In this episode we're talking about something I haven't yet approached on this show: prolapse, specifically as it relates to a very specific female condition. Many women aren't aware of the vital connection between estrogen and the health of the tissues of their pelvic floor, but you'll learn about it today.

A prolapse is caused by a weakening of the pelvic floor that supports the female organs, and this displacement can lead those female organs to descend towards the vaginal opening. There is no pill or cream that can correct this condition, especially if it's more advanced. Surgery can help, but sometimes only temporarily due to the underlying cause of the issue.

Prolapse is associated with the trauma of childbirth, but other women may never experience it until after they've gone through menopause. The loss of estrogen impacts the elasticity, tone, and consistency of the connective tissues of the pelvic floor and vaginal walls. If you maintain a strong pelvic floor, it may help you avoid prolapse as you get older.

Estrogen plays a vital role in the health of your pelvic floor, but for years, women have been told that estrogen therapy is bad for them. Therefore, so many are missing out on something that could really help them maintain the flexibility and integrity of the ligaments and connective tissue of their pelvic floor.

For women, estrogen is your best friend when it comes to your health. An optimal level helps women support their pelvic floor. Estrogen enhances blood circulation, which also brings oxygen and nutrients to the tissues (including pelvic tissues). Estrogen therapy, applied early, can prevent a severe prolapse. Consider consulting with a health professional who is trained in estrogen therapy who can give you more information.

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Today we're continuing our conversation about health insurance, health expenses, and what to consider when you're budgeting for your health. We often forget that health insurance is a business. And just like any other business, there's a lot to know, and it takes a few extra intentional steps to truly understand it.

Last episode, we discussed how your health insurance plan is not designed to maintain your health, but rather to treat diagnosed conditions and illnesses. Many people find it difficult to save for their health expenses while also paying for their insurance. So what can normal people who want to stay healthy and keep their insurance do?

More than likely, your doctors (and their support staff) are far removed from what is happening with your specific insurance plan. Between their busy schedules and managing their own work environment, they're not able to keep up with individual patient health insurance plans. The onus is on you to be prepared for your bill after each visit.

In an ideal world, insurance plans would be a lot clearer and easier to understand. The financial burden on the patients is real, but so is the financial burden on the clinic. By the time your bills are generated for your medical services, weeks may have gone by. Delayed bills confuse patients and cripple doctors, but this is just how the process goes.

Spend the time it takes to become educated on your health insurance plan. You will save yourself a lot of stress at the doctors office if you know what to expect. It's not fun to talk about it, but it is very important. Don't renew your plan without doing your due diligence, and be sure to check if your coverage will be the same as it was in previous years.

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In this episode we're diving deeper into health expenses to help you gain insight into where your money is best allocated. In the last episode, we explored how your health insurance is designed to treat illness, not to keep you healthy. Often, saving for your health treatments is the best option if you want to stay healthy.

Unfortunately, that's not an option for everybody, especially those who are already paying for expensive health plans. Be aware that most physicians, especially those working for corporations, are removed from the process of healthcare expenses. Their schedule is full and they don't have time to deeply guide you through your healthcare expenses and options.

Educating yourself is so important, especially as you get older. You have to know the basics of your insurance plan and be prepared as to what your bills will look like when you go visit your doctor. The four main numbers you need to know are: copay, coinsurance, deductible, and maximum out-of-pocket cost.

Your copay is what you have to pay every time you see your doctor, no matter what the visit is for. Your coinsurance is a percentage of the medical cost for the services you receive, and percentages vary greatly. The deductible is the amount you must pay before your health insurance plan covers any expenses. Lastly, your maximum out-of-pocket cost is the ceiling you have to meet before your insurance will pay 100% your in-network healthcare expenses.

Privately-owned, independent practices accepting health insurance are becoming less and less common. This is because their reimbursement is delayed, low, and there is poor coverage. Plus, there is also a rising cost of building a workforce, medical supplies, and more. If you can begin by educating yourself on your health insurance plan, you will make your life and your doctor's life much easier.

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Let's talk about your health goals for this year and beyond. The truth is that basic self-care practices don't always restore us to the level we desire. That's where seeking additional support comes in, but in order to use that, we first have to understand insurance plans.

The first basic question you can ask yourself is this: What kind of expense can actually bring the greatest value to your health? This can help you uncover where your money is best spent. Dedicating more time, effort, and money to your self-care now is the key to avoiding many of the health issues that some people accept come with aging.

Having an insurance plan is vital if you have a serious health condition. Not after it happens, but at the point of diagnosis. The purpose of health insurance is to support treatment of disease, not to help you maintain your health. In fact, coverage often discourages care unless it's part of an approved treatment plan for a diagnosed disease.

Don't invest in a health insurance plan if your goal is to maintain your health. The majority of people who purchase health insurance with the intention of safeguarding their health end up experiencing a rude awakening at their doctors office. It's not the best place to put your money, especially considering the other expenses many people face today outside of their health.

You may not know this, but your health insurance plan may be charging you triple (if not quadruple) what services used to cost, and here's the catch: Doctors are being paid less by insurance companies than ever before. When you find out where your money is really going, you may want to take another look at your health insurance plan and what it's really offering.

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How you can achieve your health goals in 2026 and in all the years to come? Life can (and does) get busy, and time can move by quickly. Self-care doesn't always feel easy, but prioritizing self-care is so important if you want to achieve a truly optimal state of health

Many people struggle to intentionally dedicate time to their selfcare. Why? It's often due to putting other people's health and wellness before our own, and this is especially true for women. For me, rest is going to be at the top of my priority list this year. I have a lot of obligations, responsibilities, and goals, and if I want to do all those things well I need to maintain a feeling of restoration and balance.

Our culture of achievement has its upsides. It pushes us to do more and pursue our goals, but if you want to be at your best to accomplish those things, you have to be at the top of your game. And being at the top of your game requires the best, most cared-of version of yourself.

When you take care of yourself, you're better able to deal with stress. You don't have to fight through fatigue or brain fog while working towards your goals. Self-care looks different for everybody, but for me it includes doing activities I enjoy (like pickleball and reading) and getting lots of sleep.

For you, self-care activities could include balanced hormones and hormone therapy. It may also mean eating well and getting outside. You can also include what you love to do, whether that's yoga, a community activity, or somewhere else you feel your best. I hope you'll go into each week this year remembering to put yourself first.

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Today we are continuing our conversation on women's urinary health and the issues that arise during and after menopause such as loss of elasticity, vaginal discomfort, and urinary incontinence. These changes are all related to the loss of estrogen over time. Other conditions can impact estrogen production too, for example PCOS, certain medications, and eating disorders.

Understanding the core issue of estrogen loss, regardless of the woman's age, is extremely important. Estrogen therapy can make a significant difference for women struggling with urinary issues. Estrogen promotes healthy skin elasticity, which can support the bladder as it typically holds around 300-500ml of urine.

Estrogen therapy doesn't just increase estrogen in the body, but pellet therapy, for instance, can offer more stable levels of estrogen over time. More consistent levels of estrogen can help manage weight gain, which is another issue many women struggle with during and after menopause. It also promotes a healthier sleep, and quality of sleep heavily impacts a woman's quality of life.

It's crucial that you don't ignore these urinary issues once they begin to develop. A loss of elasticity is difficult to reverse the longer it goes on. The sooner you start hormone therapy, the more effective it will be in reducing the impact of menopause. Early intervention can keep some of the most difficult urinary challenges from becoming permanent struggles.

As a woman, incontinence is something that's likely to happen, especially if you don't address it quickly. You deserve to age with dignity and a high quality of life and not with fear about tools like estrogen therapy which can actually support you later in life.

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In today's episode I'm talking about urinary health and the problems that can arise during and after menopause. These urinary problems can become an ongoing or worsening problem as time goes on. So what's happening to the urinary tract as we age? The problems start in perimenopause, primarily beginning with an increase in urgency.

Sometimes this change is subtle; an increase in getting up during the night to empty your bladder. It's disturbing to your sleep, but it may not necessarily stand out at first. Increased urgency, frequency, and discomfort can also be a typical presentation of interstitial cystitis.

These are also the same signs of a urinary tract infection (UTI). However, with a UTI, there tends to be more discomfort and pain at the end of voiding. Another urinary issue is urinary incontinence, such as urge incontinence, stress incontinence, or both. Involuntary leakage can vary depending on the woman experiencing it. These types of incidents can be extremely debilitating.

Even though many women in their 8th decade of life experience incontinence, they tend not to bring it up with their doctor. As a result, they may not know the different treatments available, including lasers, PRP injections, hormone injections, and more. Most of the options for treatment are also affordable and can actually save you money on incontinence pads and diapers moving forward.

Untreated urinary incontinence comes with health consequences like chronic UTIs, skin irritation, and an increase in falling and injuries. It can also lead to stress, anxiety, and depression. These issues naturally arise as estrogen declines, making it a normal part of the aging process for women. However, that doesn't mean women shouldn't explore the support that's available for them, especially if it can increase their quality of life.

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This week, let's wrap up our series on lichen sclerosus by discussing more of the therapies available for treatment. If diagnosed and treated early, the condition can be greatly improved—especially if you're using a hormone replacement therapy approach that's been optimized.

Aside from steroid medication, tacrolimus, estrogen therapy, and testosterone therapy (which were all options discussed in a previous episode), there are other treatment options like platelet-rich plasma, which can be injected to improve vaginal and sexual wellness.

PRP is gaining in popularity because it's considered to be minimally invasive. It's done under topical anesthesia, and although the vaginal tissues may be sensitive after, there are very few side effects. PRP treatment can improve itching and burning, and may even support regeneration of healthier skin. However, it does need to be injected in the area that is impacted the most to be effective.

The major downside to PRP therapy is cost. It is considered experimental, so no insurance plan will cover it. It's also important to know that results may vary. While some patients experience great success, others see little effect. The success depends greatly on the overall regenerative capacity of the individual.

Exosomes are a useful alternative to PRP and may even work better in women of an older age (or younger women with autoimmune issues or nutrient deficiencies). Exosomes are transport molecules that facilitate communication between the cells. Injecting exosomes locally or applying topically may reduce symptoms associated with lichen sclerosus or potentially eliminate them completely. Just like PRP, exosomes are considered experimental and not covered by insurance.

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Let's continue our conversation about lichen sclerosus, specifically focusing on treatment options this time. The treatments and therapies I'm discussing in this episode can actually be quite useful for many vaginal conditions and are something all women should know about.

The first line of approved care for lichen sclerosus is a local application of a steroid medication, usually in an ointment form. Prolonged use of a steroid medication can lead to thinning of the skin, but it is particularly useful for women dealing with significant itching and plaque formation. Keep in mind that treatment does not mean reversing the course of the disease.

Another treatment option—one I rarely use due to side effects and cost—is a topical tacrolimus. Tacrolimus is a potent immune system suppressant, and it can decrease the inflammation associated with this skin condition (as well as some others). It is only intended for short-term use, and can be compounded for application.

There are also some unconventional options for care, including topical estrogen. It can improve dryness, reduce pain during sex, and support elasticity. Estrogen can also be used as treatment in the form of pellet therapy. This treatment option can help women return to more comfortable intimacy in as little as 4-6 weeks. Nothing is perfect, but estrogen pellets offer more consistent exposure than other options.

Testosterone is another hormone that can be used in the treatment of lichen sclerosus. This hormone plays an important role in skin quality, and it has been demonstrated in improving skin elasticity and strength. Side effects and an adjustment of dose can reduce the risk of unwanted side effects.

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Let's talk about a surprisingly common skin condition that impacts women after menopause: Lichen sclerosus. It's a chronic inflammation of the skin which creates a pathological change at the vaginal entrance. These skin changes are often underdiagnosed and even misdiagnosed, sometimes even for years.

This debilitating skin condition can cause persistent and uncomfortable itching, white patches on the skin, and may also result in thinning of the skin. It can cause a disappearance of sensitive skin areas where certain tissue areas fuse. The skin can also crack, resulting in irritation and pain.

Many women, after visiting their gynecologist, are shocked to find out their doctor missed their lichen sclerosus diagnosis. Often this means they've suffered with the symptoms for years without knowing the root cause of their issues. Unfortunately, the reality is many doctors mistake this condition for atrophy during menopause.

If you're experiencing painful sex, this skin condition is something worth investigating—especially if the initial stages of intimacy and penetration is where the discomfort happens. This condition is diagnosed through a skin biopsy. For accurate results, you'll have to ask your doctor specifically to rule out lichen sclerosus.

There are many skin disorders that can create inflammation and skin changes of the vaginal area. Many are accompanied by dryness and hinder the act of sexual penetration. Telling a woman to simply use a lubricant is subpar medical care, as it's an important part of a woman's wellness and life.

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