u/ApprehensiveSwing932

The moderators said it was because I was promoting therapies that weren't standard of care. Hmm. Every one of the things I mentioned was something my Gyn and Oncologist both recommended! I'M not telling anybody to do anything, but if you're experiencing va-jay-jay related discomfort after your hormones dropped from endocrine therapy, and you want some other things to talk to your medical team about, you can find my post over in the hysterectomy group as well.

I got my first vaginal bacterial infection (BV) about three months after my estrogen started dropping from starting post-breast-cancer endocrine therapy. Then a second one right after my hysterectomy. Then a third a couple of months after that. Three rounds of antibiotics before anyone mentioned that low estrogen makes it genuinely hard to control your own vaginal pH — and that an unstable pH is basically a welcome mat for BV.

Nobody told me that. Not once, until the 3rd infection.

I spent those months wondering if it was some kind of hygiene issue. Was I using the wrong soap? Was my laundry detergent not getting my underwear clean enough? Nope. Completely pH-related. And completely predictable, apparently, once your estrogen drops, whether that's from natural menopause, or surgical menopause, or endocrine suppression therapy. 

I already knew low estrogen caused dryness and irritation, so at first I chalked my symptoms up to that. But the products I was using for dryness weren't enough, and I was starting to wonder if my situation was just never going to resolve. After the third round of antibiotics seemed to mostly clear things up but left me still feeling a little prickly, my gyn tested again and said the BV wasn't completely gone — but she didn't want to do another round because my microbiome was finally starting to recover and she didn't want to nuke it again.

That's when my whole approach shifted. Dryness products weren't enough. I needed to actively work on pH control and microbiome repair at the same time.

Here's everything I've tried, what worked, what didn't, and what I'm doing now:

pH monitoring Yes, vaginal pH strips are a thing. I started testing every morning just to understand my baseline and track whether what I was doing was working. I'm now down to once or twice a week just to confirm I'm staying in normal range. Worth doing, at least for a while, so you have actual data instead of just symptoms to go on.

Flora Power by Love Wellness (probiotic suppository) I had previously used this after a yeast infection a few years ago so I already had some familiarity. I brought it back to help rebuild the microbiome. It helped — but left behind some irritating gritty residue. Eventually switched to an oral probiotic instead (I use Culturelle, 4-in-1 for Vaginal Health) which I find much easier. I still occasionally insert a Flora Power capsule when I feel like things are a little off, but it's no longer my daily approach.

The Killer by Love Wellness (boric acid suppository) Boric acid apparently has a long history — our grandmothers used apple cider vinegar douches for similar reasons, though nobody in my family ever mentioned that to me. This does help with pH, but I found it a bit harsh and also left gritty residue. I used it quite a bit in the initial stages to get my pH back into the normal range, but switched away from it fairly quickly.

RepHresh (pH-balancing gel) This is what replaced boric acid in my routine for pH control. Much gentler, no residue, easy to use. This is now part of my regular rotation.

VH Essentials prebiotic/probiotic (hyaluronic acid suppository) My nutritionist recommended this when I first started losing estrogen, saying I'd need something for dryness and irritation, and that it was similar to Revaree but much less expensive. I used it for over a year and I do think it's a good product. Fair warning though: it's a waxy torpedo that melts at body temperature, so you need to insert it at bedtime lying down with a panty liner. Even then, I found it would melt and run out about an hour later — and more than once I woke up in a panic thinking I was wetting the bed! Not great for sleep health. So I started inserting it an hour before turning out my light just to let it do its thing before I fell asleep. It helped, but it was a whole process.

Revaree+ (high-dose hyaluronic acid) After the last BV and my focus on pH, my gyn said I still needed hyaluronic acid therapy and that I needed a lot of it, so she recommended Revaree+, which has twice the hyaluronic acid as the regular version. Yes, it's expensive. But it does not melt and run everywhere — completely different experience from VH Essentials. If your gyn is recommending hyaluronic acid and you can swing it, the Revaree+ is worth it.

Vaginal estradiol My oncologist is allowing me to use this a few times a week, which has been a game changer. The localized estrogen helps with everything — dryness, tissue health, pH stability. If you're managing a hormone-sensitive condition and wondering whether vaginal estradiol is an option, it's worth asking your medical team about it specifically, because the systemic absorption is very low and some providers who would otherwise restrict estrogen will allow it.

My current nightly rotation Estradiol → RepHresh → Estradiol → Revaree+ → repeat. This seems to be keeping the dryness manageable. I'm still occasionally a little prickly, which tells me the bacteria aren't perfectly balanced yet, so I'll add a Flora Power suppository when needed. But I'm in a much better place than I was, and I finally feel like I understand what's actually happening and why.

The thing I wish someone had told me from the start:

Low estrogen doesn't just cause dryness. It destabilizes your vaginal pH. And an unstable pH makes you vulnerable to BV, repeatedly, until you address the underlying environment, not just the infection. Antibiotics treat the BV but they also further disrupt the microbiome, which can make you more vulnerable to the next one. You have to actively rebuild.

If you're dealing with recurring BV, recurring irritation that doesn't fully resolve, or just a vague sense that things are not right down there and you can't figure out why — ask your provider specifically about vaginal pH and microbiome support. Not just dryness products. Like me, you probably need to be looking at the full picture.

p.s. And yes, if you read my other post about my hormone drop affecting me mentally, this was going on in parallel with that. It has been a fun time.

(Not affiliated with any of these products. Just a fellow patient who did a lot of trial and error so maybe you don't have to.)

I got my first vaginal bacterial infection (BV) about three months after my estrogen started dropping from starting post-breast-cancer endocrine therapy. Then a second one right after my hysterectomy. Then a third a couple of months after that. Three rounds of antibiotics before anyone mentioned that low estrogen makes it genuinely hard to control your own vaginal pH — and that an unstable pH is basically a welcome mat for BV.

Nobody told me that. Not once, until the 3rd infection.

I spent those months wondering if it was some kind of hygiene issue. Was I using the wrong soap? Was my laundry detergent not getting my underwear clean enough? Nope. Completely pH-related. And completely predictable, apparently, once your estrogen drops, whether that's from natural menopause, or surgical menopause, or endocrine suppression therapy. 

I already knew low estrogen caused dryness and irritation, so at first I chalked my symptoms up to that. But the products I was using for dryness weren't enough, and I was starting to wonder if my situation was just never going to resolve. After the third round of antibiotics seemed to mostly clear things up but left me still feeling a little prickly, my gyn tested again and said the BV wasn't completely gone — but she didn't want to do another round because my microbiome was finally starting to recover and she didn't want to nuke it again.

That's when my whole approach shifted. Dryness products weren't enough. I needed to actively work on pH control and microbiome repair at the same time.

Here's everything I've tried, what worked, what didn't, and what I'm doing now:

pH monitoring Yes, vaginal pH strips are a thing. I started testing every morning just to understand my baseline and track whether what I was doing was working. I'm now down to once or twice a week just to confirm I'm staying in normal range. Worth doing, at least for a while, so you have actual data instead of just symptoms to go on.

Flora Power by Love Wellness (probiotic suppository) I had previously used this after a yeast infection a few years ago so I already had some familiarity. I brought it back to help rebuild the microbiome. It helped — but left behind some irritating gritty residue. Eventually switched to an oral probiotic instead (I use Culturelle, 4-in-1 for Vaginal Health) which I find much easier. I still occasionally insert a Flora Power capsule when I feel like things are a little off, but it's no longer my daily approach.

The Killer by Love Wellness (boric acid suppository) Boric acid apparently has a long history — our grandmothers used apple cider vinegar douches for similar reasons, though nobody in my family ever mentioned that to me. This does help with pH, but I found it a bit harsh and also left gritty residue. I used it quite a bit in the initial stages to get my pH back into the normal range, but switched away from it fairly quickly.

RepHresh (pH-balancing gel) This is what replaced boric acid in my routine for pH control. Much gentler, no residue, easy to use. This is now part of my regular rotation.

VH Essentials prebiotic/probiotic (hyaluronic acid suppository) My nutritionist recommended this when I first started losing estrogen, saying I'd need something for dryness and irritation, and that it was similar to Revaree but much less expensive. I used it for over a year and I do think it's a good product. Fair warning though: it's a waxy torpedo that melts at body temperature, so you need to insert it at bedtime lying down with a panty liner. Even then, I found it would melt and run out about an hour later — and more than once I woke up in a panic thinking I was wetting the bed! Not great for sleep health. So I started inserting it an hour before turning out my light just to let it do its thing before I fell asleep. It helped, but it was a whole process.

Revaree+ (high-dose hyaluronic acid) After the last BV and my focus on pH, my gyn said I still needed hyaluronic acid therapy and that I needed a lot of it, so she recommended Revaree+, which has twice the hyaluronic acid as the regular version. Yes, it's expensive. But it does not melt and run everywhere — completely different experience from VH Essentials. If your gyn is recommending hyaluronic acid and you can swing it, the Revaree+ is worth it.

Vaginal estradiol My oncologist is allowing me to use this a few times a week, which has been a game changer. The localized estrogen helps with everything — dryness, tissue health, pH stability. If you're managing a hormone-sensitive condition and wondering whether vaginal estradiol is an option, it's worth asking your medical team about it specifically, because the systemic absorption is very low and some providers who would otherwise restrict estrogen will allow it.

My current nightly rotation Estradiol → RepHresh → Estradiol → Revaree+ → repeat. This seems to be keeping the dryness manageable. I'm still occasionally a little prickly, which tells me the bacteria aren't perfectly balanced yet, so I'll add a Flora Power suppository when needed. But I'm in a much better place than I was, and I finally feel like I understand what's actually happening and why.

The thing I wish someone had told me from the start:

Low estrogen doesn't just cause dryness. It destabilizes your vaginal pH. And an unstable pH makes you vulnerable to BV, repeatedly, until you address the underlying environment, not just the infection. Antibiotics treat the BV but they also further disrupt the microbiome, which can make you more vulnerable to the next one. You have to actively rebuild.

If you're dealing with recurring BV, recurring irritation that doesn't fully resolve, or just a vague sense that things are not right down there and you can't figure out why — ask your provider specifically about vaginal pH and microbiome support. Not just dryness products. Like me, you probably need to be looking at the full picture.

p.s. And yes, if you read my other post about my hormone drop affecting me mentally, this was going on in parallel with that. It has been a fun time.

(Not affiliated with any of these products. Just a fellow patient who did a lot of trial and error so maybe you don't have to.)

I wrote the following after experiencing significant (temporary!) memory issues after my hysterectomy. Since this is also related to my long-term endocrine therapy for breast cancer, and since many of you have also joined the hyster-sisterhood, I thought I should share it here as well.

Part 1: The Glove Box Incident (Or: what happens to your brain when your hormones disappear)

Back in January, at 8 weeks post-hysterectomy, I was finally healed. Physically. But mentally, things were definitely not right. I would be mid-thought and then... nothing. Not the normal "what did I come in here for" that happens to everyone. More like reaching for something that just wasn't there. Sometimes if I stayed with it, I could pull the thought back. But in January, a lot of the time I couldn't.  And then came the car dealer incident.

For months I had a to-do on my list: pick up the registration tag for my new car. In February my husband asked if I had picked it up yet. I said no, and made a plan to stop by later that day.

When I got there, they were confused. They couldn't find the tag. They went back through their handwritten daily logs and found my name. In January. I had already been there and picked it up.

I kind of vaguely remembered, but only barely, and only once they said something. I went back to the car and checked the glove box. There it was. I had apparently put it directly in the glove box, and driven away.  And with no visual reminder, the task was completed, but the memory was not formed.

That scared me.

I want to pause here, because my experience, the cliff version, is just one way this shows up. For most women it is a stair-step version. Perimenopause can stretch across years, with hormones shifting, stabilizing, and shifting again. But in both cases, the societal knee-jerk around hormone changes means your reactions get labeled and your judgment get second-guessed. You even start wondering yourself “how impaired am I?”

I told my oncologist and she ordered cognitive testing.  While I was waiting, I could already feel the fog starting to lift. The thoughts that had been slipping away were starting to stick again. By the time I sat down for the testing, I felt more like myself. And the results confirmed it. Nearly a perfect score.

Here's what I wish someone had told me. When your hormones disappear suddenly, it is much harder on the brain than a gradual transition, because there's no runway. One day the hormones are there. Then they're not. The brain has to find a new baseline. And while it's doing that, things like memory encoding and recall can be affected. For women in the slow transition, the same thing is happening, just over a longer and less predictable timeline. Either way, the brain does find a new set point.

I also keep thinking about how the people around me responded to it.  About what it means to have your judgment suddenly questioned, because of what your hormones are doing. That's why this is a two-part piece. Part 2 is about what I've learned about the science of what actually changes and what doesn't.  And how the women going through this (and those who care about us) can be aware of and work with what's real, while we find our new normal.

Part 2: Hormone Changes — What the Science Says and What To Do About It

First, I want to tell you about a woman I used to work with.

She was exceptionally good at her job. Good enough that when I was new, I shadowed her to learn. But I recall a day when some of her teammates were grumbling about her. They rolled their eyes and said she was ‘going through the change’.

I didn't join in. But I didn't object. I took it at face value, because I was younger and hadn’t developed my own perspective yet. But now I see. She was already walking the challenging / gendered line between strong and bossy. Menopause handed the people around her one more lens to view her through. And her competence, which I had witnessed directly, was no longer the focus. This is a big part of why I wanted to write this.

What's Actually Happening Physiologically

Estrogen receptors are densely concentrated in two key areas of the brain: the prefrontal cortex (emotional Regulator), and the amygdala (emotional Interpreter). When estrogen drops, the Regulator is less effective at staying calm, and the Interpreter is more likely to flag a threat.  The brain is genuinely working differently. Temporarily, as it recalibrates.

Here's how that shows up day to day, and what helps:

Emotional intensity Legitimate emotions can feel bigger. We don’t manufacture emotions that don’t exist, but we might amplify what’s valid. 

What helps: No final decisions during or right after a charged moment. "I need to think about this" is always a complete sentence.

Negative interpretations If input or tone is unclear, the brain is more likely to flag it as negative.  

What helps: Look for the most neutral explanation before reacting. Check in with someone you trust.

Under pressure Working memory can be reduced, requiring a little more time for complex decisions.  

What helps: Don't let anyone rush you on anything important. Revisit complex decisions when you're rested and not mid-conflict.

Sleep disruption Extremely common when hormones are fluctuating. Sleep-deprivation causes everyone issues, and further compounds the above. 

What helps: Track your sleep and factor it in. Don't take on the hardest conversations when you're running on empty.

What is NOT affected: Your values. Your judgment. Your competence. Your right to be taken seriously. Your capacity to make sound decisions about your own life.

The risks above are about timing and conditions, not fundamental capabilities. The answer to "how impaired am I?" is situation specific and can be easily mitigated. That's a very different thing from the broad brush the societal knee-jerk tends to use.

To Our Supporters

You don't have to understand all the neuroscience. Just don’t write us off as ‘impaired’. Ask what we need. If we need more time, honor it, without treating it as evidence we can't make the decision.

We are not incapable. We are not as impaired as the knee-jerk suggests. We are recalibrating, and we will find our new set point. 

I wrote the following after experiencing significant (temporary!) memory issues after my surgery. Sharing here in case it helps others.

Part 1: The Glove Box Incident (Or: what happens to your brain when your hormones disappear)

Back in January, at 8 weeks post-hysterectomy, I was finally healed. Physically. But mentally, things were definitely not right. I would be mid-thought and then... nothing. Not the normal "what did I come in here for" that happens to everyone. More like reaching for something that just wasn't there. Sometimes if I stayed with it, I could pull the thought back. But in January, a lot of the time I couldn't.  And then came the car dealer incident.

For months I had a to-do on my list: pick up the registration tag for my new car. In February my husband asked if I had picked it up yet. I said no, and made a plan to stop by later that day.

When I got there, they were confused. They couldn't find the tag. They went back through their handwritten daily logs and found my name. In January. I had already been there and picked it up.

I kind of vaguely remembered, but only barely, and only once they said something. I went back to the car and checked the glove box. There it was. I had apparently put it directly in the glove box, and driven away.  And with no visual reminder, the task was completed, but the memory was not formed.

That scared me.

I want to pause here, because my experience, the cliff version, is just one way this shows up. For most women it is a stair-step version. Perimenopause can stretch across years, with hormones shifting, stabilizing, and shifting again. But in both cases, the societal knee-jerk around hormone changes means your reactions get labeled and your judgment get second-guessed. You even start wondering yourself “how impaired am I?”

I told my oncologist and she ordered cognitive testing.  While I was waiting, I could already feel the fog starting to lift. The thoughts that had been slipping away were starting to stick again. By the time I sat down for the testing, I felt more like myself. And the results confirmed it. Nearly a perfect score.

Here's what I wish someone had told me. When your hormones disappear suddenly, it is much harder on the brain than a gradual transition, because there's no runway. One day the hormones are there. Then they're not. The brain has to find a new baseline. And while it's doing that, things like memory encoding and recall can be affected. For women in the slow transition, the same thing is happening, just over a longer and less predictable timeline. Either way, the brain does find a new set point.

I also keep thinking about how the people around me responded to it.  About what it means to have your judgment suddenly questioned, because of what your hormones are doing. That's why this is a two-part piece. Part 2 is about what I've learned about the science of what actually changes and what doesn't.  And how the women going through this (and those who care about us) can be aware of and work with what's real, while we find our new normal.

Part 2: Hormone Changes — What the Science Says and What To Do About It

First, I want to tell you about a woman I used to work with.

She was exceptionally good at her job. Good enough that when I was new, I shadowed her to learn. But I recall a day when some of her teammates were grumbling about her. They rolled their eyes and said she was ‘going through the change’.

I didn't join in. But I didn't object. I took it at face value, because I was younger and hadn’t developed my own perspective yet. But now I see. She was already walking the challenging / gendered line between strong and bossy. Menopause handed the people around her one more lens to view her through. And her competence, which I had witnessed directly, was no longer the focus. This is a big part of why I wanted to write this.

What's Actually Happening Physiologically

Estrogen receptors are densely concentrated in two key areas of the brain: the prefrontal cortex (emotional Regulator), and the amygdala (emotional Interpreter). When estrogen drops, the Regulator is less effective at staying calm, and the Interpreter is more likely to flag a threat.  The brain is genuinely working differently. Temporarily, as it recalibrates.

Here's how that shows up day to day, and what helps:

Emotional intensity Legitimate emotions can feel bigger. We don’t manufacture emotions that don’t exist, but we might amplify what’s valid. 

What helps: No final decisions during or right after a charged moment. "I need to think about this" is always a complete sentence.

Negative interpretations If input or tone is unclear, the brain is more likely to flag it as negative.  

What helps: Look for the most neutral explanation before reacting. Check in with someone you trust.

Under pressure Working memory can be reduced, requiring a little more time for complex decisions.  

What helps: Don't let anyone rush you on anything important. Revisit complex decisions when you're rested and not mid-conflict.

Sleep disruption Extremely common when hormones are fluctuating. Sleep-deprivation causes everyone issues, and further compounds the above. 

What helps: Track your sleep and factor it in. Don't take on the hardest conversations when you're running on empty.

What is NOT affected: Your values. Your judgment. Your competence. Your right to be taken seriously. Your capacity to make sound decisions about your own life.

The risks above are about timing and conditions, not fundamental capabilities. The answer to "how impaired am I?" is situation specific and can be easily mitigated. That's a very different thing from the broad brush the societal knee-jerk tends to use.

To Our Supporters

You don't have to understand all the neuroscience. Just don’t write us off as ‘impaired’. Ask what we need. If we need more time, honor it, without treating it as evidence we can't make the decision.

We are not incapable. We are not as impaired as the knee-jerk suggests. We are recalibrating, and we will find our new set point.