9. Sexual, Urinary & Pelvic Health: Vaginal Estrogen & Beyond! ft. Lindsay Geddes, Pelvic Floor PT
If you've ever been told that hormone replacement therapy is dangerous, or if you've just quietly accepted leaks, dryness, or painful sex as inevitable parts of midlife — this episode is for you.
Dr. Mary Pines sits down with pelvic floor physiotherapist Lindsay Geddes to cut through decades of fear-based misinformation around HRT. They cover why hormones aren't just for reproduction, how the notorious 2002 Women's Health Initiative study was flawed (and later retracted), and why bioidentical hormones are a game-changer.
Dr. Mary also breaks down exactly what vaginal estrogen does — from rebuilding tissue thickness and improving lubrication, to supporting the vaginal microbiome, reducing UTIs, and even improving clitoral sensation. Plus, Lindsay shares her clinical tips on how to actually apply it for maximum benefit.
Armed with this episode, you'll know exactly what to say to your doctor.
Additional Podcast Platforms
Listen to this episode on Apple Podcasts,Spotify, Amazon Music, iHeartRadio, Audible, Podcast Addict, PocketCasts, Castbox, YouTube, Goodpods, Castro, or on your favorite podcast platform.
Links & Resources
Learn more about Dr. Mary’s work at DrMaryPines.com and her signature Better Beyond 40 Formula program.
Follow her on Instagram at @drmarypines for day-to-day inspiration, wellness insights, and a behind-the-scenes look at her life and practice.
Explore Mary’s creative side and view her artwork at MaryPines-Art.com.
You can find the transcript of this episode here. Transcripts of all episodes can be found here.
Mentions in this Episode:
2002 Women's Health Initiative (WHI) Study — the landmark study that created widespread fear around HRT; has since been officially retracted and widely criticized for flawed methodology
Dr. Rachel Rubin — urologist and hormone specialist who successfully advocated to have the black box warning removed from vaginal estrogen products (achieved in 2025 per the FDA announcement referenced in episode)
FDA 2025 Announcement — removal of the black box warning from vaginal estrogen (Estrin); referenced as a major milestone for HRT safety recognition
Vaginal Estrogen (Estrace/Estriol cream) — topical estrogen applied to the vulva, vaginal canal, urethra, and surrounding tissue; available by prescription
Testosterone (compounded) — vaginal/vulvar testosterone for libido, clitoral sensation, and vestibular pain; requires a hormone-qualified provider and compounding pharmacy in Canada/US
Estring — a low-maintenance vaginal estrogen ring inserted for several months; mentioned as an option for women who struggle with consistent cream application
Lactobacillus — beneficial vaginal bacteria that vaginal estrogen helps support by restoring acidic pH
