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Category: Perimenopause

Estrogen, Vaginas & BV

Note: This post is not sponsored. Links to products are for information purposes only. Please consult your health care provider to help you decide what is the right course of action for *you*.

There is much to know about how estrogen supports genitourinary health. For this blog entry my focus is on one of my favourite topics – estrogen and the vaginal microbiome (also known as the vaginal flora).

During pre-menopause (your active reproductive years) estrogen causes the outer layer of vaginal cells to shed naturally. When they die off they release glycogen which converts to glucose (sugar). Lactobacillus (the “good” bacteria) coverts the glucose to lactic acid. This acid keeps pH levels in the healthy pre-menopause levels of 3.5 and 5.

When estrogen starts to diminish this vaginal cell shedding process slows down and the lactobacillus starves. The bacterial balance is disrupted and the “bad” bacteria takes over. The vaginal pH subsequently rises and can cause something called Bacterial Vaginosis (BV). This is the most common vaginal infection and is often symptomless of and when left untreated can raise the risk of Sexually Transmitted Infections (STIs). When there are symptoms they include thin, grey, white or green vaginal discharge, fishy vaginal odour, vaginal itching and burning during urination.

Recently, there have been new over-the-counter vaginal gels and suppositories on the market. They contain various acids with the aim of keeping the good bacteria fed. I wrote about some of them here. There is also the vaginal moisturizer Mae by Damiva * that contains topical sucrose. If you suffer from recurrent BV they may be something you’d like to consider.

Recommendations

If you think you have BV, I highly recommend you see your GP or gynaecologist to confirm this. There are a number of different vaginal infections as well as STIs that cause similar symptoms. Best to get an accurate diagnosis.

Keep in my mind vaginas don’t smell like flowers or spring fields. Dryer sheets do. Vaginas and vulvas have a slightly sweet or musky scent. BV can cause a very different scent – fishy.

Do not douche. This remedy is superficial, temporary and ultimately harmful. Treat the cause. Don’t camouflage the symptoms. Again, your vagina shouldn’t smell like Febreeze.

If you find you regularly have BV – for example, after your period or after being exposed to male ejaculate – you may want to consider post period or post sex use of the gels or suppositories.  Again, check with your doctor.

In my case, I have had BV so often over the years that even without major symptoms I just know when my vaginal microbiome balance is off. I got an IUD last July * and had spotting near daily for 6 months. BV seemed like my constant companion even though I tried to manage things with the gels and suppositories (as per my doctor’s recommendation). Once the spotting stopped I was treated with antibiotics. If it happens again, I will go that route again. Ultimately, I have the best, long lasting and more affordable results with antibiotics. It’s what brought me some relief and, pardon the expression, some a feeling of balance.

If you suffer with bacterial vaginosis I hope you find some relief too.

Resources

Centers For Disease Control & Prevention

 

* I will write more about it in a future post as it’s my current preferred day-to-day vaginal moisturizer. Also, I’m working on a post about why I chose to get an IUD when I did. Yes, it’s perimenopause related. Stay tuned!

 

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That Smell Down There & How To Get Rid Of It

Bacterial Vaginosis & Perimenopause

Bacterial Vaginosis (BV) can occur when the vaginal environment experiences a change in flora equilibrium – when healthy lactobacilli is diminished which then creates extra production of less desirable bacteria. This harmful bacteria produces enzymes that break down vaginal protein and causes an unpleasant discharge and odour. What researchers and doctors are discovering is that this change is often due to an increase in pH (normal levels are 3.5-5 on a scale of 0 to 14 – so low and acidic).

An increase in pH can be caused by: menstruation (blood has a pH of 7.4), semen (ph of 7.1-8), perimenopause  and menopause (because when estrogen declines vaginal pH rises), douching, medications (allergy and cold medications can dry out tissues and sometimes affect vaginal pH), and antibiotics (they are meant to kill the harmful bacteria but also end up killing off beneficial bacteria).

Not treating BV can increase the risk of contracting HIV and other sexually transmitted infections (if exposed), increase the risk of premature delivery if you’re pregnant, and the development of pelvic inflammatory disease (PID). Serious stuff! So besides the symptoms being rather unpleasant, it’s a dangerous condition for your genitourinary well-being.

Symptoms of BV: unusual vaginal discharge (white, milky or gray – also foamy or watery), strong fish-like odour (especially after sex or exercise), burning when urinating, itching around the outside of the vagina, and vaginal irritation.

There still isn’t a lot known about BV even though it’s the most common vaginal infection. When you do a Google search though you end up with a TONNE of results (hey, it’s how you likely found this post), but most are upsells for booklets of at-home treatments that have not been tested for efficacy or safety. I think if you think you have BV, it’s better to consult your doctor, get a proper diagnosis and appropriate treatment.

If you test positive for BV the likely treatment will be a prescription medication called metronidazole (oral tablets or vaginal gel). It does work, but even so most people will have a reoccurrence within 3-12 months. Finding ways to keep the vagina happily balanced pH wise after the prescription can help keep BV at bay. It requires being quite diligent about your flora. And yes, I’m speaking from experience.

My Situation

The last few years I’ve dealt with recurrent bouts of BV – especially after my period. Basically, I’m getting a double punch of high pH. From my period and from my estrogen levels because of perimenopause. I also take allergy and sinus medication and I’m generally quite dry EVERYWHERE I have mucous membranes so I think my pH might be affected by this as well. What I don’t do is have unprotected sex and I never douche. At least I have that going for me.

I went to my local sexual health clinic (Clinique A in Montreal and later The Sexual Health Centre in Ottawa) as part of my regular STI testing routine and brought up my symptoms. I knew something was fishy (bahahaha) and I was right.

Treatment

I’ve been prescribed metronidazole for BV a few times. It’s harsh on your stomach, but I don’t drink alcohol and I’m good with taking medication on a full stomach so I didn’t have any side effects. The BV cleared up fast and I was fine for two or three months, but then it came back. My health care practitioner then suggested a specially formulated Vitamin C tablet called Prevegyne that is inserted vaginally. It helps create and maintain a more acidic state. It’s available behind the counter at pharmacies, but isn’t covered by most insurance plans (in Quebec and Ontario – I cannot speak to other areas). It isn’t a one time treatment. It’s something to take to treat as well as regularly to prevent.

By the way, don’t take regular vitamin C tablets. They are not the right dose and they are not capsuled the same way. It will burn!

In the name of science I have also tried other over the counter BV treatments that aim to treat and prevent. Like the Prevegyne they will most likely have to be used once a month for a few days (usually after your period) to keep the bacteria at a healthy, pleasant equilibrium. Your health practitioner can help you figure out how much and how often to take them.

Canesbalance Bacterial Vaginosis Gel supports healthy vaginal flora by restoring vaginal pH with a lactic acid formulation.

Relactagel contains lactic acid (which restores and maintains vaginal acidity favourable to the growth of lactobacilli) and glycogen which provides nutrients for lactic acid producing bacteria.

Probaclac is a multi-strain probiotic complex that is inserted into the vagina nightly for 14 days to help build up the lactobacilli and prevent overgrowth of the harmful bacteria.

RepHresh Gel contains policarbophil which is a bioadhesive ingredient that can maintain a healthy physiological vaginal pH.

RepHresh Pro Biotic is an oral capsule that contain patented and clinically tested strains of probiotic lactobacillus that have been shown to balance yeast and bacteria.

I will write about my experiences with each treatment in future blog posts. For now, do know that I think they all showed some benefit. I think by addressing vaginal pH we have finally turned the corner when it comes to managing this condition (not eliminating it, but managing it).

I wish the science brains had figured it out sooner!

Resources

BOOKS

The V Book: A Doctor’s Guide to Complete Vulvovaginal Health

Sex Rx: Hormones, Health, and Your Best Sex Ever

YOUTUBE

Bacterial Vaginosis and Diet

Treating Bacterial Vaginosis with Vaginal Vitamin C

PS

BV is condition that can affect those of us with vaginas whether we are CIS, trans or gender nonbinary. I’m trying to write in a way that reflects this, but I may make mistakes from time to time. Thanks for your patience and understanding.

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Why Do I Have Heavy Periods & What Helped

Endometrial Hyperplasia

During perimenopause you typically experience high levels of estrogen at the same time as lower levels of progesterone. It’s a bit later when estrogen begins to drop too and you are closer to a year without a period (that’s menopause). This high estrogen low progesterone state can cause Endometrial Hyperplasia (the excessive proliferation of the cells that line the uterus). Basically, the build up of your uterine lining (what you shed when you have your period). This condition can cause heavy and long periods and leave you at higher risk of uterine cancer.

Heavy and long periods – I know them well. I’ve been dealing with them for about a year. It’s been painful, uncomfortable and annoying, but to be honest I didn’t give them much thought beyond tracking on my period app (I use Flow). What preoccupied me more were the night sweats and the sleep disruptions that have plagued me on a near nightly basis for a year (and about ten days a month the year before). I didn’t realize that the heavy and long periods could be a more serious issue until I saw a gynecologist and was diagnosed with Endometrial Hyperplasia.

How did I get diagnosed?

In February I went to the Sexual Health Clinic for my regular STI testing. While there I also asked about getting the Mirena IUD. At age 46 I absolutely don’t want to get pregnant so I was interested in a back up to condoms. I thought an IUD would be ideal because it isn’t estrogen based like most oral contraceptives. I’ve been on them before and they have made me feel horrible – neutral, nonsexual, unfeminine, and emotionally flat. That’s the best way I can describe it.

Anyway, the Mirena works differently than most birth control pills.  It releases small amounts of levonorgestrel (a synthetic form of progesterone) which thickens cervical mucus and helps prevent sperm from reaching or fertilizing an egg. It also thins out the uterine lining and partially suppresses ovulation.

The nurse I spoke to thought it would be a great option for me as the progesterone would help ease my periods and likely help with my night sweats and sleep issues. She didn’t want me to go ahead with it quite yet though. I needed to see a gynecologist for an exam to measure my uterus (IUDs are recommended for women who have had a child – I haven’t, but it turns out I have a large uterus for a childless woman – 9 centimetres), have a biopsy in case of abnormal cell build up, and get a transvaginal ultrasound to measure the thickness of the endometrium.

I was able to see the gynecologist in June and while the biopsy did come back negative for abnormal cells, my results showed significant build up of my lining. So yes, an IUD would be a good option for me, but first I would need to have my lining thinned out a bit. My gynecologist prescribed me a synthetic progesterone (medroxyprogesterone acetate).

Treatment

Like most every other prescription medication medroxyprogesterone acetate has side effects. The ones I experienced (especially when I first started taking it) were – anxiety (I had vivid PTSD panic attacks), breast swelling and tenderness, and water retention (I’ve gained about 10lbs because of bloating). I think my body has adjusted to it because the anxiety is much less pronounced (and no longer hallucinatory) and my breasts are not as sore. I’m still pretty bloated in my face, belly and limbs – OK everywhere – but I’ve gotten used to it. I’m trying to embrace it even.

I also experienced one specific side effect that was very welcomed. Sleep! You need to take it before bed because it can make you drowsy. Since I started taking it 2 weeks ago I’ve been able to sleep through the night for the first time in about 2 years. No night sweats and no sleep disturbances. It’s been amazing. I hope when I get the IUD this continues. Fingers crossed!

One More Thing

One of the consequences of very heavy periods can be significant anemia (low iron). So no surprise (except to me) this is something I’m experiencing as well. But I will write all about that in my next blog post.

Resources

My go-to-resource for perimenopause information is Barbara Taylor, M.D. as well as  The Centre for Menstrual Cycle and Ovulation Research at the University of British Columbia. I think The Mayo Clinic’s overview is useful too.

In terms of books, I learned a lot from The Estrogen Window: The Breakthrough Guide to Being Healthy, Energized, and Hormonally Balanced-Through Perimenopause, Menopause, and Beyond. Menopause Confidential: A Doctor Reveals the Secrets to Thriving Through Midlife (except for the lubricant recommendations) is a great easy read on the subject matter. I also like Sex Rx: Hormones, Health, and Your Best Sex Ever.

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Cheap Effective Natural Ways To Deal With Period Cramps

Fennel & Ginger For Cramps, Flow & PMS

One of my favourite sources for nutrition research is Nutrition Facts. Dr. Greger’s non-commercial, nonprofit, science-based website that provides free daily updates on the latest in evidence-based nutrition.

In reading up about the increased flow and PMS symptoms during early perimenopause I found this video on the benefits of fennel seeds and ginger. It’s been found that fennel seeds work as well as ibuprofen for reducing painful cramps (without the side effects and way cheaper too!) and 1/8 tsp three times a day of powdered ginger can cut menstrual bleeding in half. Ginger also improves PMS symptoms such as mood, physical and behavioural symptoms while fennel seeds can improve anxiety and depression during PMS time. Wow!

Both are definitely something I will include in my diet to help with my PMS and my flow week. Day two is particularly heavy and my flow lasts over 5 days – typically 7 since I entered my 40s.

More Nutrition Facts videos on menstrual cramps:

Benefits of Ginger for Menstrual Cramps

Ginger for Nausea, Menstrual Cramps, and Irritable Bowel Syndrome

Dietary Treatments for Painful Periods

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My Perimenopause Journey

When I was 11 years old I became obsessed with puberty and the transition to adulthood. I devoured every book and pamphlet on the subject. Thanks to the flowery text from feminine hygiene product companies I had high hopes for puberty. I thought it would lead me to an immediate state of confidence and equanimity. I was deeply disappointed. Instead, like most, my teen years were turbulent.  Pimples, growth spurts, allergies and so many feelings. Thank you hormones, you powerful substances produced by endocrine glands, for all that you did and continue to do to make life so confusing and exciting.

I’ve come to appreciate my puberty experience so much more now that my body is changing again. Yep, I’m in perimenopause and it’s throwing me for a loop and has for a few years now. Thankfully, I have my adult brain and access to much better reading material to help me make sense of it all. I feel like I am going through puberty once again, but with the wisdom of years by my side.

I’ve been posting a fair bit about it on Instagram and I’ve had many women reach out to me to commiserate as well as ask me questions. I have a whole lot of questions of my own so I decided to write a little more in depth about my personal experiences here at my blog.

I’ve been purposefully and diligently doing my research to get a better sense of what the science says and what I’ve found is a lot of inaccurate information (mainly that perimenopause IS menopause – when they are two very different states), lots of Big Pharma hype, and thousands of infommerical type blogs selling supplements. It’s pretty depressing.

Thankfully, I also found a few easy to understand well-researched resources. They match my way of thinking about this time in my life, this experience – that it’s normal and natural and that the attitude you have about it, the way you frame it, will greatly affect the way you experience it. While I’ve long been on the path of healthy living, based on what I’ve discovered I’m more determined than ever to focus on plant based, low fat high fibre eating, daily movement and stress reduction. It truly does seem to me the key to vitality through out the lifespan – during all phases. Pharmaceutical hormones may be in my future, but for the time being I’m looking to my daily choices to create a high standard of living.

A little background and a little catch up…

My perimenopause journey began a few years ago. Shortly after I got sober (December 27th 2013) I started noticing some physical symptoms (shorter menstrual cycles and the occasional night sweat) and at age 45 they began to intensify. No surprise there in terms of timing, but it was also when I became quite stressed because of my move to a new city, new job and greater role in my family’s life. Even without the perimenopause symptoms I would have wanted to make some improvements to my life, but the peri symptoms made my research and lifestyle choices all the more pressing. I’m starting to get a handle on things in recent weeks so it’s the perfect time to focus on blogging about all the things I’m learning and to bring my readers on my journey.

I especially want to reach out to women who are in the thick of it, but this journey is also one for younger women who are hoping to be well prepared for the experience and those who are past it. We can all learn from one another. Remember, it’s like puberty but with the wisdom of our age.

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Perimenopause – A Quick Definition

I’d like to start with a few definitions from The Centre for Menstrual Cycle and Ovulation Research at the University of British Columbia. It’s an incredible resource by the way – the most useful I’ve found so far.

Perimenopause is the period of time before and for a year after the last menstrual period during which ovarian hormonal patterns, experiences and sociocultural roles change. The average age at which irregular cycles develop is about age 47.

Perimenopause probably begins several years before that in CIS women with regular cycles when the ovaries start are making fluctuating amounts of estrogen (often higher than before perimenopause) and lower amounts of progesterone.

Like menopause, perimenopause is a normal part of a woman’s life cycle.

Resources

Dr. Northrup

Physicians Committee For Responsible Medicine

The Centre for Menstrual Cycle and Ovulation Research

My YouTube Playlist of Favourite Videos on Perimenopause

Disclaimers

By the way, I’m using the word CIS woman, but this information can also apply to nonbinary and transgender folks with an XX reproductive system who haven’t taken hormones as part of transition.

I’m not a doctor or registered dietitian. The purpose of my blog is to share my experiences with simple intentional living and holistic nutrition. When it comes to your health and wellbeing, do your research and consult with your doctor or medical professional before making any lifestyle changes.

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