153. The Genitourinary Syndrome of Menopause and The 2 Safeguards All Users of Vaginal Estrogen Need

Hormone Optimizing Warrior M.D. · Sep 11, 2026 · 29m

Women have been told for decades that vaginal estrogen stays where you put it, which means no progesterone and nothing to monitor.

I do not believe that is true, and this week I lay out why.

We start with what genitourinary syndrome of menopause, or GSM, actually looks like, including the urinary half of it that almost nobody connects back to hormones. Then I make my case for what happens to the estrogen after it leaves the vaginal tissue, and what two safeguards I think every woman using it should have.

I also share an ultrasound finding that changed how I think about yearly screening, in a…