Episode 255: Your UTIs Might Not Be UTIs — What Your Bladder, Your Vestibule, and Your Hormones Have in Common

Episode 255: Your UTIs Might Not Be UTIs — What Your Bladder, Your Vestibule, and Your Hormones Have in Common

If you've ever had urinary symptoms that antibiotics didn't fix — and your cultures kept coming back negative — this episode is for you. A new 2026 study in the Journal of Sexual Medicine followed 253 women with recurrent UTIs and persistent urogenital symptoms despite negative urine cultures. What researchers found reframes everything: 85% of these women had hormonally mediated vestibulodynia, 75% had pelvic floor hypertonicity, and only 15% had a classic urologic cause for their symptoms. This isn't a bladder problem. It's a hormone problem — and the vulvar vestibule, urethra, and bladder are one integrated, estrogen- and androgen-responsive system. Whether it presents as genitourinary syndrome of menopause (GSM) in a postmenopausal woman or hormonally mediated vestibulodynia in a younger one, the tissue-level pathophysiology is the same. In this episode, Dr. Carolyn Moyers breaks down: • Why persistent urinary symptoms after negative cultures have a hormonal explanation • The shared embryologic origin of the vestibule, urethra, and bladder trigone — and why it matters • How androgen deficiency drives vestibular inflammation, pelvic floor guarding, and bladder dysfunction in a self-perpetuating cycle • Why this affects premenopausal women too — 98.9% of premenopausal patients in the study had below-range free testosterone • What the Rubin et al. 2025 data adds: vaginal prasterone (DHEA) was associated with meaningfully lower UTI rates in women with vulvovaginal atrophy — treating the hormone environment changed the urological outcome • What integrated treatment looks like — vaginal estrogen for GSM, compounded estradiol/testosterone gel for vestibulodynia, pelvic floor PT for hypertonic muscles • The honest limits of this research: selection bias, non-uniform hormonal evaluation, absence of long-term outcome data — and what prospective studies still need to answer This episode builds directly on Episode 149 — When Sex Hurts with Dr. Jill Krapf. If you haven't listened to that one, it is linked below and is essential companion listening. https://podcasts.apple.com/us/podcast/sky-womens-health/id1541657642?i=1000630939731 [https://podcasts.apple.com/us/podcast/sky-womens-health/id1541657642?i=1000630939731] 🔗 References & Resources: • Agrawal et al., Journal of Sexual Medicine, 2026 — Hormonally Mediated Vestibulodynia and Persistent Urogenital Symptoms • Rubin et al., Menopause, 2025 — Prevalence of UTIs in Women with Vulvovaginal Atrophy and the Impact of Vaginal Prasterone • Sky Women's Health Podcast — Episode 149: "When Sex Hurts" with Dr. Jill Krapf [link in show notes] • skywomenshealth.com [skywomenshealth.com] 🔗 Connect with Dr. Carolyn Moyers 📸 Instagram: @drcarolynmoyers [https://www.instagram.com/drcarolynmoyers/] 🎥 YouTube: @drcarolynmoyers [https://www.youtube.com/@drcarolynmoyers] 🌐 Website: www.skywomenshealth.com [https://www.skywomenshealth.com/]

Episode 254: Lift Heavy, Live Longer: Muscles, Menopause & Midlife with Dr. Di

Muscle loss in midlife is real, it is measurable, and it starts earlier than most women are told. Declining estrogen during perimenopause directly affects skeletal muscle — reducing mass, impairing muscle protein synthesis, and accelerating a process called sarcopenia. By the time many women notice it, they've already lost meaningful ground. In this episode, Dr. Carolyn Moyers is joined by Dr. Dianah Lake — emergency medicine physician, fitness and weight loss coach, and menopause wellness expert — to talk about what's actually driving muscle loss in midlife and what the evidence says about reversing it. 🔗 Connect with Dr. Carolyn Moyers 📸 Instagram: @drcarolynmoyers [https://www.instagram.com/drcarolynmoyers/] 🎥 YouTube: @drcarolynmoyers [https://www.youtube.com/@drcarolynmoyers] 🌐 Website: www.skywomenshealth.com [https://www.skywomenshealth.com/] 🔗 Connect with Dr. Dianah Lake Schedule a complimentary consultation Instagram: @drdifitlife Facebook: Dr. Di Fitness Free Community: Professional Women Getting Fit

Episode 253: The Hormone Question I Answer Multiple Times a Day: Progesterone vs. Progestins

Is progesterone the same as a progestin? It sounds like it should be. It is absolutely not. And that distinction matters more than most women — and many providers — realize. This is the conversation Dr. Carolyn Moyers has multiple times a day in clinic — especially with women in perimenopause who are trying to understand their options, figure out why a previous hormone regimen made them feel worse, or advocate for a prescription that actually fits their biology. It is also one of the most consequential mix-ups in all of menopause medicine, and it is long overdue for a dedicated episode. Bioidentical progesterone and synthetic progestins are not interchangeable. They have different molecular structures, different receptor profiles, and meaningfully different effects on your breast tissue, your cardiovascular system, your sleep, and your brain. The WHI study — the one that scared a generation of women off hormone therapy — tested a synthetic progestin, not bioidentical progesterone. And the breast cancer finding it reported was not even statistically significant. That context has been almost entirely missing from the public conversation. Until now. In this episode: • What bioidentical progesterone actually is — and how it differs from synthetic progestins at the molecular level • The WHI study: what it actually tested, and why its results have been misapplied for 20+ years • Breast cancer risk: the ESTHER study and what the evidence actually shows • Cardiovascular differences between progesterone and MPA (Provera) • Why progesterone is a neuroactive steroid — and what that means for your sleep, anxiety, and mood • Uterine protection: what it is, why it matters, and whether bioidentical progesterone is sufficient • What to do if you don’t have a uterus — and whether you still need progesterone • Perimenopause: why the progestogen conversation is completely different when you still have cycles, variable ovarian function, and potentially need contraception • The levonorgestrel IUD, norethindrone acetate 5mg vs. the minipill, and Slynd (drospirenone 4mg) — what each one does and who it’s for • Exactly how to advocate for yourself at your next appointment Resources mentioned: • ESTHER Study (Fournier et al.) — progesterone vs. MPA and breast cancer risk • Women's Health Initiative (2002) • Prometrium prescribing information • Labia Logic (@labialogic) — vulvovaginal specialists | Memorial Day vulvar health post: instagram.com/p/DYqK9uvj2M8 [https://instagram.com/p/DYqK9uvj2M8] • Sky Women’s Health Podcast — Episode 158: Progesterone Intolerance | podcasts.apple.com/gb/podcast/episode-158-progesterone-intolerance/id1541657642?i=1000640152675 [https://podcasts.apple.com/gb/podcast/episode-158-progesterone-intolerance/id1541657642?i=1000640152675] Work with Dr. Moyers: skywomenshealth.com [https://skywomenshealth.com/] | In-person: Fort Worth, TX | Virtual: Texas & West Virginia 🔗 Connect with Dr. Carolyn Moyers 📸 Instagram: @drcarolynmoyers [https://www.instagram.com/drcarolynmoyers/] 🎥 YouTube: @drcarolynmoyers [https://www.youtube.com/@drcarolynmoyers] 🌐 Website: www.skywomenshealth.com [https://www.skywomenshealth.com/] Sky Women's Health Podcast is for educational purposes only and does not constitute medical advice. Please consult your own provider for personalized care.

Episode 252: Ask Me Anything: Hormones, Sexual Health, and Midlife Myths Debunked

You asked — Dr. Moyers answered. In this Ask Me Anything episode, Dr. Moyers — board-certified OBGYN, Menopause Society Certified Physician, and Fellow of the International Society for the Study of Women’s Sexual Health — tackles 18 of the most pressing questions she hears from midlife women every day in her clinic. From hormone therapy and blood clots to low libido, vaginal changes, bladder leaks, and medications for desire — no topic is off limits. If you’ve ever left a doctor’s appointment feeling dismissed, unheard, or more confused than when you walked in, this episode is for you. In This Episode • What to do when you’re on hormone therapy and still have symptoms • CombiPatch and progesterone — is it safe? • Blood clots and hormone therapy — is it really off the table? • Breast cancer and hormone therapy — the nuanced truth • Bioidentical vs. conventional HRT — what’s the difference? • How to know if you’re in menopause when you have an IUD and no period • Options to stop heavy perimenopausal bleeding without a hysterectomy • Why normal hormone levels don’t always mean you feel normal • Postmenopausal bleeding — what it means and what to do • Low libido and vaginal dryness — there is more than lube • How labia change during menopause and what a proper vulvar exam should include • How Addyi works in the brain and its interaction with antidepressants • Testosterone in women — normal levels, superphysiologic levels, and side effects 🔗 Connect with Dr. Carolyn Moyers 📸 Instagram: @drcarolynmoyers [https://www.instagram.com/drcarolynmoyers/] 🎥 YouTube: @drcarolynmoyers [https://www.youtube.com/@drcarolynmoyers] 🌐 Website: www.skywomenshealth.com [https://www.skywomenshealth.com/]

Episode 251: What Every Woman in Menopause Needs to Know About Dementia Prevention

Two-thirds of dementia cases are women. Two-thirds of caregivers are women. And the brain changes that lead to dementia begin 20 to 30 years before symptoms appear — which means, for most women, that window falls directly during the menopausal transition. That's not a coincidence. It's a clinical reality that neurologist Dr. Ashanthi Gajaweera has built her entire practice around. Dr. Gajaweera is the founder of Healthspan Neurology PC in New York and one of a rare few clinicians who holds dual expertise as a board-certified neurologist and a Menopause Society Certified Provider. With 25+ years of clinical experience, she specializes in cognitive longevity and dementia prevention — with a particular focus on women. In this episode, we cover: • Why dementia is, above all else, a women's disease — and what that means for prevention • What is actually happening in the menopausal brain — and why it matters • The 14 modifiable risk factors identified by the Lancet Commission — and the four critical factors specific to women that don't appear on that list • Why the menopausal transition is the most powerful window a woman has to protect her brain • Evidence-based strategies you can start now The brain is resilient. The window is open. This episode will show you what to do with it. 🔗 Connect with Dr. Carolyn Moyers 🔗 Connect with @dr.gajaweera on YouTube, Instagram, LinkedIn www.healthspanneurology.com [www.healthspanneurology.com ] 📸 Instagram: @drcarolynmoyers [https://www.instagram.com/drcarolynmoyers/] 🎥 YouTube: @drcarolynmoyers [https://www.youtube.com/@drcarolynmoyers] 🌐 Website: www.skywomenshealth.com [https://www.skywomenshealth.com/]