117 - Painful Sex: The Story of Lichen Sclerosus, a Shockingly Under-Diagnosed Post-Menopause Skin Condition, Part 2
W.O.W. MD - Your Wellness Optimizing Warrior
Release Date: 12/05/2025
119 - Estrogen’s Role in Urinary Health for Aging Women: An Eye-Opening Discussion, Part 1
W.O.W. MD - Your Wellness Optimizing Warrior
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...
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118 - Painful Sex: The Story of Lichen Sclerosus, a Shockingly Under-Diagnosed Post-Menopause Skin Condition, Part 3
W.O.W. MD - Your Wellness Optimizing Warrior
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...
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117 - Painful Sex: The Story of Lichen Sclerosus, a Shockingly Under-Diagnosed Post-Menopause Skin Condition, Part 2
W.O.W. MD - Your Wellness Optimizing Warrior
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...
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116 - Painful Sex: The Story of Lichen Sclerosus, a Shockingly Under-Diagnosed Post-Menopause Skin Condition, Part 1
W.O.W. MD - Your Wellness Optimizing Warrior
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...
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115 - Holistic Non-Hormonal Approaches to Menopausal Urinary and Vaginal Health, Part 2
W.O.W. MD - Your Wellness Optimizing Warrior
Today we’re continuing our conversation about natural solutions for vaginal wellness after menopause. There are various issues that can arise after menopause due to a drop in estrogen, and vaginal lubrication is one of the main ones that women seek to address. The tissues in the vaginal canal and opening are very sensitive, and after menopause, the area can be dry and the skin begins thinning. One of my favorite solutions is DHEA (dehydroepiandrosterone)—a hormone typically made by the adrenal gland but that can also be obtained through supplementation. For purposes of vaginal wellness,...
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114 - Holistic Non-Hormonal Approaches to Menopausal Urinary and Vaginal Health, Part 1
W.O.W. MD - Your Wellness Optimizing Warrior
There has been very little research done in the area of urinary and vaginal wellness for menopausal and perimenopausal women, despite the number of women experiencing these issues increasing. This week, I’m starting a series of episodes about non-hormonal options available to women to overcome these concerns. Urinary tract infections (UTIs) tend to increase as women age, and staying hydrated is one thing that can help flush bacteria from the bladder wall, reducing the instance of infection. Cranberry juice can also protect the bladder from bacteria, but it has to be unsweetened (or you can...
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113 - Restoring Comfort and Confidence in Menopause with Vaginal Estrogen, Part 2
W.O.W. MD - Your Wellness Optimizing Warrior
We’re getting intro part 2 of our conversation about vaginal estrogen and its usefulness for treating GSM (genital urinary syndrome of menopause) symptoms in this episode. Last time, we began discussing the importance of timing for hormone replacement therapy, including estrogen therapy. When you act early—before your symptoms get worse—it can make a big difference. The vaginal walls and vaginal lining will lose lubrication and architectural support over time without estrogen. This is also called vaginal atrophy. The loss of moisture, which is the main symptom, is directly linked to a...
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112 - Restoring Comfort and Confidence in Menopause with Vaginal Estrogen, Part 1
W.O.W. MD - Your Wellness Optimizing Warrior
Today we’re talking about GSM: genitourinary syndrome of menopause. This new term encompasses the vaginal and urinary changes that happen during menopause. These changes don’t just impact women during menopause—they have long-lasting implications post-menopause as well. Some of these changes include increased urinary frequency and urgency, plus recurrent vaginal infections. Menopausal women may also experience urinary tract infections differently: they aren’t as painful. While this could be seen as a positive, it also makes it much more difficult to identify when the woman is...
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111 - Understanding Hormone Therapy Timing: The Secret to Post-Menopausal Optimal Health
W.O.W. MD - Your Wellness Optimizing Warrior
Get ready to learn all about the timing for estrogen therapy and exactly when you should start hormone therapy for menopause. Timing is crucial because many women don’t know when the best time to use it is, often realized when there have been irreversible changes and it’s too late to undo them. Previous studies done on estrogen have scared women away from taking advantage of its benefits as a therapy earlier on. Yet, one of the main studies that led to widespread misinformation used oral synthetic estrogens. Keep in mind this hormone was one of the main ones available at the time. As...
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110 - The Truth About Estrogen and Breast Cancer: What You Should Know - Part 3
W.O.W. MD - Your Wellness Optimizing Warrior
In this episode we’re bringing our conversation about the WHI study about estrogen to a close. This study scared many health care professionals (and their patients) out of using estrogen therapy. Today, we’re focusing on the reality of the risks associated with estrogen replacement therapy, especially whether or not there are actually any cancer-related risks. The breast cancer incidence in the women who took part in this study but did not receive hormone therapy (the placebo group) was almost identical to the women who received hormone treatment. The results, percentage wise, presented in...
info_outlineLet’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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