In this episode of Women Mastering Midlife, I welcome back Nurse Practitioner Vanessa Weiland for a candid and much-needed conversation about vaginal estrogen, genitourinary syndrome of menopause (GSM), and sexual wellness for women in perimenopause and beyond.

Too many midlife women suffer in silence from vaginal dryness, recurrent UTIs, painful sex, and bladder issues—often unaware that safe, effective treatments exist. Vanessa and I unpack the myths, explore the latest research and guidelines, and explain why vaginal estrogen is not only safe but also life-changing for many women.

We also dive into alternatives like vaginal DHEA, the role of pelvic floor therapy, how to advocate for yourself with your provider, and why the FDA’s outdated black box warning continues to create unnecessary fear.

What You’ll Learn in This Episode:

• What Genitourinary Syndrome of Menopause (GSM) is and how it affects sexual and urinary health

• Why vaginal estrogen is different from systemic hormone therapy—and why it’s considered safe, even with a history of breast cancer or blood clots

• The pros and cons of creams, tablets, and rings for vaginal estrogen

• How vaginal estrogen can improve blood flow, sensation, lubrication, and overall sexual experience

• The growing evidence for pelvic floor physical therapy, yoga, and lifestyle strategies as part of GSM care

• How to confidently start the conversation with your provider, even if they don’t bring it up

• Myths and misconceptions that prevent women from getting the care they need

Resources & Links Mentioned in the Episode:

• Menopause Rating Scale (Self-Assessment Tool)

• ACOG guidelines on vaginal estrogen safety

• GSM Clinical Guidelines (latest recommendations)

• Connect with Nurse Practitioner Vanessa Weiland on Instagram: @phases.clinic
  

 If you’ve been struggling with vaginal dryness, painful sex, or recurrent UTIs, this episode is for you. You’ll walk away with knowledge, confidence, and practical steps to reclaim your comfort and sexual wellness in midlife.

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Disclaimer  

This podcast is for entertainment, educational, and informational purposes only. The hosts, guests, and experts featured are not your personal healthcare providers or advisors. The content should not be considered as professional, personalized medical, psychological, or prescriptive advice.  

Always consult qualified professionals such as your physician, therapist, pharmacist, or coach for specific concerns and decisions related to your health or lifestyle. *Women Mastering Midlife* is not responsible for any undesired outcomes resulting from actions taken based on the content of this podcast.