# 1 ESTROGEN ESSENTIAL FOR VAGINAL HEALTH

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DeeTroll wrote: HI all, earlier I said I was going to re-send something I wrote about the value of Estrogen (Estrace) and how essential it is for V. health. I had to run... and threw this into my Drafts section and just remembered I never did.. So for what it's worth. I must have # 2 'somewhere' in my chaos. LOL Hugs Dee WHY

ESTROGEN IS ESSENTIAL FOR VAGINAL HEALTH Hi Everyone,I've thought and thought long and hard about how to write something on the hormones or just 'what' to write. I'm sincere when I tell you that I must have at least 60,000 articles and probably 4-5,000 on hormones alone. There is unfortunately not one single article or even two or three that has everything in it, (it would be so easy to just copy & paste as well as no time involved.) But it's the collective information over the many years that I've found. Some may only be a small paragraph or even a sentence, so what I thought I'd do is sort of ramble a bit as things come to me with some back ground on what Estrogen does for the vaginal tissue, so forgive me if I stray a bit as I put the pieces out here. All of you ''know'' me so this will really be long *chuckle* so be forewarned

if this doesn't interest you can stop now. <grin> Much of this I've repeated more than several times, but I hope you find it enlightening, especially you newer members. "Why Estrogen is essential for vaginal health and comfort." by Dee Troll..... .....The clinical features of estrogen 'starvation', whether in menopause or younger women who've had oophorectomy, (ovary removal) chemo or radiation therapy, hysterectomy, use of anti-estrogenic drugs or lactation (nursing) (all states of low estrogen).......include vaginal dryness, tissue thinning, splitting, ripping, and fragility and loss of elasticity, along with shortening and narrowing of the vaginal canal. Note many of those are very similiar to the symptoms of Lichen Sclerosus (LS) especially the condition of the tissue. Changes in the vaginal epithelium (vaginal skin) from a lack of Estrogen also inhibit the growth of lactobacilli

with the reduction in lactic acid production and an increase in vaginal pH. That in turn raises the risk of urogenital infection. Another important change we see with lack of Estrogen is a decrease in vaginal secretions, which, combined with the shrinkage of tissue, makes intercourse often very difficult or painful. Additional common symptoms we can have with a loss of estrogen are vaginal itching, burning, or discharge, and urinary urgency or frequency.As one ages and the estrogen levels naturally drop or fall, we become more alkaline (higher pH levels) in the vaginal area and there is no glycogenization, nor is there a normal bacterial environment which should be lactobacilli dominant. If we 'add' the estrogen back via a direct route, called 'site-specific' meaning the vaginal area, the estrogen assists in producing glycogen in the vaginal tissue giving us back our wanted acidic state by dropping our pH

levels from a more alkaline state (because of a lack of E) to a lower pH of <4.5 which we want. Also the lower pH level helps prevent bacterial infections as well. In addition, more moisturization and lubrication results with estrogen stimulating the blood flow and increasing the nitric oxide giving the tissue back it's tone, color, and recuperative powers . By the way someone mentioned a Libido connection with Estrogen..... I don't believe that's so much of a help as is the Testosterone. That's where the libido lies, BUT............ they are both needed as they work synergistically together. (sorry for the side bar there) but testosterone is absolutely as important as is the estrogen. Especially for women with LS or any woman is who is menopausal and often even peri-menopausal. One study I have says approximately 90% or more of women on systemic estrogen therapy, (HRT) who are otherwise asymptomatic, (no

symptoms) will 'still' have evidence of atrophic vaginitis. (another study I have says it's nearer 100%) They say that "All'' menopausal women -- irrespective of their hormone therapy status -- should at least be screened annually for atrophic vaginitis by testing the vaginal pH, it's one of the easiest tests to check for and very inexpensive and can easily tell you the status of your vagina. I'd think it would be an excellent way to test to see if the Estrogen levels are low in the vaginal area, although with an atrophic vagina no test would be needed as it can be quite visible the longer it goes on with the thinning and fragility of the tissue. Many of you with LS or sometimes vulvodynia, have been told you had the vagina of a 60 year old or older, had a loss of the smaller labial lips etc. yet were quite young. It makes so much logical sense to 'me' that it's mostly likely caused by a state of

estrogen deprivation. (as well as probably testosterone which again there is no doubt patients lack that as far as T receptors with Lichen Sclerosus and not only the vaginal area but the whole body may have less T. receptors. Also the pH level is an excellent test for the status of the urethra as well, as it contains many Estrogen receptors that one looses as one ages as well and is often why incontinence, lower abdominal pressure, urge frequency, etc is high on the list for menopausal women and again why the estrogen applied directly (either topically or intravaginally *inside*) can help those conditions as well. Apart from nourishing the atrophic vulva, urethral and bladder tissues, estrogen improves both the amount and type of 'collagen' and elastin as well as the blood flow to this region. Studies support the suggestion that treatment with local (direct) estrogen therapy

is much more effective than systemic treatment such as an oral, patch or sublingual supplements. The reason why systemic estrogen does not work as well for the genitals is not clear, but some studies say it may be attributable to the disappearance or lessening of ER-beta 'receptors' from the vaginal tissues of postmenopausal women! By the way the ESTRACE (17beta-estradiol) cream is for the ER beta receptors. And it's the ER beta receptors that we lose or have less of as one ages and perhaps as well in LS regardless of age. (ER stands for Estrogen Receptors). Why they disappear or lessen is the big question no one has an answer to! It was 'that' key, like connecting the dots or pieces of the puzzle that brought me the realization almost 5 years ago, that it may be the answer at least partially to restore that tissue and it definitely 'was' the answer for

me. I knew I HAD to restore that tissue somehow and it was the only thing I saw in thousands upon thousands of pieces of literature I read that said it 'could' restore it and not only that but possibly unfuse that tissue as well. As well as the Testosterone creams tho to a lesser degree but used to strenthening and toughing up the tissue, and that was regardless of age IF the tissue was damaged or atrophied or needed restored to health. Just thinking here that I won't even touch on the hundreds of articles on wound healing alone I've read that estrogen can do. I'll spare you. <smile> Several things come to 'my' mind as a possibility as to why it can help. One is in the first line that mentions estrogen 'starvation' as being from anti-estrogenic drugs and one of them is progesterone or progestins (others may be drugs like tamoxifen or taxol etc. for breast cancer) And those meds like the progestins/progesterone are against estrogen so to speak (called anti-estrogenic). It is known to block those E receptors as I think of the Birthcontrol pills being mainly a progestin base and might assume many of those younger were on those or may still be. ('might' account for the loss) OR...... perhaps even those on a daily regimen of a combined HRT (Prem-pro) where the progestin or progesterone (esp. Provera) is added daily (or even cyclically) to protect the uterus but what does it do to those receptors, let alone breast tissue, especially long term? Another is Soy as well as chronic Yeast infections..... as those too can block those E receptors. Yeast loves progesterone so you might have both filling in those receptors and again blocking our much needed estrogen. Whether these anti-estrogenic drugs damage the ER

receptors or lessen them down the road who knows. As far as age and a loss of ER receptors, that would seem natural to me and more understandable as a part of the aging process. As for the mechanisms involved in reversing vaginal atrophy with 'locally and directly applied' therapy, they know from a number of studies that if you put an estrogen tablet into the vagina, within 16 hours you’ll see a change in cell growth and maturation. The time line from total atrophy to total restoration is about 30 days with an inserted pill form or even with the Estring.....(I've sent the picture on before showing the changes) .This would also be true for a cream that was 'inserted' vaginally. Though for those who are not menopausal using the cream topically can restore that tissue as well. Especially for those with LS since it is on the surface and not internal and yet would not have the systemic affect if one is

younger as one would need if menopausal. I don't know if I've touched on anything someone may have asked specifically, but I have so many files and I must have read through several hundred of them tonight spending many many hours to pick and choose various sentences to include from many many sources as well as many from continuing medical ed. classes... I could probably write 5 books on it alone and still not cover all I'd like to say, but a few below are some of the resources I used. I'll definitely close for now, and bottom line is 'still' we don't know why we lose those E receptors in an unhealthy vulva or vagina but we do know that applying the E topically from an external source and even more so intravaginally (for those menopausal) 'can' work and why it can work, but why we lose the receptors who knows? *sigh* And once again a reminder that the original term for LS is ''Lichen Sclerosus et

Atrophicus.'' *lichen sclerosus with atrophy* Also keep in mind these suggestions are only beneficial if 'all' infectious causes have been ruled out but if the skin needs restoration I've not found anything better. Big hugs to all and if you've stayed with this post that long, *<grin> you must have the patience of a saint but I sincerely hope it helps. G'night all, as it's almost 5AM ; ) Dee~ ; ) DTroll@... Resources garnered from: Chaikin DC. Urogenital consequences of estrogen therapy. Women's Health Care in the New Millennium. Program and abstracts of 4th Annual Conference of the National Association of Nurse Practitioners in Women's Health. October 10-13, 2001; Orlando, Florida. Clinical Presentation. Lila E. Nachtigall, MDProfessor of Obstetrics and GynecologyDepartment of Obstetrics and GynecologyNew York

University School of MedicineNew York, N. Y.Sauerbronn AVD; Fonseca AM; Bagnoli VR; Saldiva PH; Pinotti JA Department of Obstetric and Gynecology, Hospital das Clinicas of University of Sao o Medical School, Brazil.Philip M. Sarrel, MDProfessor of Obstetrics and Gynecology and PsychiatryYale University School of MedicineNew Haven, Conn. M. Kaunitz, MDProfessor and Assistant ChairDepartment of Obstetrics and GynecologyUniversity of Florida Health Science Centerville, Fla. Many many more, too many to mention as well as studies from Medscape, the BMJ, Blackwells synergy, Amer. College of Gynes, Elisiver, Dermatological sites. etc.etc.etc. Copyright © 2003-2005 by Dee Troll *****END OF MESSAGE/REMOVE WHEN REPLYING*****http://groups.yahoo.com/group/VulvarDisordersto search our archive or view our files.***