Is vaginal estrogen safe? If you have ever read the paper insert that comes with a vaginal estrogen prescription, you have probably wondered the same thing, because the warnings on it sound frightening. Dr. Sarah Shaw, a physician with twenty years in women's hormonal health and co founder of Lume Women + Health in Toronto, joins The Hole Shebang to explain why that label is outdated, why it does not reflect current evidence, and why vaginal estrogen is one of the safest, cheapest and most underused treatments in menopause care. Sarah also breaks down premature ovarian insufficiency, the real difference between systemic and local hormone therapy, and the non-hormonal options for hot flashes that most women have never heard of.
What You Will Learn
Listeners will hear the story of a patient who spent years on daily antibiotics for recurrent urinary tract infections before anyone mentioned vaginal estrogen, and what changed once she started it. Sarah explains why the product monograph on vaginal estrogen carries warnings meant for systemic hormone therapy, why vaginal estrogen does not raise the risk of blood clots or dementia, and why it remains a safe option for women who have had breast cancer. She also covers how to find a menopause certified provider, what premature ovarian insufficiency looks like in a woman in her thirties, and the newest non-hormonal medications for hot flashes.
In This Episode
[00:49] Sarah's day to day focus on hormonal health and preventive medicine
[02:29] From harm reduction outreach in Halifax to co founding a women's health clinic
[05:08] The patient story: years of recurrent UTIs, and the vaginal estrogen conversation nobody had with her sooner
[08:14] Shared decision making and being the CEO of your own body
[11:36] What to look for in a menopause certified provider
[16:15] Premature ovarian insufficiency and why early symptoms deserve to be taken seriously
[20:20] Hormone therapy as gold standard care for premature menopause
[21:57] Systemic versus local hormone therapy, explained
[27:32] Why the vaginal estrogen warning label is outdated and what the current evidence actually shows
[31:31] Non-hormonal options for hot flashes: fezolinetant, elinzanetant, SSRIs, SNRIs and low dose gabapentin
[39:57] Practical sleep advice for early morning waking in midlife
About Dr. Sarah Shaw
Dr. Sarah Naomi Shaw, MSW EdD MD FCFP MSCP, is a family physician and Menopause Society Certified Practitioner who spent fifteen years running a family medicine practice in downtown Toronto before co founding Lume Women + Health with Dr. Woganee Filate, Dr. Amy Louis Bayliss and Lindsay Stollery Jephcott. She holds a doctorate in Human Development and Psychology from Harvard University and began her career running a harm reduction outreach program for sex workers in Halifax, Nova Scotia.
Theme Song: I Will Survive by Gloria Gaynor
Key Topics Covered
- Vaginal estrogen safety and the product monograph
- Genitourinary syndrome of menopause
- Premature ovarian insufficiency
- Systemic versus local hormone therapy
- Non-hormonal hot flash treatment
- Choosing a menopause certified provider
Resources and References Mentioned
Listen to More Episodes Like This
- Why 85 Percent of Women Develop the Genitourinary Syndrome of Menopause with Dr Daiana Castleman
- Your Vagina Is Shrinking and Nobody Told You: The Hormone Conversation We NEED with Dr. Carrie Jones
- Sleep, Sex and Menopause with Dr. Woganee Filate, Sarah's co founder at Lume Women + Health
Find every episode at podcast.blueberrytherapy.ca.
Connect with Dr. Sarah Shaw
Website: lumewomenshealth.com
Instagram: @lumewomenshealth
LinkedIn: linkedin.com/in/sarah-naomi-shaw
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Visit blueberrytherapy.ca to book a pelvic health consultation, subscribe to The Hole Shebang wherever you listen, and connect with us on Instagram @blueberrytherapypelvichealth.
