral probiotic regimens, but probiotics that were rich in lactobacillus species, and they noticed huge changes in their vagina. But again, like we're talking about, you know, a specific symptom, like I'm having a recurrent infection. Okay, well, let's get you good bacteria. But when it...
comes to, you know, an estrogen loss, we really have to do things specifically for building that, that tissue back, which really, there's just really not much that's as good as estradiol in my opinion. Nothing as good as that, right.
Ade Akindipe, DNP, APRN, NP-C (27:13)
No, mean, totally agree. Espidial for sure.
But again, holistically, holistically, looking at the whole picture, know, fixing the gut, all of those things could definitely improve, especially if you're having those recurrent symptoms and you're on antibiotics over and over again. It's just something that you could do to really protect yourself because a lot of people, a lot of women are really inflamed. You know, the bloating, the gas are all symptoms of what we call dysbiosis.
Jillian Woodruff MD (27:18)
Yep.
absolutely.
Mmm.
Ade Akindipe, DNP, APRN, NP-C (27:41)
Adding that on top of estrogen loss is a huge problem.
Jillian Woodruff MD (27:44)
I think there probably we should do ⁓ a program even about all of the vaginal changes and skin things besides because genitourinary syndrome and menopause is just one thing. ⁓ And recurrent infections, that's one thing. But there's so many skin issues that arise too, right, during this time, which are really from what you're talking about, the dysbiosis. There are some
Ade Akindipe, DNP, APRN, NP-C (27:56)
Absolutely.
Yeah.
Jillian Woodruff MD (28:10)
is it well like lichen sclerosis and we're not going to get into it but right autoimmune skin thing but diet makes a huge difference like histamines can and like a diet with with you need to think about the histamines the nitrites the ⁓ what is the other thing
Ade Akindipe, DNP, APRN, NP-C (28:13)
I can throw out this. that's a whole other episode. Yeah.
Jillian Woodruff MD (28:30)
I forget. ⁓ well, when we do this this program by your diet, you just have to be really you need direction. Right. And nightshades, nightshades is one too. You need direction. And then it's it's not easy. Right. But it can make a huge difference. Right.
Ade Akindipe, DNP, APRN, NP-C (28:45)
It's not easy at all knowing what you can tolerate from other people, you
what is different from the other, complete difference. So that's why.
Jillian Woodruff MD (28:52)
But it's amazing
to think of the power you have.
Ade Akindipe, DNP, APRN, NP-C (28:55)
Yes, absolutely. If you have food sensitivity, there's a whole other way that things can impact you in your gut health, vaginal health, and all of that. So anyway, we digressed a little bit, but that's okay.
Jillian Woodruff MD (29:06)
Yes. One last insert that
I wanted to mention is boric acid. Boric acid you can get as an insert. They have many over-the-counter options, but this is something that can be used to treat yeast infections. Especially there are some non-traditional yeast infections that aren't treated in the traditional manner. It's treated with boric acid and also can be used as prevention. So if you're someone that has recurrent yeast infections or a BV, you can do this to prevent that from
occurring. So whether you are perimenopause, menopause or not, this can be something helpful and then allow you to be building up that tissue in the vagina as well. So I just wanted to, because that kind of goes along with this time too, because it's not an overnight fix, know, none of these are overnight fixes.
Ade Akindipe, DNP, APRN, NP-C (29:50)
Absolutely. Yeah.
None of them are definitely. And I know we're kind of running out of time here, but pelvic therapy is also something that can help women who are losing that elasticity and just bladder leaks and things like that. And I think it's getting more common now. We have a lot more physical therapists that are more concentrated on pelvic floor health.
So that is something that can incredibly help women. I'm sure you've probably seen that too in your practice and how that can help women, you know, try to tighten up the muscles down there. You're using estrogen, those are all great, but that's another tool that can help women feel better.
Jillian Woodruff MD (30:27)
Absolutely, and we don't talk about that enough, the many benefits of pelvic floor PT. I think now we've just given you really a name, genitourinary syndrome of menopause. ⁓ An older term, you have the diagnosis right there. An older term was vaginal atrophy, but as you can see, it doesn't encompass all of the many things that can happen with your genitourinary system.
Ade Akindipe, DNP, APRN, NP-C (30:30)
Yeah.
There's a diagnosis.
Jillian Woodruff MD (30:50)
So, genitourinary syndrome in medicine is a much more clear and all-encompassing diagnosis. So, if someone is saying, you know, your urinary symptoms are separate, couldn't have anything to do with low estrogen or genitourinary syndrome of menopause, you will say, just respectfully disagree and I'd like to share this information, share this podcast with them.
so that they can learn more about it. I think more and more people are thinking of this and whether they're prescribing or referring for a prescription for a treatment, I think it's happening. And we just have to keep this conversation going so that more and more people hear about this, providers and other women and patients.
Ade Akindipe, DNP, APRN, NP-C (31:35)
Absolutely. The takeaway today is that dryness, leakness, leakness, leaks, pain are all common and there is a name for it, GSM, Genitory Urinary Syndrome, and they are treatable. So with the approaches that we've mentioned, you can definitely find something that can work for you.
Jillian Woodruff MD (31:42)
Yes.
That's right. Well, thank you for joining us. gotten, you we I think we both got many ideas of where to take this from here, but we would love to hear from you and we want to know what you would want to hear from us, what you have questions about. So email us and we will have our email in the show notes. Follow us on Instagram and leave your questions there. If there's a topic we need to cover, we want to know.
So thank you for joining us today. We'll see you next time. Bye.
Ade Akindipe, DNP, APRN, NP-C (32:21)
Thank you. See you next time.