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Symptoms, Risks, Vaginal Estrogen, Pelvic Floor PT & Radiofrequency Options
This Peri & Pause episode features Jamie Gallagher, a nationally board-certified family nurse practitioner and Menopause Society certified practitioner, discussing genitourinary syndrome of menopause (GSM), the updated term replacing “vaginal atrophy” because it affects both vaginal and urinary tissues. They explain how declining estrogen causes tissue thinning that can lead to dryness, burning, itching without discharge, pain or bleeding with sex, urinary leakage, increased UTIs, and even life-threatening urosepsis, noting symptoms are often underreported and frequently dismissed as “normal.” First-line options include vaginal moisturizers and lubricants, with vaginal estrogen emphasized as key and not “duplicate therapy” with systemic hormones. Additional approaches include pelvic floor physical therapy and emerging energy-based radiofrequency (including microneedling RF) to stimulate collagen, improve continence and tissue health, with a typical three-treatment series and annual maintenance.
00:00 Welcome to Peri & Pause
00:39 What Is GSM
02:01 Why It Matters
03:32 Estrogen and Tissue Changes
05:10 How Common and Why Silent
06:42 Diagnosis and First Steps
08:31 Vaginal Estrogen Options
10:35 Beyond Estrogen Treatments
12:03 Radiofrequency Explained
13:36 Practice Mission Break
15:16 Expected Results Timeline
17:19 Research and Incontinence Types
20:35 Procedure and Downtime
24:04 How to Get Help
25:51 Wrap Up and Disclaimer
Creators and Guests
Host
Jamie Gallagher DNP, FNP-C, MSCP
Jamie is a doctoral-prepared, board certified family nurse practitioner and a Menopause Society Certified Practitioner. She is the owner and founder of Peri & Pause. She has served as a nurse practitioner in the Triangle area of North Carolina since 2009 in family medicine, urgent care and women's health. She is an active member of The Menopause Society, the HERmedicine Provider Alliance, the National Association of Nurse Practitioners in Women's Health, and the International Society for the Study of Women's Sexual Health. She is also a proud military spouse, mother of four and grandmother of three.
What is Peri & Pause The Podcast?
The Peri & Pause Podcast is for women in midlife who know something in their body has changed—but haven’t been given real answers, or have been left overwhelmed by conflicting information.
Hosted by Jamie Gallagher, DNP, FNP-C, MSCP, a nurse practitioner specializing in perimenopause and menopause care, the show explores hormones, metabolism, mental health, sleep, sex, weight changes, and chronic conditions through an evidence-based, deeply practical lens. We unpack the physiology of midlife alongside the lived experience of women navigating careers, relationships, finances, and identity during this transition.
Every woman deserves this conversation—and the clarity, language, and confidence to advocate for better care.
Because “Your Labs Are Normal” Is Not the Whole Story.
Welcome to Peri in Pause, the podcast where midlife women get real answers about their bodies, their health, and what's actually changing. Because every woman deserves this conversation
[00:00:18] Speaker 2: Welcome back to the Perimenopause the Podcast, where we talk all things midlife women's health, life experiences, and share all the best. I'm Jamie Gallagher, nationally board-certified family nurse practitioner, a Menopause Society certified practitioner and owner of Perimenopause, a midlife women's healthcare practice serving women in North Carolina.
I'm so glad you're here. You too, Jamie.
[00:00:37] Speaker 3: Thanks.
[00:00:37] Speaker 2: Welcome back. Thanks for having me back. So today we were gonna talk about, um, a condition in midlife women's, uh, health called genitourinary syndrome of menopause, AKA GSM, um, and all the, the symptoms and the repercussions, the risks, uh, and treatment options for that, because that is a one-direction, um, condition- Mm-hmm
in midlife women's life or, or m- midlife women's care, and it- it's one-way meaning it does not improve on its own at all. So welcome.
[00:01:10] Speaker 3: Absolutely. Thank you. I'm so glad to be here to talk about that, and I'm so glad that you went ahead and said GSM instead of genitourinary syndrome- Right ... of menopause-
because I'm gonna definitely mess that up.
[00:01:19] Speaker 2: So when you hear GSM, we're gonna define that for you, and then you'll know what that is. Yeah. And, um, it won't be a tongue twister,
[00:01:26] Speaker 3: so. Perfect. All right. So GSM, just so everybody knows, um, is a new updated term. It replaces the old term of vaginal atrophy- Mm-hmm
that we were using before. Um, part of the reason they updated that term is because it's not just the vagina that's affected. It is literally the genital tract, which is the vagina and everything, but also the urinary tract as well. There are so many urinary symptoms involved with it. Mm-hmm. And so they updated that because people assumed that vaginal dryness was, that was it, but it's not.
There's so much more that goes into the health of that vaginal tissue and supporting urinary health for women. Mm-hmm. And it impacts women's life by, you know, urinary leakage, y- you know, UTIs increasing in perimenopausal, menopausal states and that decrease in estrogen that we have. It also increases our chance for, um, you know, having our day just impacted by that urinary leakage and potentially getting urosepsis.
Yeah. That is life-threatening, and so it's really important that we understand it's not just some vaginal dryness that is an issue. It is all the tissue down there, and it can be life-threatening.
[00:02:32] Speaker 2: Yes. When urosepsis is no joke. If, um, If anyone listening has had a grandmother or someone, um, where you've heard that, oh, she died of a urinary tract infection, that's true. Mm-hmm. That is true. It starts as a urinary tract infection, moves up the organs, and can enter the bloodstream, and it is- kind of a insidious onset, uh, that particular, um, condition can just present as confusion in the older woman.
Mm-hmm. Mm-hmm. Not necessarily fever or, you know, discomfort with urination, so that's what makes it, um, something that is super high risk.
[00:03:08] Speaker 3: Yeah, absolutely, 'cause we think about urinary tract infections when we're younger, having that, you know- Right ... I have to go to the bathroom. Yeah. I feel like the burning and all of that, but it doesn't present like that- Yeah
in our older women, and so it can be very insidious and sneak up on us. Yep. And so, you know, doing everything we can to protect that vaginal and urinary tissue down there to help support our bladder health and prevent that is really, really important. Yep. So this happens during menopause because estrogen receptors are very, very, um, dense throughout all the tissue in that vulvovaginal area- Yes
as well as the uri- urethra, and then as well as the bladder tissue. There's like a little triangle of tissue- Mm-hmm ... right underneath the bladder that supports our urinary health, and that has tons of estrogen receptors in it. So when we start having those changes in estrogen, and then eventually no estrogen- Yeah
um, all of that tissue atrophies and it becomes thinner. It becomes like tissue paper. Yes. So it's a lot easier to have, you know, pain with sex, bleeding after sex, um, that vaginal dryness, burning is things that people experience. Sometimes people will say, "It just feels like I have a yeast infection all the time."
Mm-hmm. "It's itching, but I don't have a discharge." That is genitourinary syndrome of menopause.
[00:04:20] Speaker 2: Yes, absolutely. Define atrophy again, um, just so we'll understand.
[00:04:25] Speaker 3: Yeah. So atrophy is just that tissue breaking down. So when you have nice healthy tissue there with lots of estrogen receptors, your tissue is supportive.
It has a lot of collagen in it. It's very elastic. It's like having a nice thick piece of paper that's down there really thick, but as it atrophies, it kind of thins out. It loses that stretchiness. It loses the moisture that's in it, um, and it becomes more like a piece of tissue paper where it's very easy to kind of punch through and it doesn't really hold anything.
Um, you don't have that support that you used to have.
[00:04:56] Speaker 2: Yeah, absolutely. Yeah, and a lot of older women, when I think back in family practice over the last decade plus, um, older women would be like, "I, I think I have an infection," and it just was never really an infection. Mm-hmm. So that's, that's what it was.
So, um, start with the basics. So how common is this for midlife women and beyond, and why don't we talk about it?
[00:05:20] Speaker 3: Yes. So unfortunately, the answer I get a lot from a lot of my patients is, "No, just the normal urinary leakage."
It is- Oh,
[00:05:28] Speaker 2: absolutely ...
[00:05:29] Speaker 3: absolutely not normal. Do
[00:05:30] Speaker 2: not associate the word normal with just the normal leakage when I sneeze or when I jump on the trampoline with my kids. Not normal.
[00:05:36] Speaker 3: No, let's please not normalize this. It does not need to be normal. Um, so I think part of that is that women think that leaking as we get older is just a normal thing.
Their, their- Need to be expected ... grandmothers did it, their mothers did it, and that it's true, it happens because of that decrease in estrogen tissue down there. So yes, it is normal in the fact that they have had that decrease in estrogen tissues and experienced it, but that doesn't mean it needs to be normalized.
Right.
[00:06:01] Speaker 2: Yeah.
[00:06:01] Speaker 3: Um, but generally about 50 to 70% of women in, um, menopause will experience genital urinary syndrome- Yeah ... symptoms.
[00:06:09] Speaker 2: That's a lot.
[00:06:09] Speaker 3: Um, which i- it is actually under-reported Mm-hmm ... because we think it's normal, and because people are embarrassed. It's an embarrassing thing. And so- Yeah ... that's the numbers that we have reported, but they think that it's a lot higher than that.
[00:06:22] Speaker 2: Yeah. Um. Absolutely. Absolutely. I would agree. Um, and you know, when a woman says, "Oh, just normal leakage," like can you imagine your, our male counterparts going, "Oh, no, it's just the normal leakage"? That would be a no.
[00:06:33] Speaker 3: Yes.
[00:06:34] Speaker 2: Yeah. You know? And agree for both, you know, women and men, it's, it's a no. Yeah. And it, it puts us at risk for, um, lots of other things as well, so.
[00:06:41] Speaker 3: Yeah.
[00:06:42] Speaker 2: What about if someone is diagnosed with this GSM, um- What does that mean for long term? And then talk about the first line treatment, super simple.
[00:06:53] Speaker 3: Yeah, absolutely. So being diagnosed with genitourinary syndrome of menopause, it doesn't mean you're doing anything wrong. It is a normal part of aging in the fact that we lose those estrogen, um, or lose estrogen in those areas that are dense in receptors.
So it's not anything you're doing wrong that's making it happen. It just is normal in that part that that happens as we age. Um, so please don't feel like you're not doing the things that you're supposed to. Yeah. Um, but it is, like you said, a lifelong condition. It doesn't get better on its own. Yeah. That estrogen is not gonna come back magically and fix itself.
And so unless we're replacing that estrogen down there and helping to support that tissue, getting the estrogen back- Yeah ... we will continue to have symptoms that worsen and, um, become more problematic for us.
[00:07:39] Speaker 2: Yeah. Yeah, absolutely.
[00:07:40] Speaker 3: Um, and then as far as treatment wise- Mm-hmm ... there's lots of things you can start with.
Um, so vaginal moisturizers are a good, like, first line non-hormonal thing- Yep ... that we can do, and that's ... When I say vaginal moisturizer, that's not lubricants. Yes. That's something that you use every day to help with adding moisture back to the vaginal area.
[00:07:58] Speaker 2: Mm. It's like, it's like skincare for down there.
Yes. That's what Kelly Casperson said, "Skincare for down there," because, you know, we take care of this tissue because this is forward facing. Keep in mind, this tissue can harm us later, so we need skincare for down there too. Yes.
[00:08:11] Speaker 3: I like that. I like that. I'm gonna- Yeah ... I'm gonna start a just skincare line called Skincare for Down There.
[00:08:16] Speaker 2: Right? I know. Kelly will be like, "Wait, that's my term."
[00:08:18] Speaker 3: I know. I was like, "That's great." Um, so yes, vaginal moisturizers, lubricants when you're having sex, all of that helps with the vaginal dryness portion- Mm ... of that. But it doesn't do a lot to support the urinary symptoms- Right ... that you can have. Right. So vaginal estrogen is a go-to for sure.
So-
[00:08:35] Speaker 2: Should be over the counter. Mm. Hear me FDA.
[00:08:37] Speaker 3: Yes, absolutely should be over the counter, should be covered by insurance if you're gonna have to go through the pharmacy. Um, all those things. It shouldn't be expensive. It should be something very easy for everyone to use because, again, it's something that everyone is going to have experiences with because our estrogen is going to go downhill as we age.
Mm-hmm. And that, even replacing it systemically doesn't always talk to that genital urinary tract very well. Right. So that vaginal estrogen is really a key component in this.
[00:09:04] Speaker 2: Agree. I, uh, when I first started doing this a couple years back, I would get, uh, notifications from pharmacists, um, and pharmacy benefit people.
Um, and they would say, "Oh, y- duplicate therapy, duplicate therapy." That is not duplicate therapy. Systemic estrogen, be it a gel, a patch, um, oral or whatever, along with vaginal estradiol is not duplicate therapy because a lot of women do not experience, um, improvement in symptoms, uh, here when they have systemic improvement.
So it's not duplicate therapy. You can absolutely do systemic estradiol, in other words, the patch, the pill, the spray, the, the gel, along with the vaginal estradiol cream.
[00:09:44] Speaker 3: Mm-hmm. Yes, and I feel like it's absolutely necessary to put it right next to that tissue to really see- Yes ... that improvement. Mm-hmm. Um, and so of course, you know, inserting it vaginally is gonna help with that vaginal tissue, but it's messy.
It comes out. Uh, but we want all of that mess to happen and be there to help support- Yeah ... um, that outside tissue, that urinary tissue as well. Mm-hmm. And so, you know- That's
[00:10:06] Speaker 2: the cream. Uh, what are- Yes ... other options-
[00:10:08] Speaker 3: Yeah ...
[00:10:09] Speaker 2: uh, for that if, if some... 'Cause some women have an aversion to that lotion-y feeling.
[00:10:13] Speaker 3: Yes, absolutely.
So there's also vaginal tablets of estradiol- Mm ... that we can use. Um, there's, like, the Estring, which is another type of vaginal estrogen. Mm-hmm. Um, and then of course we have, like, we can compound things- Yes ... different versions that you need. Those little compounded pills. Yeah.
[00:10:28] Speaker 2: Love those.
[00:10:28] Speaker 3: Yes. I was gonna say little suppositories- Yep
that are great. Um, so lots of different vaginal options there.
[00:10:33] Speaker 2: Nice. Nice. Okay. So, um, we talked about how oral hormones, things like that may not hit that tissue, and I find that true in a lot of women. Um, a- outside of this for, I'm kind of segueing into pelvic floor dysfunction- Mm-hmm ... which is really not, you know, where we're going with this podcast.
But when these don't help perfectly. Mm-hmm. Um, talk about other treatments that we are now using that are, um, getting good evidence behind them to help with GSM. Yeah. For women who are like, "This is good, but I'm, I'm not there yet, and I, I, I don't want surgery. I, I went to this clinician," and they're like, "Well, we could do surgery."
What, what can we do in between? Because who likes surgery, right? Yeah. Especially in that area.
[00:11:22] Speaker 3: No, absolutely. , Surgery is an option, but again, very invasive and- Mm-hmm ... probably not the first place that we wanna jump.
[00:11:29] Speaker 2: Right.
[00:11:29] Speaker 3: Vaginal estrogen can be helpful as far as supporting that tissue and everything, but we don't always get to that vaginal estrogen in time for people because, again, we're not everybody has identified it early enough- Yes
for us to be able to kind of support that tissue where it needs. So some people need more than just the vaginal estrogen for support.
[00:11:45] Speaker 2: Yeah.
[00:11:45] Speaker 3: So people that have weak pelvic floor muscles, doing, um, pelvic floor therapy can be very helpful- Yes ... for supporting that. And I definitely feel like pelvic floor therapy for people that have weak pelvic floor muscles is important to start when you're starting that estradiol.
[00:11:59] Speaker 2: Agreed.
[00:12:00] Speaker 3: Absolutely. Mm-hmm. And definitely getting that tissue as healthy as possible. But there are new emerging treatments. There are new, um, energy-based radio frequency treatments that help with increasing the moisture down there. Mm-hmm. Um, it works by putting, um, heat in the area and actually heating up the tissue to stimulate collagen production.
Yes,
[00:12:19] Speaker 2: yes.
[00:12:19] Speaker 3: some of it goes with, um, like, topical ways of trying to get the tissue to heat up, but then there are a little bit more, um, productive forms that do, like, microneedling with radio frequency- Yes ... and as well that helps with getting that, that heat down further into the tissue- Yeah
that really helps with collagen formation and elastin, which help to support the bladder, help to help with, um, creating that, um, re-epithelialization of the vaginal tissue. Big word. Yes, I know. Yes. I love that. Means, means regrowing new skin and new, um, top layers of skin for your vaginal area, which helps with that moisture and with supporting the tissue down there.
[00:12:57] Speaker 2: So when you say microneedling, I go, "Yeah."
[00:12:59] Speaker 3: Yeah.
[00:12:59] Speaker 2: So talk to me about
[00:13:00] Speaker 3: that. Yeah. Yeah, absolutely. So people think microneedling, they think of their face, and they're like, "Ah, no." Yeah. "I don't want that anywhere near there."
[00:13:06] Speaker 2: Absolutely.
[00:13:06] Speaker 3: So- ... absolutely, absolutely numbing goes on there. Yeah. But honestly, you have a lot more pain receptors in the skin on your face- Yeah.
Mm-hmm ... or anywhere else on your body than you actually have internally. Yes. So it's usually much, much, much easier tolerated by patients. Yeah. But there is a 30-minute numbing process that happens- Mm-hmm ... beforehand. Um, and most of the time what you feel is more like a, like, touching, pulling type sensation- Yeah
versus, like, actual, like, needles, which is what, you know, you think of-
[00:13:35] Speaker 2: Yeah, absolutely ... when you hear microneedling.
[00:13:36] Speaker 7: Hi, I'm Jamie with Peri & Pause. We are passionate about midlife women's care during the perimenopause and menopause years. Women see an average of four healthcare providers before they find genuine midlife women's care. I started Peri & Pause to fill the gap that is midlife women's care. If you have felt a change in your body and don't feel like yourself, you've sought care, felt dismissed, unheard, or told labs were normal, but you still feel like your concerns as a midlife woman haven't been addressed as thoroughly as you would like them to be or that you deserve, that is what Peri & Pause was built for.
This gap that's midlife women's care involves relationships, how a woman feels about herself, her performance at work, how she feels about herself as a, a spouse, a partner, a mother, a daughter, a sister
When a woman comes in and says, "I know this is normal, but I, I need help. It's affecting every part of my life." I don't want any woman to feel like they're, they just have to power through or that there's no help for the symptoms. There is absolutely help for your symptoms. I don't care what your history is, medical, family history, everyone deserves this conversation.
They return and say, "I feel like myself again." Those are magical words. Every woman deserves this conversation. You do not have to suffer in silence, and that is why Perimenopause is here.
[00:15:16] Speaker 2: since you're providing this service, what, what are the outcomes? What can women expect after having this?
[00:15:23] Speaker 3: Yeah, absolutely. So normally it takes about three to six months, um, to really see the biggest benefit of that collagen formation.
Yeah. And so normally when you're doing that procedure, you're gonna see some benefit, um, within a month or so of feeling like- Nice ... things are getting tighter, things are getting a little more Plump. Mm-hmm. Good word. For lack of better, better terminology- Yeah, yeah ... where it just feels like, oh, that tissue is a little bit more healthy than it used to be.
Yeah. But it can take a full six months to really see some of that happen, but you're gonna have improvements in dryness down there. You're gonna have improvements in urinary continence, um, because we're supporting that tissue. Nice.
[00:16:00] Speaker 2: Yeah.
[00:16:01] Speaker 3: Um, people-
[00:16:02] Speaker 2: That, urinary continence, I, I ... makes me think of the self-confidence too.
Uh-huh. I'm like, talk about a, a pair, you know. If you're not, "Oh, I've got to go to the bathroom. I have to wear a little pad," or, "I have to stop here," you know, the, the just overall sense of, mm, again, one portion of I'm feeling like myself again. Yeah. Super helpful, so.
[00:16:20] Speaker 3: Absolutely. Yeah. And for women that have a lot of vaginal pain with sex- Mm-hmm
having that new, more full tissue down there- Yeah ... usually helps with that vaginal pain during sex. Um, it also helps if you have scar tissue from, like, episiotomies or tears. Mm-hmm, yeah. Um, it kind of thins that scar tissue out so there's not as much pulling- Yes ... during the act of sex, and so it helps people feel better from pain with sex in that way.
[00:16:43] Speaker 2: Yeah.
[00:16:43] Speaker 3: Um, and then some people will even say just by regenerating all of that tissue, they have more sexual satisfaction during it, um, as well.
[00:16:51] Speaker 2: Important quality of life. Um, define what an episiotomy is in case someone doesn't know.
[00:16:55] Speaker 3: Yeah, absolutely. Episiotomy is where when you have a vaginal delivery, um, and the doctor thinks that it's a little bit too tight down there, they will cut a little bit to help ease that baby out.
Mm-hmm. They are trying to control you from having a tear that's worse- Yes ... and so that's why they cut. Um, but when they cut you, they have to stitch you back up, and sometimes you'll have more scar tissue that isn't as flexible as- Yeah ... the rest of your vaginal tissue.
[00:17:18] Speaker 2: Yes. All right, so you're talking about radiofrequency treatment for this. What does the research, what does emerging research show? And, um, talk more about that
[00:17:28] Speaker 3: there are lots of studies emerging about radio frequency treatments. Um, there have been multiple studies that show that it can help with increasing ver- urge incontinence, stress incontinence, um- Mm-hmm.
[00:17:41] Speaker 2: Define those. Urge is-
[00:17:42] Speaker 3: Yeah, so urge is I have to go to the bathroom and I have to go right now, and I'm not gonna make it in time.
[00:17:47] Speaker 2: Yes.
[00:17:47] Speaker 3: Stress incontinence is I'm jump roping, I'm, you know, sneezing- Mm-hmm ... I'm coughing, and I can't hold it in because that sphincter isn't tight anymore. Yes. And so I, you kinda let go of that.
[00:17:58] Speaker 2: I had a patient share with me, she, she is working out and just in tears. She said every time she does a crunch- Mm-hmm
she said, "I would empty my bladder before I did a cr- I would do all the things." She said, "Still, I could not." Mm-hmm. So think about how that is impacting her life, trying to maintain her strength- Yeah ... join the gym, you know, be a participant. And she's like, "I, I'm stuck. I'm trying to do all the things." So she was a classic example- Yeah
of stress incontinence, and I, I appreciated her sharing how it wasn't just, "Oh, when I'm jogging." She w- like, when she laid it out, her experience, it was pretty profound.
[00:18:33] Speaker 3: Yeah. Absolutely, and if you can't go to the gym and do what you need to, it's a negative reinforcement of- Yeah,
[00:18:39] Speaker 2: absolutely ...
[00:18:40] Speaker 3: you go in, and you try to do what you're supposed to, and you're having all this happen.
It's embarrassing. Yeah. It's defeating feeling- Mm-hmm ... like you're not doing... You feel like you can't do what you need to do, and so why would you exercise? So then we're- Yeah ... we're putting our, our health at risk just in that way because of something that we can treat.
[00:18:56] Speaker 2: Right.
[00:18:57] Speaker 3: And so it's really important to support that urinary stress incontinence- Mm-hmm
especially for that reason, but also too, so that you can go out in public and laugh.
[00:19:06] Speaker 2: Have a great laugh with your friends. We,
[00:19:08] Speaker 3: yes, exactly, and not feel like- Yeah ... "Oh no, I think I might have peed on myself."
[00:19:12] Speaker 2: Right, exactly, so we're relating vaginal health with joy in life in multiple, um, areas. I hope you're picking that up.
Yes. So.
[00:19:19] Speaker 3: Absolutely. Um, and then the, so some of these studies that are coming out have actually done, like, imaging to kinda see- Mm ... what happens after- Yes ... the radio frequency energy treatments. Like, is there actually a change in the tissue? Mm-hmm. And so a lot of them are showing that the bladder neck mobility was, was actually decreased, so you don't have as much movement there, creating that leakage of urine.
[00:19:41] Speaker 2: Nice.
[00:19:42] Speaker 3: Um, the vaginal area, um, when I say the vaginal area, like the opening of the vaginal area- Mm-hmm ... is actually closing up, so that gaping-ness has closed up a little bit. So people tend to have tighter vaginal areas, which is more satisfactory in sex a lotta times for them. Um, and then also the, the angle of the actual urethra becomes improved because it's supported better.
Yes. And so because of that, you have decreased risk for urinary tract infections and things like that 'cause it's harder for bacteria to crawl up in there and get, get in there to cause a urinary tract infection.
[00:20:14] Speaker 2: So starting with the basics, vaginal estradiol, that's a, a no-brainer. Mm-hmm. Um, that helps on a cellular level. Sure. sometimes can help y- with healthy tissue and improve a lot of these symptoms in and of itself.
Yeah. Pelvic floor PT coupled with vaginal estradiol- Mm-hmm ... um, is, is always a win. Mm-hmm. Thank you to our local pelvic floor physical therapist. Um, but when we're not getting anywhere with that and we're beginning to offer the radiofrequency, tell me what, what would a woman expect before, during, and after?
You, you touched on the after, like, how long- Mm-hmm ... to, to feel, uh, more healthy there, less lax, less irritated. Um, so but talk about the, maybe the procedure itself.
[00:21:00] Speaker 3: Yeah, absolutely. So the treatment's done in office. It's not anything that you would have to be put under anesthesia for. Okay. We use a local anesthetic, a topical one, um, vaginally, and then also on the outside tissue if you're having that done as well to numb the area.
Mm-hmm. Um, that lasts about ... Or it doesn't last about 30 minutes. We do it for about 30 minutes. Yeah. Make sure it's working. It lasts longer than that, yes. Um, to make sure it works really well. Um, the downtime is super minimal. Um, usually what you can expect after the procedure is just having a little bit of swelling, a little bit of redness.
Mm. Some people that are prone to bruising might have a little bit of micro bruising there. That tends to clear up after a few days. , But mostly it just kind of feels like, kinda like it's worked out really hard. It just gets really swollen. Yeah. Kinda looking for a couple days. Um, and then after that, I mean, we're not talking about any big life changes.
Yeah. We're not talking about major surgery that you're down forever. You might feel like you don't wanna exercise that night, and I probably wouldn't recommend it- Mm ... 'cause we don't wanna put extra heat in that area. Yeah. Um, but you know, we're talking about, like, a reduced activity for one evening. Mm.
And then usually you're fine. Um, you know, you might wanna make sure that you're putting some hyal- hyaluronic acid on the outside of the tissue there- Mm ... to help it recover really well. That's good. Um, but most people, there's very, very little downtime. Um, usually within a week or so you're feeling like it's back to normal down there.
Um, and so like I said, it takes about three to six months to really see the actual improvement in the tissue. Mm-hmm. So most of the time, by the time you come back and see us, 'cause it's a set of three, um, that are one month apart, usually one month, four weeks to six weeks depending on how you'd like to do it.
But usually between, you know, four to six weeks you're coming back to see me and people are like, "Oh, I feel like it's better-
[00:22:43] Speaker 2: Yeah ...
[00:22:43] Speaker 3: than it was before, but it's not the best." Yeah. And so that's why... That, that maximum benefit is that three to six month time-
[00:22:50] Speaker 2: Yeah ...
[00:22:50] Speaker 3: um, to really see it. So by the time you're getting your third one, you're like Oh, it looks so good now.
Yeah. Like, and it feels so good, and I really see a difference, and you're gonna continue to see improvement after that.
[00:23:01] Speaker 2: Good.
[00:23:01] Speaker 3: Um, so the initial series is three, um, treatments about a month apart or so. Mm-hmm. And then after that, usually we recommend coming back in about once a year. Mm. That being said, if you start having symptoms, um, flaring up a little bit sooner than that- Yeah
we can do a maintenance sooner than that. Um, some people will go as long as 18 months. It really just depends on how their symptoms are doing. But we don't generally recommend longer than 18 months- Yeah ... because we wanna keep that tissue in good repair and not have you go back to having those symptoms that you were having.
[00:23:32] Speaker 2: Yeah, that makes sense. It seems like, you know, a little up- upfront push with this after vaginal estradiol and pelvic floor therapy may, you know, not get us optimized.
[00:23:41] Speaker 3: Mm-hmm.
[00:23:41] Speaker 2: Um, and then once a year, oh gosh, who wouldn't do that, right?
[00:23:44] Speaker 3: Yeah, absolutely. So good. Yeah. And it's, it's a very short procedure. Other than the 30 minutes of numbing, it's about 30 to 45 minutes, um, that you're just sitting there.
Yeah. You just chill out and play on your phone, listen to some music. And it really is not bad. Most people, we just converse the whole time and-
[00:24:00] Speaker 2: Yep ... like- Get up and-
[00:24:02] Speaker 3: Yep ...
[00:24:02] Speaker 2: drive themselves home.
[00:24:03] Speaker 3: Yep.
[00:24:04] Speaker 2: Thank you so much for sharing this information that a lot of women, I think, like you're talking about c- either consider normal or something that they don't wanna talk about, or, or they don't even know if there is help for.
They know, oh, their neighbor had surgery for this. I don't want surgery. What is the best approach? Um, so how would you suggest someone, um, make the first step in getting a consult for this- Yeah ... treatment with you?
[00:24:30] Speaker 3: Absolutely. So I would say if you are experiencing symptoms of genitourinary syndrome of menopause, please, please, please let somebody know.
Right. Please, please take that step. It is okay. It is not something to be embarrassed about. It is not something that has to be normal for you. Yes,
[00:24:45] Speaker 2: it's treatable.
[00:24:46] Speaker 3: So please, please let us know. Um, as far as steps to move forward and get treatment, set up a consultation with us. Yeah. Get, get started with us.
Um, we can talk about your options that you have. We can talk about your history. We can talk about what's right for you. It's everything that, you know, is good for one woman isn't good for the next woman. Right. So we can indi- visualize the approach for you to find what is going to fix your symptoms- Mm-hmm
and help improve your life in a way that you wanna do. And so there are options. There's lots of things out there that we can do that, but please don't live with this. You do not have to live with this.
[00:25:20] Speaker 2: Right. Exactly. Agree. It, it's not just, oh, I, I want to feel better here. Uh, like we talked about at the beginning of the podcast, um, genitourinary syndrome of menopause can walk all the way down to be something that is life-threatening.
Yeah. And there are treatment options, you know, including and up to the radiofrequency, simple vaginal estradiol- Mm-hmm ... um, pelvic floor physical therapy, and surgery is not off the table if that's what's needed. Mm-hmm. But, but I'm, uh, you wanna be as conservative as possible to that point. Yeah.
[00:25:51] Speaker 3: Absolutely.
[00:25:51] Speaker 2: But thank you so much. Yes. Jamie, I appreciate this, and thank you so much for joining and listening. I hope this helps in understanding GSM and, you know, the risk associated with that. If you found this episode helpful, please share it with a friend, a sister, coworker, partner, anyone you think might find this helpful, and we'll see you on our next show.
[00:26:09] Speaker 5: Thanks for listening. If this episode helped you feel more informed or less alone, please subscribe, leave a review, and share it with another woman who needs this information. You can also follow us on social media for more education and updates at facebook.com/perryandpause and Instagram at perry.and.pause.
Until next time, take good care of yourself. The information shared on the Perry and Pause podcast is intended for informational and educational purposes only and should not be considered medical advice, diagnosis, or treatment.