Estrogen and your vagina, vulva and bladder

Beyond its critical roles in brain function and heart health, estrogen keeps your vulva and vagina happy. Specifically, it helps vaginal lubrication, vaginal immune health and bladder and urethral health. Low estrogen can contribute to all kinds of genital problems.

There are at least five reasons why your doctor might recommend you try using vaginal estrogen:
• Vaginal dryness, leading to painful sex
• Delicate skin of the vulva, leading to bleeding with sex
• Lichen sclerosus, which is worsened by low estrogen
• Certain types of urinary incontinence, usually with urgency
• Recurrent infections, especially urinary tract infection and vaginal bacterial infection or bacterial imbalance

But doesn’t your body produce estrogen? Why take artificial estrogen?

From puberty, estrogen levels start to increase in a female. Once a girl is having periods, there are regular variations of estrogen level – it goes up and down through the cycle. During pregnancy, estrogen remains high. After pregnancy, estrogen levels plummet, and they stay low for most of the breastfeeding period. When periods stop around menopause, estrogen levels start to fall and will never return to their previous levels. If you have a hysterectomy while you are still getting periods, your estrogen levels will still drop to some degree. If you have your ovaries removed at the same time as the hysterectomy, your estrogen levels will drop more dramatically.
In summary, there are three main times of your life that a doctor may prescribe estrogen:
• With prolonged breastfeeding after having a baby
• After menopause
• After a hysterectomy

So is there a difference between taking estrogen orally or vaginally?

There are major differences between oral and vaginal estrogen! Oral estrogen can be taken as the combined oral contraceptive Pill (or just “the Pill”) or, at menopause, oral hormonal replacement therapy (“HRT”). There has recently been a move to change the name of HRT to MHT (menopausal hormone therapy), maybe because of bad press around HRT. But because most people know it as HRT, let’s just call it HRT!
Yes, there are big differences between taking estrogen orally and vaginally, and this influences their safety profile. More about this in Part 2 and Part 3 of this series on Estrogen and Your Vagina, Vulva and Bladder!