In Your Pants with Dr. Susie G - Escaping Hormone Hell

Episode Date: December 14, 2018

On today's show, we're talking about the 3 P's that can happen in your pants when hormone levels fall: prolapse, peeing, and pain. To help me do this, I've got expert Dr. Anna Garrett on the show today. Dr. Anna Garrett has been a clinical pharmacist for over 25 years and has worked in a variety of practice settings. While traveling her career path, she discovered that working with women in midlife is her true passion.

You're listening to In Your Pants with Dr. Susie G, the physiotherapist for your private, helping you get in the know down below. Hey guys, it's Dr. Susie G here and welcome to the In Your Pants podcast, a show where we talk about the issues in your undercarriage so that you can keep embarrassing search histories off your web browser. On today's show, we're talking about the three Ps that can happen in your pants when hormone levels fall, prolapse, peeing, and pain. And to help me do this, I've got expert Dr. Anna Garrett on the show today. Dr. Anna Garrett has been a clinical pharmacist for over 25 years and has

worked in a variety of practice settings. While traveling her career path, she discovered that working with women in med life is her true passion. Dr. Anna believes that suffering menopause is not necessary. She offers a variety of services, including hormone testing and balancing, weight loss and epigenetic health coaching, designed to help women in perimenopause and menopause escape from hormone hell and feel amazing in their body so they can rock their mojo through midlife and beyond. Dr. Anna is a doctor of pharmacy and a board-certified pharmacotherapy specialist. She's also a certified intrinsic coach and has studied through the American Academy of Anti-Aging Medicine. Wow. What an impressive bio, Dr. Anna.

Thank you so much. You must be talking about somebody else. No, I'm just kidding. Yeah. Nope. It's you. So thank you so much for being on the show. I really appreciate it. This is a topic that I think is super important for all women to hear. I think of all ages, to be honest, to really know what happens in our bodies as we age, um, and, and what to expect. So we're not freaking out. And I think to know that there's help for this and that we don't have to live in hormone. I totally agree. And, um, that was actually what drew me to working with women in midlife is there were so many women that were, that I would see at the hospital that were like, I'm about to turn 50 and X, Y, and Z is happening. And why is that happening? And why doesn't anybody

talk about this and what can I do? So it was a perfect business opportunity. It is the perfect thing for me to be doing right now. That's great. And so I think we should just start with what happens to our hormones when we hit a certain level and how does this predispose us to the three Ps? Well, so I'll get a little bit of the terminology out of the way first because a lot of people don't understand where they are in the menopause transition. So perimenopause is that period of time before you get into menopause and it can last anywhere from five to 10 years. And so for many women, it starts in their late 30s or early 40s. And it really is characterized by low progesterone levels and estrogen levels that are swinging around wildly um and then menopause

is actually just one day of your life it's the day that marks 12 months since your last period and then everything after that is post-menopause um so you're not having periods anymore and your hormone levels are usually fairly low so when i say hormones i mean your estrogen progesterone and usually your testosterone is low as well. And so perimenopause isn't so much where the problem comes in for the peas in your pants. It is more of a syndrome that comes when your estrogen levels start to drop. So it could be late perimenopause, but for many women, it's in that postmenopausal period. and so if we talk about um the first p which is prolapse that happens uh because of low estrogen

levels and and the support for your pelvic organs uh needs estrogen and when the levels fall then everything kind of starts to loosen up and that is that is not a good thing and so many women describe it as like it just kind of feels like your vagina is falling out or your rectum and all of that stuff drops in it and it can feel really heavy um so some women experience it after multiple vaginal births or if they have hysterectomy or if they do heavy lifting and something pulls loose i actually had this happen to a friend of mine she was weight lifting and all of a sudden she felt something pull and like everything just went and it took her two years to actually recover from that injury so um but the biggest cause is the lack of estrogen that

is supporting everything holding it in place okay so that i mean i see patients um who have prolapse in my career as a physical therapist and i think not a lot of health care providers understand that the hormonal aspect really makes a difference um in your opinion though how there are some women who go through have menopause and are post-menopausal but don't experience maybe a prolapse what do you think what are the other factors involved in that do you think i would say the biggest one is probably childbirth that kind of sets people up to have that happen um just because if you have multiple vaginal births everything's going to be kind of loose to start with. And then you throw in the lower estrogen levels and then it just

allows those support structures to break down. Got it. Got it. And what's your take on like vitamin D deficiencies and hormones? I mean, I don't know if it's a hormone, it's a pro-hormone, but is there a correlation? I'm not sure if there's a correlation, but I mean, Every cell in your body needs vitamin D, and vitamin D deficiency is rampant in our country, largely because people aren't outside as much to get sunlight, and if they are, they're slathered with sunscreen. And so, you know, unless you're outside 15 minutes a day or so without any sunscreen, it's likely that you have a vitamin D deficiency.

So when I first got mine tested, it was 17, and the optimal range is 50 to 80. So I was a little way from the goal, and I see that very, very commonly. And a lot of physicians, the upper limit of normal in most labs is 30, so that even isn't in the optimal range. But I'm not sure about the relationship between vitamin D deficiency and prolapse. Are you aware of any correlation? Yeah, there have been some studies out there and I actually wrote a blog post on it that those that were more vitamin D deficient, perhaps because of the calcium and the association between muscle contraction and connective tissue health because

it is a pro-hormone, they were more predisposed to having prolapse or symptoms of prolapse. Gotcha. Well, that's interesting. I've learned something today. Yay. Yeah. But yeah, again, not for everyone. And I think the most important thing is exercise, diet, getting out in the sun, going out in nature, and being just more proactive in one's health, even though you've maybe had multiple babies. And not a lot of women understand or get pelvic rehab after having a baby. I mean, in Europe, it's standard practice. To get six weeks postpartum, here you go, go to pelvic floor rehab. My daughter had a baby in November and she was having a lot of pain in her pelvic area and things like that.

She's on her feet a lot. She's a nurse practitioner. She finally went to a chiropractor and she got sorted out in about two or three visits, I think. It was great. She feels like she's back to normal. um i personally had a c-section so i was like i don't know what that's like so right right and and really c-section or vaginal i mean there are some obviously if the baby's coming out of the vagina there's a lot of things that are coming and stretching along with it but but that's not to say that you know the pelvis is such an amazing i mean those the muscles in the body um can adapt so quickly like you have a uterus growing in a baby inside of you for nine

months and there's so many things that change and even post postpartum uh with that too you know so you're if you're breastfeeding or not that will determine you know what's happening in your body and the hormones with that so um very common to have pain or issues postpartum but not forever and i think we're not educating women enough about what are these things to expect and that things can be like with your daughter it can be helped well and nobody said anything to her about you know what to do and she had seen her physician and um and she's in the health care field so you know she kind of had to go out and seek answers on her own right and yeah we just need to be more active which is why we're talking on the show today so that was a tangent but all

related to hormones in any case but um yes hormones are very important when it when it comes to, um, prolapse, which is a big P, um, but physical therapy can certainly help. Um, we can definitely help with functions and with symptoms. It's hard to say whether or not the amount of prolapse can be reversed. I think it's very hard to anybody to say that. Um, but I think we can certainly make things, your quality of life much better and really prevent, uh, or decrease the risk of further exacerbation of the prolapse depending on where you're at. So, um, very important. And, and bowel health is really important. I don't know if you, if you talk about gut health, I'm sure you do as a coach. Um, but that's really important if you're constipated

and you're straining and you've got a history of hemorrhoids and there's a lot of pressure, I mean, that in itself will exacerbate prolapse. So, you know, constipation just from a hormone level standpoint, um, can make estrogen dominance so much worse because the estrogen just recirculates in your body if you're not eliminating it in bowel movements, because that's how it gets out. So, um, so yeah, it's, that's super important. That's an interesting point. And I, that's great. From your standpoint, pelvic, um, pelvic therapy is, is super helpful. And this is actually a situation where vaginal hormone therapy can be, uh, useful to restore, um, some of the, the pelvic, uh, floor. Um, so that comes through, uh, vaginal estrogen replacement is actually the

most effective way to do that. So it's localized. It gets where it needs, it needs to go. Um, you can also use the vaginal rings. Again, that's localized therapy. And a lot of women, you know, are concerned about estrogen and that could be a whole nother show. We don't have time to do that today. But the risks of using local estrogen are really low because it's really not absorbed into the bloodstream to any appreciable extent. And, you know, some oncologists will even let their breast cancer patients who have estrogen receptor positive breast cancer use creams, uh, for things like this or for vaginal dryness. So it's a, it's a pretty low risk, um, opportunity to make things better. Awesome. And so, and you're talking about a cream base, not like a, uh, uh, estradiol like

pellet or yeah so um that can help the the pellets can help you can also do it with um with oral tablets or patches i'm not a fan of the oral tablets just because they have been shown to increase the risk of blood clots heart attacks and strokes because of the way it's metabolized through the liver um when you're using a pellet or cream or a patch, you bypass the liver completely. And so you don't really get into those issues of that kind of risk. So I am not a fan of oral estrogen at all. But there are so many other choices now that shouldn't be someone's only choice. Right, right. And there was a recent research article, and I know Dr. Jen Gunther, she's a gynecologist that's pretty well known

in the country here, but she does a lot of writing about myths and all sorts of things you shouldn't put in your vagina. And she's really politically charged. But anyway, she had an article about estradiol and vaginal estrogen. She said that it really didn't show the dose really mattered. The dose that she was giving to her patients and the dose that has been studied is not enough per se in terms of hormone replacement therapy i don't know if you know anything about that but i was just curious so like for for situations other than than what we're talking about like full body kind of symptoms no no just for like pain yeah no just for it was more so for pain uh menopause um i guess this new research article said that it wasn't enough

or it didn't really show a significant change in terms of a placebo. That is interesting because I've had clients who have been on the vaginal cream and they do really well with it if they use it correctly. So that's the first hurdle. But, well, you're supposed to use it daily for the first two weeks and a lot of people just start out using it two or three times a week and they're going, well, why isn't this working? And it's like, well, because you didn't do it right.

That's right. And that's what she was saying. she was saying like i think the the dose the frequency you know the way the prescription is being used um may play a role in it i'm actually trying to look it up right now to see if i can um find that article but um but yeah so i think that's what made a difference and i think most individuals or doctors are not prescribing or telling patients how to use it correctly like you just said which will make a difference i mean again this is a whole nother show we could talk about is how to get good quality care from your physician. You know, everybody likes to blame the

doctors because they're not getting the care they need. But the truth is, is the medical system is not set up to really incentivize anyone to spend more than seven minutes with you because they're all on productivity. And, you know, you don't see patients, you don't get paid. And so, especially when it comes to hormones, it's really hard to have a conversation and get down to the root cause of what's going on and give really good instructions because some doctors are standing there with their hand on the doorknob from the time the visit starts. So that's why I love what I do because I can take the time to spend with people as much as they need and really explain in depth, um, how to do certain things. And my knowledge as a pharmacist certainly comes in

for that. So, um, it's like the best of all worlds. Yeah, absolutely. Absolutely. So I just pulled up the study and it said, um, uh, let's see if this was more for pain. So pain with sex and menopause, um, and it compared low dose vaginal estrogen estradiol with a vaginal moisturizer like replens so every three days and a placebo vaginal gel every three days and it was a randomized double-blinded placebo control trial um funded by the nih but in any case it said it was ineffective for pain with sex which was very interesting um so it's a big surprise but she mentioned in here that she wasn't really surprised after all the total amount of estrogen vaginally was only 10 micrograms. Yeah. I'm not sure about that one so much.

I know the cream, you do it daily for the first two weeks and that kind of is a loading dose because really what you're trying to do is cure the underlying problem of low estrogen in the vaginal tissue. So obviously if you start out two or three times a week, it's probably not going to give you that load that you need. exactly right right and that's what is exactly what she was saying she's like it's not enough you know it's 10 micrograms tablets twice a week is very very low so no wonder it fails with women because it's not enough so it's like a homeopathic dose almost you know so um all right second p is peeing yes let's talk about incontinence and peeing and urgency and all that

So this is the one that just kind of makes my blood boil because you see all these ads on TV for, you know, all these pads for light bladder leakage, like it's something that we're all supposed to experience. And I'm like, that is just nuts, you know, for people to accept that that's just their lot in life when they get older because it doesn't have to be. So it just makes me crazy. um again this goes back to lower estrogen levels and that's that's what makes the bladder weaker and so um incontinence comes with all sorts of uh there are several types of it so stress incontinence is um the one where if you're coughing or sneezing or laughing you might have a little bit of urine leakage. Uh, urge incontinence is the one that you have when you just have to, you feel like you have to pee and you got to go, got to go, got to go right now.

Exactly. So it's sometimes referred to as overactive bladder. I think that's another one that drives me crazy, but yeah, there are the women that have to get up several times during in the middle of the night to pee. And then there are some people that have painful urination. And part of this is because, again, the lining of your urethra, the tube that goes up to your bladder becomes thinner because of the lack of estrogen. And then again, the pelvic floor issues that can come up. So there are several things you can do to help this. Obviously, there are medications that can help with overactive bladder we see ads for them all the time it can help to avoid things like coffee and soda and alcoholic beverages that are bladder irritants um spicy foods can do that

as well um i i personally try not to drink anything after about six o'clock because i just don't want to be up in the middle of the night so limiting fluids after a certain time of day can can be helpful as well and then there's a whole bladder training routine you can do which the bottom bottom line of which is you're just basically increasing the interval between trips to the bathroom to train your bladder not to contract as much as it does some of the things i tell my patients of course that's great yep so increasing the time exercising your bladder essentially because a lot of yeah and a lot of people will go just in case that that's what gets me because they're like i'll just go just in case and you're teaching the bladder to

to go it's very behavioral based as well so if you're going you know every 30 minutes or you're going you know like key in the door syndrome you just went to the bathroom but you went to the grocery store came back to your house like it's really impossible for that bladder to fill that much like the bladder can hold over two cups of urine you know i mean if you think about it when you're sleeping, it's holding like six to eight hours worth of fluid. What's the difference in the morning? Right. Or during the daytime. Right. Um, so yeah, so, so retraining, you know, bladder retraining, neuromuscular retraining and exercising the bladder. And oftentimes people, I think will stop drinking like water because they think, right. They're going to, they think

it's going to help them like not pee so much, but in, in reality it makes, you know, your urine a little bit more concentrated and and and if you're talking about the hormones changing the lining of the bladder and changing the lining of the urethra well things can things that were once not really noxious or or irritating and are now a little irritating and now you're not diluting the urine with water so yeah so that could that could potentially play into oh now we've got a little bit more sensitivity and then we've got the urge, right? And so that, um, that becomes, and so, yeah. Uh, so we, we do a lot of that in therapy to help with all of that, like urge control techniques and bladder, uh, or urge drills, um, the pelvic floor muscles themselves, uh, you can

use if you contract, um, around the urethra, like if you're going to hold back pee almost like the feeling like when a hold back pee, um, you can contract and relax, uh, several times and that will send a signal to the bladder via a feedback loop, a neuromuscular feedback loop to calm the bladder down. So the bladder muscle will calm down while doing some of these urge drills. That is very cool. Yeah. That's something that you can practice. Do it next time you got to go to the bathroom. But yeah, so I love that. That's great. And so we mentioned going back to medications, dietary changes um what kind of medications do you usually see here that are helpful for people

well there's a group of drugs called antispasmodics that can block the signals that cause the muscles in the bladder to spasm and urine to leak um so they can be helpful um i can't remember what the newest ones are because it's been so long since i practiced in a pharmacy So Adetrol was one that was used quite a bit back in the day. And I'm sure it's generic now, but I can't remember what the newest ones are because I'm not paying attention to that on TV. No worries. Yeah.

I mean, those are ridiculous. Have you ever heard? Yeah, every side effect under the sun. And this is a situation where vaginal estrogen can be helpful again. but the patches and pills really don't work as well and they may actually worsen it so i want people to be aware of that because they think you know that it's not a cure for everything in menopause and this is one situation where that is true interesting so why i'm just curious to follow up with that like why do the patches and pills why do why could they potentially make

things worse you know i'm not sure what the mechanism of that is i would have to look it up um but again you think about vaginal you're if you if you're applying it to the urethral area or the vagina then it's it's getting where it needs to go um but i'm not sure about the mechanism it just may not get into concentrations that are high enough in that area um to do the job and i will have a look at that because i want to understand more about that cool no that's that's interesting to me uh do you get a lot of your um clients that complain of uti like symptoms because you mentioned painful urination as part of the symptom that's really not a uti but it feels like a uti is this part of the whole picture here um it can be and

women in menopause do tend to get more frequent utis because that lining of the urethra is so much thinner and fragile that bacteria have an easier entry point but yeah i have um i have i have one client who has um just this really intense bladder pressure from day like the week before her period starts and um she's been on estrogen and it hasn't really seemed to make a difference um she might need to try some vaginal because she's on patches now i'm sitting here thinking about her. Well, see, I don't prescribe that. This was her OBGYN that did that. So now I'm going, huh, maybe we should try a different route. So let me mention that to her. Got it. So that's great. So vaginal estrogen. Now, would you just recommend,

I know you can't, everyone's different. And what's the best, let's start with that. What's the best way if somebody wants to get on vaginal estrogen cream, do you recommend getting tested first with your hormone levels? I mean, what's the appropriate, like, what is the appropriate dose for any one individual and how can they figure that out? Well, so it comes in standardized doses. I can't remember what the concentration of esterase cream is, but I don't, this is a situation where I don't necessarily recommend testing first, just because it's such a low risk, poorly absorbed kind of thing that it's unlikely to do anything to the levels throughout your body so it really does stay localized in the area that that you need it to

be and so um i read a book once by an ob-gyn and she was like don't use the nasty applicator that comes with it it gets gross and she's like just use your fingers and so if you're doing that you can kind of rub it around the urethral area or opening as well okay and so that it will get into that area as well. Okay. Okay. And would you, and is it common to have compounded creams with the estrogen? So I I've seen some doctors do testosterone, uh, estrogen and progesterone as a combination. Is that, is that more, is that more helpful for someone or, or is it just like, keep it simple and just do vaginal estrogen? Well, you actually can use all of those things vaginally and they're really well absorbed. So the vaginal lining is really one of the best

sites of absorption in the body. In this particular situation, I would say, unless you need the other ones, I would stick with just the vaginal estrogen. But it's very common to see all three of those mixed together. I don't generally recommend doing that until you know what the correct dose is for each one um because especially with testosterone it's really easy to overdo it and if you're mixing it all together then you know you just you have to throw the product away you can't there's there's no way to adjust it right got it got it okay yeah and testosterone is more so so if if they're having like labial because we know in menopause um our parts look different down there. So the labia might be, might be recessing in, um, so things might look a little

different. Uh, this could obviously help with that, right. To help reverse or potentially prevent some of those changes from occurring. Um, is that more so I've heard that testosterone and I just heard at this conference, but I've heard that testosterone therapy was more beneficial than perhaps estrogen therapy in terms of like the genitals themselves or like the labia, that testosterone, a little bit of testosterone therapy really helps with that. But I don't know if you know anything on that. Just curious. Not so much. I know that for women who are having like sensitivity issues or libido issues, that vaginal testosterone can actually be a better choice than just like topical on your arm or whatever. Because it gets to the, if you think

about it i mean anatomically it's gets close to where you need it to be and uh so one of the things that can happen if testosterone doses are too high is you can get a lot of clitoral enlargement and things like that so if you're if you're rubbing it there the likelihood is that's you know going to be a little bit more likely but not a bad thing to do right got it yeah just i'm so curious because there's so much out there, right? I mean, when you're searching the internet and the information out there is overwhelming and you think you're doing yourself a favor, I've had even some patients just take oral progesterone sometimes to help with things. And not that that might, again, I don't know where progesterone plays a role in all this

because usually it's estrogen that's lower testosterone, but I'm sure progesterone is also impacted. It's a balance, right? And that's the whole key is you can't necessarily just fix one aspect. And that's why I think testing comes in really handy. I mean, a lot of physicians will tell their patients that hormone testing is useless, but I think that's a little bit like throwing the baby out with the bathwater. Yes, your hormone levels do change during the month and they even change during the day, but you can still get an idea of the magnitude of the imbalances to each other and and be able to target um target what they're what the deficiencies are right you're just you're just gathering some information an overall picture right it's not

like it's that's not helpful like you're saying and then you put that together with what the patient is telling you and then you have even more information right exactly the history tells us so much right yeah so what is the gold standard for testing my personal preference is to do the dutch test which is a dried urine test um so you're basically dipping strips of filter paper in urine and letting them dry and then you send them back to the lab and the reason i like it is because not only does it give us the absolute levels of the hormones um as well as cortisol but we also are able to see the metabolites so how your body uses those hormones and breaks them down So, for instance, with estrogen, your body actually makes three kinds of estrogen.

And some of the metabolites are associated with increased breast cancer risk. And I'm able to see that on this test and then manipulate the pathways that eliminate it from the body and make sure that they're being optimized as much as we can do that. It is a test that has just an almost overwhelming amount of information, which I think is good because that's, you know, if you're going to do it, you might as well do it. Right. Right. And do it right the first time. So if they are menopausal, does it matter when they do it then? Because I know if you do do this test, it's helpful to do, you know, in different times of your cycle. Yeah. So if you're perimenopausal and your cycles are still

regular, then you would do it on day 19 to 21 of your cycle with day one being the first day of your period but if you have irregular cycles or you're or you're menopausal um then you can do it any day of the month it's too hard to well if you're menopausal it doesn't matter but if you're still having occasional cycles it's just too hard to time right right okay oh that's very interesting i love it right that's great that was a lot it's a p none of this jicking ways none of this dribbling none of this just in case going where a couple drops come out this is the full blow monty okay this is great i love it cool so yes and and i'll put in again my two cents sorry anna i don't mean to take it away from you but but knowing that

that kegels aren't everything. I know everyone says kegel to death. And I think we were talking about that earlier a little bit, but it's all about balance. Just like with the hormones, you got to balance those muscles. You can't just be kegeling and squeezing to death. It's, well, how is the rest of your body working with your pelvic floor? And are you optimizing the function? You can't just be clenching and holding because you got to let those muscles relax so they can do their job too. And that'll help with, I mean, I can imagine that having you know optimal tissue health mobility and blood flow will help with any absorption too of of these creams that you have and what you're doing so you know we're just we're all playing

along together and really again creating balance it's not just you know looking at it with tunnel vision but looking at the whole person and and their function and their goals and how do we make how do we optimize that for them it's so important i think yeah so that was my two cents thank you that was more like a nickel all right all right okay i did i snuck that in there okay um so the last p uh dr anna tell us about the last p the pain part so this is a probably i would say the most problematic and and distressing for for many women um and so it's it's pain during intercourse And again, this is due to falling estrogen levels. And it's the number one reason for pain during sex at midlife and beyond.

So what happens is the estrogen levels fall, the tissue in the vagina becomes thin and dry, and it increases the amount of friction during sex. And it just hurts. And then your vagina also stretches less. So that can cause problems as well. and it's really kind of a vicious cycle because once this gets set up um then you have fear and worry about pain and you start to dread it so that can make your muscles tight it can make you drier and it just goes around and around and around and so this um this one's tricky because um

you know a lot of women don't want to talk about it so there's that and if you don't talk about it can't do anything about it if nobody knows but um it it actually can be helped quite a bit with uh the estrogen cream and um you know there are other things you can try first like you know moisturizers or things like astroglide or you know other silicone or water-based products um they don't do anything to solve the underlying problem um so not going to be a long-term solution but if you're not having severe dryness and i mean some people have so much pain that it hurts to walk around and so that's that's quality of life altering and you know you need to do something about that so um the other thing to do is avoid things like bubble baths and

you know fragrances and things like that can that can be irritating um and then have more sex because it's a use it or lose it kind of thing so um it's probably not the answer most people want if they're in this situation but it's also not the first step so right right so the you know we've talked a lot about vaginal estrogen um this is another situation where all forms can help with the dryness so not just the local forms but again if you have issues with using patches or tablets or whatever, then the vaginal cream or the rings will certainly do the job. And then one of the things that is starting to emerge as something that's super helpful is vaginal DHEA. And DHEA is a hormone and it lives in the hormone cascade right above

testosterone and estrogen so it can go into either one production of either one of those in women to the testosterone pathway and i'm talking about when it's taken orally not when it's used vaginally and in men it tends to go more into the estrogen pathway but there is a lot of data coming out about the helpfulness of vaginal dhea in the setting of vaginal dryness and it does cure the underlying problem so that's that's a good option especially if somebody doesn't want to use estrogen for one reason or another and it's available over the counter so so that's why i like it because you know people don't have to go to the trouble of going to the compound pounding pharmacy or getting a prescription for it you can order

right off the internet that's right and there's relatively low risk with this as well because again it's not a sorb to any great extent low risk that's that's great and and i like that you mentioned the freight don't douche don't bubble bath avoid those frequencies more than it already is yeah that's right it's a self-cleaning oven down there no need to do that but but hey um if just changing your diet will change the way you smell i mean i know this from my own personal experience. Like if you're eating healthy and you're exercising, like you don't stink as much. I mean, I don't know if I can prove this scientifically, but I think this just makes more sense because you're not, you know, the toxins aren't really coming out of your body so

much because you're taking care of it. I mean, I don't know, but I know from experience that this may be TMI for everyone, but you know, before I changed my diet, like down there was a little not so pleasant and then after i changed my diet things smelled started smelling really good and it didn't stink as much which is very interesting well and i i may be i may be wrong about this but i think if you eat a high protein diet it tends to be stinkier i think i could be wrong um haven't really dug into that but i do know that foods that feel feel yeast and things like that can yes cause issues that makes sense i mean there's bacteria living i mean there's bacteria everywhere but some like to have more of a party than others and if you're and you're like sugar like if you're

feeding it things can smell more fishy more yeasty um even if there is no underlying effect infection it just it does change the ph and the microorganisms living in your tissues yep right i mean just makes sense biologically totally i would think um but anyway no idea why i got that tangent oh because fragrances and cleaning right so fragrances cleaning bubble bath there is something really interesting you may or may not know this but there was a big study done on lubricants and they said that ky uh ky and certain types of lubricants do alter the ph h of the vagina and can almost decrease the strength of the tissues of the vagina yes and so it's all about the asthma uh asthma osmolarity osmolarity yes yeah yeah thank you osmolarity

of the product and and how that all kind of changed but yes so the ones that they found out that were really good were like the water-based um less stuff in it like the propylene glycols and all of that um the cleaner you can get it the better now there hasn't been any studies on coconut oil i don't know maybe you know something you could chime in but there's nothing i can find about coconut oil and whether or not that that does anything to change what's happening down there whether good or bad um i haven't seen any studies but coconut oil has a lot of antibacterial properties so i don't know if you're you know doing more harm than good um with that i don't I hear that a lot of people use it.

The other thing that you can use is vitamin E. I mean, you can basically get vitamin E oil, and that also can be helpful as well. Yeah. So it's just a person to person, right? Whatever works for you. Whatever works for you. That's right. But everything in balance, right?

You can't just look at the pelvis and the genitals, but what's everything else? And how do you address things like this with your clients? I'm sure you talk about exercise and diet and nutrition and stress because that can change your hormones as well, right? I'm writing my book right now. And yesterday I tried, well, Saturday, I tried to jam out the entire chapter on stress. I didn't quite get it all done, but I'm calling it the key to the kingdom of hormone balance because it really is because cortisol runs the show for all the other hormones and your

body makes cortisol at the expense of everything else. And so if you're stressed all the time, your body is going to divert all of the hormone precursors, like pregnenolone, the mother hormone from which all hormones come. It gets shuttled right into the cortisol pathway. And what happens then? Your estrogen levels go down, your testosterone levels go down, your DHEA goes down, your cortisol goes up. And it's just, it is an unsolvable problem if your stress is not managed.

it is literally unsolvable. Right. And that definitely can interfere with all the three things you talked about. Prolapse, peeing issues, pain, and weight. High cortisol causes you to gain weight around your middle. And so of course then what's the next thing that women do? They cut back on what they're eating to unsustainable levels. That raises the cortisol even more. And then they start exercising like crazy and that raises the cortisol all even more. It's just, it is this vicious cycle. And so, you know, one of the things I talk to my clients about when they tell me they can't do X, Y, and Z is turning that around and asking themselves, how can I? And really starting to look at self-care in a different

sort of way because, you know, hormone imbalance is so impactful for a lot of women. I mean, I personally haven't had a terrible experience, but I also know enough to know what I need to do to take care of myself. But it's just life-altering for so many people, and it doesn't have to be. And that's, like I said in my bio, I believe that suffering is optional in menopause. And a lot of people don't believe that, but I know that it is. And it's my mission to stamp out unnecessary suffering. I love it. That's such a great note to end on. Suffering is unnecessary. Hormone hell doesn't have to exist. Nope. Hormone hell does not have to exist.

One of the things is that people, they try to do the do-it-yourself approach and they don't get anywhere. It's like, look, if you'll invest the time and money into working with somebody who knows what they're doing you're going to get a lot farther than you would by you know standing in the aisle of whole foods and filling up your shopping cart full of stuff that may or may not work um and you know people again well i can't afford to do this and i think about all the things that people spend money on and it's like i think you probably could when you really think about it yeah right exactly absolutely and because you're without your health i mean does everything else really matter. Right. Right. I totally agree with you on that. It's, it's getting connected with the

right people. And sometimes I feel like, like you mentioned earlier in the show about that medical system, just not being able to educate and provide the quality care that we seek, uh, or that we need. Um, and so they, we think we're getting help from individuals that can help us, but it's just not, it's not enough or it's just the wrong advice. Well, and I saw an article. It was published in AARP's magazine just a few weeks ago, and it surveyed doctors, and the title was Doctors Don't Know How to Treat Menopause. And I was like, duh. There's a glimpse of the blindingly obvious. But anyway, they surveyed medical residents and OBGYNs, and it was just a shocking number, especially of OBGYNs that just had no clue. Because what does an OBGYN really do? They're there to help you have babies, and they're not there to help you on the other end of the spectrum, really and truly.

They don't have the training. and um right and and if a doctor does have knowledge about hormones i can guarantee you they have gone out and sought that on their own because it is not taught in med school right right oh there's so much that isn't taught in medical schools and in you know in our my profession too and in your profession i'm sure you know there's a lot of things that it's like wow why don't they just teach us this in the beginning what did i pay for what did i pay for i got a piece of paper i'm still paying for it a treat have blood pressure and babby that's pretty much it right right exactly so i love that definitely invest in

yourself invest in your health because the better that you're feeling and the more optimal you're feeling in your own skin life life will be much better and and the perspective and the lens that you're looking at will be much different. Absolutely. So, but, oh my gosh. So how can listeners get in touch with you, connect with you? Tell us about how we can find you. So I have a website, drannagarrett.com and got all kinds of free information on there. I've also got a free ebook. It's my nine step plan to escape from hormone hell. And that can be downloaded for free as well. So that's the easiest place to find me is on my website. Awesome. Thank you. And you said you're mentioning you're writing a book. I am. It's

called You've Got This, The Savvy Sister's Guide to Hormone Harmony and Perimenopause. Oh, great. And when is the debut? When should we anticipate your book coming out? I'm hoping March. Great. I got to finish it first. You've got this, sister. I can see the light at the end of the tunnel. Oh, good, good. So March. All right. Well, that's great. Now I'll have the links to how people can connect with you on our show notes and anything that we talked about. I'll kind of link that as well in the articles we talked about. But yes, thank you, Dr. Anna, so much for being on the show. This is really helpful. And I think a lot of women are going

to appreciate the show. So thank you so much for all your wisdom. Well, and I appreciate you having me here. It's been a lot of fun. Thank you so much. And to all your listeners out there in loving wellness for your pelvis, this is Dr. Suzy G. Until next time, my friends. Thanks for listening to today's episode. Be sure to head on over to drsuzyg.com where you can get more information, show notes, and related articles on today's topic. Also, if you like what you're hearing, head on over to iTunes, subscribe to the podcast, and leave us a rating and review.

We'd love to hear your feedback. Thanks again. This is the full-blown Monty.