00:00 – Dr. Girard: Definitely aloe-based lubricants are really good at helping to improve
00:04 – lubrication, making sure that patients have enough essential fatty acids.
00:22 – Melissa: Let’s talk a little bit about hormonal therapy. A lot of people in our community are on
00:28 – hormone replacement therapy or are often using estrogen and/or progesterone. Can you explain
00:33 – what your approach to hormonal therapy is and how hormonal therapy could help with recurrent UTI?
00:39 – Dr. Girard: Yeah, absolutely. So having healthy hormones will support the rest of the body, so my
00:44 – personal approach is we look at symptoms that might be associated with a hormone imbalance
00:50 – and then we complement that with testing, and then from there we choose whether or not a
00:56 – patient needs to take estrogen, progesterone, or both. There are some conditions like vaginal
01:03 – atrophy where we don’t necessarily even need to test, we can go right for it, we can go
01:08 – forward with a topical estriol, for example. The tissue level of an estrogen in the vaginal
01:16 – area may not be reflective in the systemic area, so and that could be a blood flow issue or it
01:23 – could be a lack of receptors for estrogen in the vaginal area specifically, and of course the
01:29 – vaginal area has an impact on the bladder area. We do know that when levels of estrogen are healthy
01:36 – in that area of the body, they help to reduce recurrent urinary tract infections as well because
01:41 – they’re, you know, there’s a close relationship between those systems. So using hormones
01:50 – has to be individualized for the patient, whether or not they’re premenopausal or postmenopausal.
01:57 – I think some patients are wondering about using estrogen therapy for preventing recurrent UTIs
02:07 – pre-menopausally because of most of the research. Melissa: Yeah, that’s a big question.
02:10 – Dr. Girard: Yeah, most of the research or all the research is post-menopausally. I am seeing practitioners and
02:18 – and as myself, including myself, that are using it to help and we are seeing that it is helpful because the hormone levels start
02:26 – to decline in some women as early as 38. So if a woman is in that pre-menopausal time and
02:39 – they’re starting to get recurrent UTIs and we find that their estrogen is lower,
02:44 – obviously not menopausal lower, but if we find that it’s lower then it’s potentially a treatment
02:50 – option that patients should be considering in order to reduce reoccurrence of their infections. Yeah.
02:56 – Melissa: Yeah, that’s good to know. That question did come up a few times and we haven’t found
03:01 – any research that helps with the aspect of premenopausal hormone use, but it does seem
03:06 – to be quite well-evidenced post-menopausal. Dr. Girard: Yeah, and that’s what, this is something that practitioners
03:14 – are doing to try and help patients. One of the top urologists in Canada, here, he also talked about it and that it
03:24 – should be something that urologists are trying with patients to to reduce these numbers of infections because they are causing
03:31 – a lot of,
03:33 – a lot of loss of quality of life and distress for patients. Melissa: Definitely.
03:39 – Dr. Girard: So it’s, like I said, definitely important to consider that one. Melissa: Okay. Are bioidentical hormones safer than the
03:46 – non-bioidentical versions? Dr. Girard: We think so, yes. We don’t have lots of research to be able
03:54 – to say for sure,
03:56 – but the conventional hormones… There is the Women’s Health Initiative that showed a slight increase in
04:03 – clotting and strokes associated with estrogen use, however that increase in risk was very, very slight.
04:11 – So if a patient is using conventional hormone therapy successfully and they’re being
04:18 – monitored by their physician, I don’t necessarily think patients have to jump over to bioidenticals.
04:26 – However, I do feel that bioidenticals, you know, just as their name says, they look the same
04:32 – as the estrogens and the progesterone that is present in our own bodies,
04:38 – so why not use a compound that is the same as what’s already present in our own bodies that
04:45 – should increase the safety profile of it? But taking a hormone exogenously,
04:54 – there is always the risk of taking too much or taking more than what we need,
04:58 – right. So it is important to support the body’s own ability to produce
05:04 – those hormones, but also if those therapies aren’t improving hormone levels enough,
05:10 – then considering the bioidenticals. Melissa: When it comes to vaginal dryness, irritation or
05:16 – pain during sexual intercourse, are there natural supplements that you can use that might help?
05:22 – Dr. Girard: Yeah, and it’s important to really address this particular symptom because this is something
05:27 – that can predispose to recurrent urinary tract infections or developing that chronic
05:31 – infection, right. If there’s inflammation in the vaginal area, it often has that crosstalk
05:37 – with the pelvis, with the bladder, the urethra, and can predispose, so it’s just more friction
05:44 – if there’s vaginal dryness going on, so definitely aloe-based lubricants are really good
05:51 – at helping to improve lubrication, making sure that patients have enough essential fatty acids,
05:57 – whether from supplements, usually from supplements because not very many people are eating that much
06:02 – fish, and fish also have their own issues with contamination these days. So, you know, having a
06:09 – really good quality and enough of a good omega-3 supplement is useful. There’s some good,
06:16 – I’ve had other practitioners have some really good reports about using sea buckthorn oil
06:23 – and it being able to orally improve vaginal dryness, so those are once you improve the
06:30 – dryness, the irritation tends to go down and then there is less pain. But pain
06:36 – with intercourse can also be other factors. It can be pelvic floor dysfunction, and that’s something that
06:42 – definitely needs to be addressed because if there’s not good circulation and blood flow
06:46 – to the area, then you’re not going to have robust estrogen levels which might help to produce that
06:54 – that natural lubrication. And also there’s a lot of mental emotional connection there.
07:01 – If patients have fear and are anxious or have trauma from previous incidences, then
07:07 – that’s going to predispose to vaginal issues as well. Melissa: Many people report that their UTI symptoms
07:15 – actually fluctuate with their menstrual cycle. Can you give us some insight on why
07:19 – that might happen and if there’s anything people can do to proactively help with that?
07:26 – Dr. Girard: Yeah, so as we go through our cycle, our hormones are fluctuating quite a bit.
07:32 – Estrogen is going up and down and up and down, and progesterone is usually down
07:36 – at the beginning and then goes up after we ovulate. So during those different phases
07:43 – of the menstrual cycle, there’s the potential for estrogen to become too high or not be high enough,
07:50 – and same with progesterone. So we can have a frank dominance of estrogen or we can have
07:55 – what’s called a relative estrogen dominance, so that’s basically just the progesterone actually
08:00 – isn’t high enough. The estrogen is good but the progesterone isn’t matching it. So things need to
08:05 – be in balance, and when we’re developing especially, if you’re seeing it every cycle then that’s a good
08:11 – time to potentially test to see whether or not those levels are… what’s going on? Is it way
08:19 – too much estrogen? Is it not enough progesterone? You know, so, or is it not enough estrogen? And that
08:25 – way we can we can address that particular symptom at that time with the right hormonal therapy.
08:32 – One of the things that I often see is patients getting worse before their menstrual cycle
08:38 – and that could be that the estrogen has fallen too quickly. And as that estrogen becomes too low,
08:46 – we start to get basically more micro-fissures in the tissue, which then can set up more inflammation
08:52 – and irritation and then predispose to symptoms or a full-blown infection. And then on the other hand,
08:59 – if estrogen overall is much too high in patients, then what we tend to see is that
09:07 – impacts the immune system actually and it makes them more prone to infections because the immune
09:12 – system isn’t able to respond the way that it it normally can, and that’s, I don’t know
09:19 – the exact mechanism as to how that happens, but we do see that as well. So patients that are
09:26 – getting more yeast infections, for example, right before their period, and we know that once we get
09:30 – a yeast infection, often that that can trigger a urinary tract infection. So there
09:37 – is hormone-immune aspects to be looking at as well for patients. And then the progesterone,
09:45 – if that’s not high enough, that can often make tissue again more prone to potentially getting
09:53 – infection. But then too much progesterone, that I’ve seen develop, predispose patients to more
09:59 – symptoms as well. So patients that are taking it for fertility and things like that.
10:05 – Melissa: Does that mean the potential solution to this then, if it is because of hormone levels at different times of
10:10 – the cycle, will it be a hormonal therapy answer or is there something else that people can do?
10:17 – Dr. Girard: Usually it’s a hormone therapy answer, but that could also start from something diet- and herbal-based
10:23 – and stepped up to bioidentical if need be. We also have to make sure that we’re watching
10:30 – the other hormone, stress hormone, because that is going to have a cascading effect on our
10:36 – female hormones as well. So making sure that we’re addressing those other things. I’ve also seen
10:42 – patients who have a thyroid hormone that is not, you know, have hypothyroidism.
10:49 – They’ve developed symptoms and then once their thyroid gets properly managed again,
10:54 – they start to have less UTIs or no UTIs at all. So it’s important to look at all the different
11:00 – hormone systems and how they’re impacting one another. Blood sugar, right, we know diabetics are
11:05 – definitely more prone to UTIs and that’s a complicated relationship between
11:11 – insulin and blood sugar and feeding bacteria and inflammation, essentially. So that’s,
11:19 – you’ve got to look at all of those hormone systems. Melissa: So it’s really important to work with someone that
11:24 – can help with that then? Because it sounds quite complex. Dr. Girard: Yeah, individualized medicine. Like I said,
11:30 – making sure that it’s not just a protocol for every person, you know, that’s not how,
11:36 – that’s not how we get people healthy. We have to address all those different fundamental underlying issues.