UTI and Hormones: Vaginal Estrogen Therapy with Dr. Rachel Rubin (Part 1)

so the data shows it helps frequency it helps your urgency it helps all Interstitial cystitis symptoms and pelvic pain and pain with sex if you have a weak orgasm that should get better as well hi welcome back to the channel my name is Melissa and today it lead me to a free we're talking about UTI and homeworks we have another amazing guest Dr Rachel Rubin and in our conversation we're going to cover things like estrogen therapy contraceptives and hormone replacement therapy at any stage of life I also wanted to mention that we have many other resources for patients experiencing recurring to Chronic UTI and we're going to some of those in the video description below lastly if you enjoyed these videos think they're important and want to support what we do make sure you click subscribe and check the Bell so you'll be notified of videos when we post them and other than that thanks again for joining us on this journey to making change in women's health foreign we're very lucky to have Dr Rachel Rubin with us who is board certified urologists and sexual medicine specialist among many other things she also shares our passion for patient education thanks so much for joining me today to answer our community's questions I am so thrilled to be here thank you for having me amazing I would love it first if you can give us a bit more information about your background and how you came to specialize in sexual medicine yeah absolutely so I'm a urologist which is uh in the United States you do four years of medical school it's five years of training as a urologist which is surgical training in kidneys and bladders and prostates and urethras in I wish more vulvas but that's another story and then after my five years of training I did a one-year Fellowship in something called sexual medicine so we take care of all genders and I deal with issues like pelvic pain hormone issues libido orgasm arousal and I see I always joke I'll see the weird and the wacky the things nobody else really quite sees very much of the medication-induced sexual dysfunctions the things people don't like to talk about uh and yeah and so I started my own practice about eight months ago in the Washington DC area in the United States that's great then you're the perfect person to answer the questions and we we get a lot of questions about different symptoms that many people don't experience and we have a whole bunch of questions on hormones but I wanted to start with a few on Anatomy that came up which could provide a good foundation for some of the questions that come later and so the first question was are there similarities between the lining of the bladder and the uterus uh that's a great question um and so it's different the lining of the bladder is endoder actually this is a good question I don't know if I know the answer to this the lining of the bladder is endoderm the lining of the vagina is mesoderm the lining of the uterus is um endometrium which I don't know it's different tissue because the endometrial tissue is is very special so I'm not a gynecologist but this is a I don't believe they are the same tissue um but that is a very good question I thought it was an interesting one too the second one was about the bladder itself and what the term trigonitis means and it's what it means in association with UTI yeah so the bladder trigone is where um the body so if the bladder if you think of it like a bowl when you're standing up it's like a bowl the bottom of the bowl is where all the urine pools and then there's two little holes at the bottom where the urine then um uh the urine comes into from the ureters and then goes out through the urethra so it's at that bottom where the urine is coming in and it's leaving where everything's happening that way it's called a trigone so sort of like the bottom area and it's um and so it can look inflamed uh and and irritated and we often call that trigonitis um sometimes they can have little lesions on it when we look visually that can be called cystitos cystica there's things like squamous squamous metaplasia there's all sorts of visual and biopsy proven irritants chronic inflammation ulcerations uh infectious you know things where you have a UTI what it looks like on on on on scoping um yeah so that means trigonitis itself is the inflammation and it could be caused by a UTI or it could be caused by a number of other things yeah and there's a lot you know there's a lot of non-specificness to it and which frustrates the hell out of everyone in your group as it should because there is so much gosh I was speaking with a a pathologist on the phone yesterday I have a patient who has these horrible vulvar lesions that we cannot figure out that biopsy or absori biopsy or and it keeps coming back as chronic inflammation and and the pathologist I said it has to be something it has to be something well it's just chronic inflammation I'm going to offer you thoughts and prayers and I was like I I can't I just the thoughts in prayers are not going to help my patient uh figure this out that is a source of frustration among our group definitely the the topic of trigonitis has come up recently and it's sort of given as a diagnosis but it really means that you should be looking for the root cause it seems and so one of the questions associated with that is are there symptoms that would indicate that the inflammation could be in the Trigon area as opposed to somewhere else in the bladder yeah it's certainly anything's all options are on the table right in terms of what is causing it and sort of that's when we think about it is is the inflammation in the tissue level is there a bacteria in the urine that's causing it is it in the lining of the of the walls of the bladder is it coming from somewhere else is the vagina a microbiome leading to it is it even an infection at all which even that is a huge controversial topic that I'm sure at some point today I'll have tomatoes thrown at me because there's so much we're just not sure about and so sometimes our testing and our terminology is beyond our ability to treat it and and wave our magic wands to make everybody feel better and that's where so much frustration lies yeah it would be great to be able to get some more answers and but I guess the main topic we want to cover today is about estrogen therapy so we can move into some of those questions I thought it would be helpful to start with an explanation of the link between estrogen and bladder health I love this monkey favorite topic so this one I can handle so this is really important and this actually could explain some of the trigonitis stuff I really believe that so if everyone can think about a baby girl okay anyone who's ever changed the diaper of a baby girl right baby girls have teeny tiny labias their vulvas are red raw and irritated they pee in their diapers constantly now they don't complain of bladder pain or UTIs but they're also not putting anything in their vaginas they're not uh um we're not uh poking and prodding at this era very much to introduce bacteria and so um we even put diaper cream all over it because it looks so raw and painful babies have no hormones in their bodies no estrogen no testosterone the tissue is very hormone sensitive we are rich in estrogen receptors and androgen receptors both in the urethra in the bladder in the vulva in the vulvar vestibule and without hormones the tissue is very raw thin and irritated so then baby girls go through puberty they become very mean to their mothers as I like to say uh but then you know their bodies literally change and transform right the tissue gets thicker it gets uh Pink it gets healthy um the vagina acidifies so that it can fight infection and so it's a hormonal response the tissue is very hormonal and as I always like to say when you play with hormones there are consequences sometimes they're very good and sometimes they're very bad but there are consequences and so for things like birth control pills or breastfeeding or or breast cancer medications or of course menopause which is the thing we see the most what happens is you lose hormones and so the tissue starts to thin it starts to involute it starts to get dry and cracks and gets irritated and it can't mount a healthy response to bacteria the way healthy tissue would and so in my opinion and what I'm trying to change the the um um The Narrative on all of this is hormones are the Baseline hormones are the foundation hormones are a must for everybody and if you don't have that not I think all the other treatments are third line therapy compared to first and second line therapy being hormones and so you can't in your groups you can't have women say I failed vaginal hormones and nothing's working for me they must be on vaginal hormones and it's not every type of vaginal hormone is right for every person but they must be on that therapy as a Baseline and then the additional therapies can be that doesn't mean that's the only therapy but it's like the foundation of the house without it nothing else is going to is going to work very well does that make sense definitely makes sense and it kind of lays a base for most of the questions later which is great so you talked about vaginal Health why is that important for bladder health and for reducing UTIs absolutely so the it's it's all one microbiome kind of a thing and there's lots we need to learn about the microbiome but the only thing in the world that has shown to make a healthy microbiome and acidify the vagina to prevent urinary tract infections is vaginal hormones so vaginal estrogen and actually vaginal DHEA we have a paper that I it's in my email I have to review it but we looked at a paper where we also looked at vaginal DHEA which does decrease the incidence of UTIs as well and so um the what happens is the vagina as it remember has receptors for estrogens and androgens without the hormones you lose the acidity of the vagina the lactobacilli all the good bacteria and so the bad bacteria start to overgrow and remember that urethra is right in that vulva and so it's only four you know four centimeters long and so the bacteria can crawl into it and then all the antibiotics can lead to antibiotic resistance and I don't have to tell your your listeners you know all of the the the difficulties of just getting more and more antibiotics um and so the vaginal hormones are not a treatment for a UTI but they're preventative and a protector and so that your body can now mount a response so if you use vaginal hormones it acidifies the tissue the vagina becomes healthier able to fight infection and actually it's not just for the vagina that that a little bit of hormone also it will heal the urethra and will also lead to bladder health as well so the data shows it helps frequency it helps your urgency it helps all Interstitial cystitis symptoms and pelvic pain and pain with sex if you have a weak orgasm that should get better as well and so it helps so many things but the most important thing vaginal hormones do is prevent UTIs and and I can't stress that enough I need your 89 year old grandmother on vaginal hormones I need your 98 year old great grandmother on vaginal hormones it is so safe it is safe for all patients there is really the only patient on Earth I would even have an extra conversation with is someone who had active breast cancer on an aromatase inhibitor specifically actually to any tamoxifen is fine and that patient have a discussion but I would convince that patient why it was safe and why UTIs are way more dangerous than the negative the no risk of any kind of breast cancer issues and so those are the only patients where it's even a conversation if you have history of blood clots if you have a family history of cancer if you have any none of it matters vaginal hormones are safe that was one of the questions that was going to come up later but maybe we can address it now why are there so many fears around the use of estrogen if you have breast cancer or a family history of breast cancer politics politics politics and it's so infuriating so uh basically the at least in America we have a box labeling on our vaginal hormone products that are the same box labeling that's essentially on what's on on on birth control style pills that we give to women in menopause they're very different products they don't do the same thing but they have the same warning labels on them that warning label is not actually based in up-to-date data the warning label says it caused stroke heart attack blood clots dementia breast cancer you have to use it with progesterone there is zero data to go with that box and yet the FDA and if the FDA is listening or if someone at the FDA or someone is married to someone at the FDA please let them listen they're not interested in Nuance it would be like saying that condom wrappers should have a warning of risk of blood clots right everyone knows birth control pills have a slight increased risk of blood clots so that should mean that every contraception should have a box labeling that says cause blood clots so your IUD your diaphragm your condoms should all say that they cause blood clots to well that doesn't make any sense neither does it make any sense that a hormone therapy is not all the same thing in menopause and local low-dose vaginal estrogen or DHEA has zero risk of bad things happening to you and so the politics are huge here but the data there is no and and I have been screaming on social media on Twitter on Instagram on LinkedIn screaming about this for five years actually six years now and no one's been able to present me with one piece of data to show that there should be fear with vaginal hormones not one I encourage you all to try and I will meet you on a debate stage on the internet because it just doesn't it doesn't exist do you think there's any chance those guidelines or labels will be changed I absolutely think we have to keep trying and the advocacy work that you are all doing is actually even more important it is I believe it is Patient Advocates that get changed excuse my language in this world because we're doing a terrible job a group of doctors did go to the FDA a couple years ago and sent a citizen's petition and the FDA changed the conversation made it about systemic hormones and said no we're not changing the Box labeling and it was infuriating and so we need a few um motivated folks to go out there and really get angry and make this the issue and so I would love to join all of you in marching down on Washington because I tell you people are not marching uh for vaginas they're not marching for bad they're they're they're the vaginal estrogen is never anyone's number one priority but it should be because the number of people who are dying of urinary tract infections or Euro sepsis or you know or antibiotic resistance we would save the Health Care system so much money by investing in vaginal hormone products every Nursing Home Patient it's so important and it's so easy which is why it's totally totally ignored yeah yeah we find the same thing I'm sure we could get a few people together if you want to organize that let's do it that sounds fun but the topic of messaging comes up a lot but what about other hormones is there a link between progesterone or testosterone and bladder health absolutely and we need more data um so that just like I said I have a paper sitting in my email that shows that vaginal DHEA prevents urinary tract infections what I love about vaginal DHEA it's the only FDA product in the United States that has an androgen in it and so we know that there are Androgen receptors there and I would love to see more research on testosterone specifically for bladder health because I am certain there is a role and we just the problem is again politics we don't have FDA approved testosterone for women in the United States and so it becomes more difficult to do studies to know what doses to play around and to get companies to kind of buy into this and understand the important link here vaginal DHEA is a wonderful product but it's hard to get into patients which vaginas because the expense of with insurance companies and so it's very frustrating um I think progesterone is an even more unknown topic I saw a recent abstract that there are progesterone receptors in the vulvar vestibule which to me means there's probably progesterone receptors in the urethra and the bladder and so it's just never as far as I know and I don't know everything it hasn't been looked at with any a significant degree but for all those women in your group who say man my bladder symptoms really fluctuate with my cycle of course there's it's hormonally related it has to have some hormone connection um and so I couldn't agree more that that's a an exciting a future place of research is that the same case a few people mentioned progesterone pellets not being FDA approved but finding them beneficial is the same thing just the lack of data pellets in general are a controversial topic because they are an FDA approved products you know and my my frustration with them is if the pellets are so great and the companies are so proud of their safety their efficacy and I'm not saying it doesn't work but if they're so proud and the patients are so happy why not do the work to to do scientific studies to a high standard and get your products approved by the FDA other companies do it why do you think like and so that's where my problem with it is is why don't we hold and so you could have dangerous things put in there because no one there's no oversight and so that's my issue with it I love we have we have an FD approved male a testosterone pellet it's fabulous if I could get it in more patients I would it's always sometimes not always easy with insurance and so I love the idea of pellets but no one's studying it at a rigorous level and if these companies have so much money and are doing such a great job and they think they're doing such a great thing then we should hold them to that high standard of saying why don't we go through the price process and actually do what they for women and it's my issue with it yeah we would love that if your research was done in this space definitely it's what what are the indicators that might prompt you to instigate estrogen therapy for a patient if it is a patient who has a vagina uh that's it right you must have vagina no so so uh anybody over 45 so if you're anyone over 45 and you have any symptoms so so I I'm very aggressive because it doesn't hurt anyone vaginal estrogen has never hurt a fly occasionally when you start it you as your microbiome acidifies you can get a yeast infection or a thrush infection you treat it it goes away it's not something that creates a chronic a yeast situation right but it can have that is the worst thing that happens with vaginal hormones now if you don't like the cream switch to a tablet if you don't like the tablet switch to a ring if you don't like the ring switch to DHEA there are different forms and sometimes the base or what it's in or the modality is not right for you but you have to find a product that works for you anyone over 45 I believe should be on it for preventative care but that's very aggressive that's a very aggressive statement that I know not everybody agrees with but what I think is I don't want you to have urinary frequency and urgency and I don't want you to get a UTI and I don't want sex to become painful and I don't want to treat you once your orgasm has already become muted I want to prevent all of those things from happening so I believe that early in perimenopause we should all be encouraging vaginal hormone therapy now we need more data when it comes to premenopausal women vaginal hormones will not hurt you they will not change your cycle they will not hurt your partner they will they will only help locally now if you're on birth control pills I don't have much data and my my impression is it's it sometimes they counterbalance each other and so it's hard to it's hard to fully help that microbiome and so I I tend to like iuds for that reason is it seems to be a little less caustic on the microbiome and on the tissue we're still learning we need more data we treat young babies with labial adhesions with vaginal estrogen we give this stuff to babies it is so safe for everybody and yet it is so under discussed because we hate the word vagina and we cannot handle uh the terminology I actually think the terminology vaginal dryness is killing women because we minimize that natural dryness doesn't sound like a big deal right oh just suck it up lady you got vaginal dryness just take that I saw a woman in my office yesterday she couldn't sit she could not sit she could not wear pants she was miserable she is so miserable she needs uh she's had inpatient psychiatric care because of how much pain she is in her vulva this is not vaginal dryness people this is horrific and it's hormonally mediated it does seem from our perspective that the quality of life is just not taken seriously if it doesn't kill you then you just have to deal with it that's kind of the message we're getting from many people in this sphere but quality of life is so important to our community that's everything and there were a couple of questions about you mentioned that they're not really side effects to this but a few people said they have experience burning or pain is that because of the estrogen or the type that they're using it's typically the type they're using a couple things there and so if you're using a cream and I I don't love creams the reason I don't love creams is a couple reasons one they're messy and goopy and Gloppy and this is something that you have to do forever so if you hate putting goopy creams in your vagina it's really hard for me to say do this twice a week till death do you part and so the creams also sometimes have um chemicals in them that could be very irritating and caustic to the tissue Premarin Cream which I don't even think is available in Europe but for some God unknown reason we still happening in the United States and so many people prescribe it has alcohol in it it has chemicals in it that are raw that irritate and also um it's like they like torture horses to make it happen but I don't love those creams now if the creams are the only option you get the only affordable choice that you have then yes use the creams they're so much better than using nothing um uh the other side effects again as I said you get a yeast infection that can pop up the creams are a little bit if you use the creams you want to make sure you dose it properly this is a very common mistake that is not your fault it is all the doctors who tell you uh I try to educate I'm not working on educating all of the doctors because they say take a pea size of the cream and just rub it on your urethra just a tiny bit of cream on the outside it's not enough to acidify the vagina and so if you really want to know if it's working get a pH paper and see if your vagina is four and a half pH you gotta get the pH of the vagina to four and a half and so um that's really important because the the urologist and the urogynital colleges and the gynecologists are saying just take a little pea size and it's wrong it just it's not enough and so that's why I like the vaginal estradiol tablets tablet inserts the 10 micrograms I like the rings that stay in for three months at a time I like the DHEA inserts because you don't have to think about it dose anything out and wonder am I using enough and they're not goopy and messy does that make sense yeah it definitely is the the tablet something you would use every day or is that a twice a week you use them it's twice so every day for two weeks and then twice a week the DHEA are are written for every day although I certainly do have patients who do it two or three times a week and think that that's enough but they were studied as every day occasionally you'll see a woman who has breast tenderness and that is not breast cancer it does not mean you have breast cancer think of when if you've ever been pregnant that very first sign of oh my gosh I'm pregnant is breast tenderness and you say you don't run to say oh my God I have breast cancer I must go get a mammogram right away you run to your your a drugstore and you get a pregnancy test and you said is this it is this the you know it's the time I'm pregnant that typically goes away what happens is a very your tissues are so thin they're so raw they're so cracked that the littlest bit of estrogen um you know goes in the bloodstream and and your your nipples get stimulated but as it builds up in the tissue um uh as the tissue builds up um it no longer goes into your bloodstream and you don't get the nipple tenderness anymore it's rare but I have seen patients have it okay and so once you do start on that therapy how long does it typically take to alleviate symptoms it this is the best question because people we're women we're used to an antibiotic for a week for our UTIs or a one-day Diflucan for our yeast infection Rome was not built in a day it takes two to three months to build up the tissue two to three months to make it strong and healthy two to three months to acidify to uh make sex not painful again and that's step one so you're not going to see benefit for two to three months so don't expect it you gotta refill it you got to take it forever it will stop working if you stop using it the other thing to know is that um what was I going to say it takes two to three months to start start working oh if you still have pain that doesn't mean it's not working it means that you may need an additional Androgen to the tissue because remember it's not just an estrogen story it may mean that you need a pelvic floor physiotherapist to work on your muscles because underneath that angry tissue is thick muscles that really get tight and tender just like if you put your hand on a hot stove your muscles are going to pull away and so you need often a physiotherapist to really help you work on those muscles and do rehab it's rehab and we don't think of it like that yeah it makes sense though a lot of people in our community are seeing a pelvic physical therapist so that's something that a lot of people have covered already yeah and we also have interviewed a few of them on our Channel and there were a few questions around where there are people who are estrogen dominant or have endometriosis can use topical estrogen therapy absolutely it's a great question they can certainly try it and it will not um remember when you use local estrogen or DHEA therapy it does not go through your bloodstream let's talk numbers here people because I think numbers make people less scared if you draw my blood right now okay depending on where I am in my cycle my ash and we're going to talk picograms per milliliter picograms that's the what we do in the United States my estrogen level is going to be somewhere between 50 and 150. okay just to give you an idea 50 and 150. my husband's estrogen levels are 25 okay when I was pregnant with my kids my estrogen level was probably about three thousand three thousand that's pretty damn high right like really high um when I go into menopause my estrogen level will be zero zero right my husband will get to keep having more estrogen than I will although I doubt I'll ever let my estrogen get to zero let's be real I'll put a patch on myself but um but with with endometriosis when you use vaginal hormones your estrogen stays zero in your bloodstream you can check your Labs it stays zero it stays in menopausal levels so if you're estrogen if you have endometriosis in your estrogen is fluctuating between 50 and 150 if you add vaginal hormones it stays between 50 and 150 it doesn't change your estrogen levels there is no reason to believe it would grow endometriosis or it would change endometriosis in any way certainly people with endometriosis try to get pregnant and their estrogens are 3 000 and that happens all the time and so I think there's this fear of the word estrogen there's this fear of the word hormones and you have to understand that hormones are not all the same thing they are not all good they are not all bad if you've done badly with birth control pills that doesn't mean you would do badly with vaginal estrogen because they're totally different things if an IUD wasn't right for you that has nothing to do with vaginal hormones so you have to understand that there's a lot of nuance here there's also a lot of misinformation around endometriosis which is kind of the problem well it's not just yes there's a ton of misinformation but there's it's 2022 and we have crap research right like we don't have it figured out yet PCOS endometriosis and so there's so many you know people trying to make these giant claims without the data to back it up and we must hold we must hold our scientists accountable and say we need good data because there's a lot of people pedaling not real stuff out there that's definitely true for people that don't want to use estrogen therapy other non-hormonal purchase to vaginal dryness so you can suggest I would really try to convince them I will always try to convince them that hormones is the right answer for them because they can't find a data point to tell me that they're dangerous and so I always encourage them follow my social media watch what other people are saying there is no uh you know give it a try change the modality vaginal DHEA is a great choice so DHEA is you can get it at um any a supplement Center you can see DHEA it's a quote-unquote supplement right this we have an FDA approved option which is just call it a supplement put it in your vagina it's a precursor hormone right it's the precursor to estrogen and testosterone so DHEA would be a great option for that person who's afraid of the word estrogen now moisturizers hyaluronic acid is something that's being looked at in the breast cancer Community their data is pretty good I haven't seen any data to say that it prevents urinary tract infections but I'd love to see that data I haven't seen you know perfect pH data to say that it comes down maybe it exists um and so uh moisturizers and lubricants are nice Band-Aids I like to fix the problem with vaginal hormones but um the Band-Aids are acceptable as well if you're really um unwilling but I don't know that it's going to fix the problem okay does hormone replacement therapy address the vaginal dryness or is that kind of asking the best questions in the world so hormone replacement therapy so hormones for your whole body body so say you're in menopause you have hot flashes night sweats brain fog you just you feel awful you're not sleeping and your doctor said okay hormone therapy is going to fix all of this so they give you a patch and they give you a um a natural micronized progesterone pill and they say okay this is going to fix all of that I still think that that patient should be very seriously screened for and treated for the genital and urinary problems because often the patch is not enough to get to the vaginal tissue and so for some people it's enough but I'm very very quick to add the local therapy because it doesn't add any extra risk it doesn't add any extra harm and it will I know it will prevent urinary tract infections and so that is a really good question do you think everyone posts menopause should be on both HRT and local estrogen so I would never say everyone should be on everything I think giant I think the uh the reason why I love my job so much is because I get to spend a lot of time with people and really hear their stories and their fears and their histories and their medical problems and I get to use what I know about medicine and biology and Physiology and and psychology and I get to say okay this is what with all the data that I know in 2022 this is the thing that I think makes sense for you let's talk about it here's data here's literature and let's decide together I think think that hormone therapy in menopause is incredibly underused and there is a lot of fear-mongering and I think people in the UK are doing a kick-ass job of getting the word out and being angry and picketing in the streets I wish I could come pick it with you like I'm so proud of what people are doing in the UK um because they're they're getting mad and they should be and and we I would love to see the same things happen in the United States but it's kind of slow um I think way more people should be on hormones than than are currently but do I think it's a one size fits all is so far from a one size so it's on the problem that we have in the United States because our doctors are not trained how to properly do menopause care there's some data to show that less than seven percent of doctors you know actually feel like they know how to do menopause care and so I feel very lucky that I do but there's one of me right we have to really do a lot of teaching and training uh because a lot of people don't do it well and don't know how to do it yeah there are a lot of people that report being taken off HRT for something for a blood clot or for some other kind of illness but in general would you say that people should remain on it for the rest of their lives the type so the answer again I can't say that it it uh it the this answer applies to everyone in all situations the type of hormone matters um so uh oral estrogen therapy is much higher risk for blood clots and strokes and uh and it's also worse for sexual function so I'm not a big fan of oral pills for estrogen now transdermal products seem to be much safer when it comes to blood clots and strokes so a patch a ring a gel seems to be much safer um and so I certainly it's all about counseling and it's all about gosh like I'm a urologist we deal with men's Sexual Health all the time men and quality of life it is a given when a man says I don't want to have this prostate cancer surgery because I want to ejaculate our field says all right cool we'll just watch you like your body your choice you do whatever you want and we are supportive of that that's the world I was raised in and so now I am in the women's health space and I see men about 50 of the time and I do the same thing I say okay here you have this history here's the data we know here's what we don't know certainly there is some uncertainty but you know what it's your body your choice let's make the best informed decision that we can together and and and you get to choose I you can never go wrong in that situation right like as long as you're well informed now will we get more data as more data comes out will we analyze it and then look to it and change our opinions yeah but we have to be able to adjust to new information uh and and demand new information which is the most important thing thanks so much for watching I hope you enjoyed the video if you'd like to learn more about this and related topics be sure to check out our other videos or head over to webviewta free.com we have some really important articles related to this topic for instance we have one on UTI and menopause one on UTA during pregnancy we'll also drop those links in the description below of course if you like what we're doing be sure to hit subscribe and tick the Bell so you'll be notified of our future videos thanks again for watching and until next time keep asking questions and pushing for better Solutions [Music]

Channel: Live UTI Free

Views: 32,384

Keywords: estrogen therapy, vaginal estrogen, recurrent uti, hormone replacement therapy, menopause, hrt

Id: xAWWsIb_7rg

Length: 34min 8sec (2048 seconds)

Published: Wed Oct 26 2022