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    Periods are Useful & HRT
    medwisegrace posted:
    It seems to me that the female body uses the period as a wonderful way of recycling. It's a natural way of disposing of nasty bacteria and old cells, etc. What I don't understand (partly because I haven't researched it yet) can the usefulness of this recycling "go away", just because women are older and in peri-menopause/menopause?? How then are foreign/bad bacteria expelled?

    I told my physician that I want my periods to continue, even with HRT, after reading that it can be done by varying the progesterone (and keeping the estradiol constant). I guess I can see that the egg doesn't need to be expelled because it's not produced anymore, and the lining is not building up and sluffing off, but aren't there other microscopic organisms that need to be recycled?
    Mary Jane Minkin, MD responded:
    Dear medwisegrace,
    The lining of the uterus actually harbors very few bacteria (it has been studied, and there are some in there, but not too many.) The vagina does have a considerable bacterial flora, and indeed it can change postmenopausally because the good guy bacteria, lactobacilli, tend to like a well estrogenized lining of the vagina better (more delicious glycogen for them to munch) and the vaginal flora can indeed become less favorable (fewer lactobacilli, and more of the other intestinal flora coming to take up residence in the vagina.) But you can use vaginal estrogens to maintain the vaginal flora, as well.
    One certainly can keep bleeding going by using cyclical estrogens and progestins, that is true. But again, very few bacteria relatively living in the lining of the uterus.
    Good luck,
    Mary Jane
    medwisegrace replied to Mary Jane Minkin, MD's response:
    Let me check my understanding...I"m not following the logic. Periods "refresh" the vagina but not the uterus so much, if I'm understanding your statements. It seems to me, if it's good for one part of the body and not another, it's useful! Especially since women get vaginal infections/imbalances more frequently (and not uterine imbalances so much). AND it's very important for women to have active sex lives, and that involves the vagina, not the uterus! Another thought: more than just the lactobacilli are affected. Doesn't the body have hundreds of good guy bacteria in that location? That's the case in the digestive tract, but I haven't researched the vagina so much. Does the lacto strain outnumber everything else?
    Mary Jane Minkin, MD replied to medwisegrace's response:
    Dear medwisegrace,
    Hope I can clarify a few things. It's really not the "period" itself that cleans the vagina; it is the estrogen made by ovaries (or taken as a supplement, systemically or vaginally) that keeps the vaginal bacteria in balance. There are many different types of bacteria which are good guys, that is true; there are several strains of lactobacilli, for example. And the bacterial flora of the gut are really quite similar to the bacterial flora of the vagina.
    Hope that's helpful,
    Mary Jane

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    For more information, visit the North American Menopause Society website