48: Genitourinary Syndrome of Menopause: Why You Can Have It In Your 20s & 30s

Why do the tissue changes we link to menopause also show up in women on the pill, breastfeeding, or in their twenties?I'm joined by Dr. Sameena Rahman, OB-GYN and sexual medicine specialist, founder of the GSM Collective in Chicago and ISSWSH scientific committee chair.We unpack genitourinary syndrome of menopause (GSM), why the same hormonal mechanism drives vestibulodynia in younger women on birth control or spironolactone, and how vaginal estrogen, vaginal DHEA and estradiol-testosterone cream are used. We also cover the removed boxed warning on estrogen, why under 5% of women are offered a treatment linked to fewer UTIs and deaths, blood work, mast cells, and medical gaslighting.For anyone told their hormones are "normal" when something clearly isn't - and the clinicians who treat them.Sponsors:- The Pelvic People, makers of the Ohnut and the Kiwi. 15% off with code TWTC15 at thepelvicpeople.com/twtc - Origin, in-network pelvic floor PT. Get your first month of On Track free with code TWTC at theoriginway.com/twtc Dr. Sameena Rahman:Instagram: @gynogirlWebsite: thegsmcollective.comBook: "Brown Girls' Disease”? coming out October 6Resources: isswsh.org, prosayla.comConnect with Mathilde:Instagram: @theworldstightestcommunityWebsite: theworldstightestcommunity.comNewsletter: https://tinyurl.com/4h4snzzdSupport the podcast: https://tinyurl.com/mtxnzhsdTimestamps00:00:00 Introduction, Dr. Sameena Rahman00:01:28 GSM, Terminology00:03:12 Vaginal pH, Thinning Tissue00:04:37 Recurrent UTIs, Sepsis00:05:12 Vestibule, Pain with Sex00:05:52 Lactation, Cancer, Fertility00:06:36 Birth Control, Androgens00:07:24 GSM in Younger Women00:08:37 Dryness Misread, Q-Tip Test00:09:40 GSM Prevalence, Prevention00:11:15 Chronic Progressive Condition00:11:48 Nerve Proliferation, Mast Cells00:14:31 Birth Control and Vestibular Pain00:15:43 Anti-Androgen Pills, Spironolactone00:17:13 Drospirenone, Yaz, Yasmin00:18:13 Tool: Flagging Side Effects00:18:50 Genetic Testing, Pelvic Floor PT00:20:09 Weighing the Pill00:20:54 Local Hormone Therapy00:22:22 Vaginal DHEA, Formulations00:23:01 UTI Risk Reduction00:23:47 Tool: Coming Off the Pill, IUD00:24:22 Estradiol-Testosterone Cream00:25:36 Choosing Treatment, DHEA vs Estrogen00:27:26 Breast Cancer Fears, WHI00:28:10 Boxed Warning Removed00:29:16 No Systemic Increase00:30:01 Undertreatment, UTI and Sepsis Data00:32:11 Tool: Treating After a First UTI00:32:48 AUA Guidelines, Premenopausal Gap00:33:42 ISSWSH Vestibulodynia Algorithm00:35:04 Tool: Reactions, Switching Products00:37:26 Blood Work, SHBG, Testosterone00:40:26 Mast Cell Staining, Pain as Trauma00:41:26 Pelvic Floor Botox00:42:19 Medical Gaslighting, Team Care00:43:55 Reasons for Hope, New Treatments00:45:46 Hypermobility, Connected Conditions00:46:43 Book: Brown Girls' Disease?00:49:42 Where to Find Dr. Rahman