Vagtionary™

The Periprofessional Vagtionary™ - Glossary of Terms

I like to make things fun so let’s call this glossary of terms a “vagtionary.” We already have men in our everything; we have men in menopause, we have men in women, we have men in menstruation, we have men in our body parts. Enough already! Let’s take the dic out of dictionary and call it a vagtionary.

🎤 If you’re looking for the funny stuff, scroll to the bottom.

Hormones

Estrogen (or oestrogen for my international friends) - This is the primary sex hormone of women. Even though it’s called a “sex hormone,” it regulates everything in our body, from fertility, brain functions, endocrine system, musculoskeletal system, hair and skin, etc. We have estrogen receptors throughout our entire female body. Picture estrogen as that friend with a ton of energy who wants to stay out all night and party. It’s the hype hormone.

There are four types of estrogen that our bodies make at different times:

• E2 - Estradiol estrogen is the powerhouse estrogen produced during your PRE-menopausal years by your ovaries and is much more potent (up to 10x more potent¹). This is the estrogen that most people online talk about when they say “estrogen.” Perimenopause is when your ovaries start to stop producing estradiol on a regular schedule and can cause havoc. This is the type of estrogen given for FDA-approved hormone replacement therapy (see HRT below). This form of estrogen is also called 17-beta estradiol.

• E1 - Estrone estrogen is the estrogen your body begins to make during the menopause transition and will continue to make throughout your post-menopause years. It’s a weaker form of estrogen than E2 and is made by the adrenal glands and not the ovaries. See, nature didn’t take away all of your estrogen, it just gave you an alternative version of it.

• E3 - Estriol estrogen is the form of estrogen your body primarily makes during pregnancy to support a growing fetus. Some compounding pharmacies use estriol in their HRT products, but this is not approved by the FDA. Compounded drugs are not covered by insurance. See my explanation of compounding pharmacies below.

• E4 - Estetrol estrogen is made by your itty bitty baby body when you’re in your mother’s womb. I don’t talk too much about this one (neither does anyone else during perimenopause), but it’s becoming used as an active ingredient in some oral birth control pills.

Estrogen receptors - A group of proteins activated by estrogen that tell a cell how to behave. I picture them as little guppies opening wide to swallow up the estrogen. As females, we have estrogen receptors throughout our entire bodies, including our brains. When your ovaries stop producing estradiol, the poor, hungry estrogen receptors don’t get the signaling that they need to perform their functions.

Progesterone - Another sex hormone and it counterbalances estrogen. It’s the yin to the yang. If estrogen is your fun party friend, progesterone is the friend who likes to Netflix and chill. Progesterone calms you down and helps you sleep. Scientists are discovering other benefits of it as well, such as regulating breathing and boosting brain function. Progesterone is one of the first hormones that drop during perimenopause because you start skipping ovulation. This lets your party girlfriend have too much fun and run around uncontrolled. You may end up with sleepless nights and more anxiety when your progesterone drops. Progesterone is one of the hormones included in HRT (see below). Also, see LH below.

FSH - Follicle Stimulating Hormone - This is the driver of ovulation and I believe it plays a bigger role in perimenopause symptoms than anyone is giving it credit for. FSH is the hormone that prepares and releases an egg for ovulation. It’s made in the pituitary gland in the brain. As your brain receives fluctuating high and low estrogen as you go through perimenopause, it starts making more and more FSH to try to jumpstart ovulation. If you’re a parent, it’s comparable to asking your child to do something nicely for the first 50 times and then yelling at them when you have to ask 51 times, and then yelling louder if they still don’t do what you asked. The brain is releasing more and more FSH to “yell” at the ovaries to prepare and release an egg. It’s a cycle, the ovaries release less and less hormones the closer to menopause which causes the brain to release more FSH. I have a theory that the combination of low progesterone, fluctuating estrogen, and rising/fluctuating FSH are what cause the most perimenopause symptoms. I’ll have to wait for science to test this.

LH - Luteinizing Hormone - Like FSH, this is also made in your brain by your pituitary gland. It triggers the release of an egg at ovulation. It stimulates the corpus luteum to produce progesterone at ovulation. The corpus luteum is a temporary group of cells formed on the ovary around ovulation that produces progesterone. So, if you don’t ovulate, then progesterone doesn’t rise like it should in the second half of the cycle. The corpus luteum will break down shortly once you no longer need it in that cycle.

Testosterone - Although associated with men, women also have testosterone. It is made in the ovaries as well as the adrenal glands (just above the kidney). Testosterone helps build bones and muscle mass, stabilize mood, improve brain function, keep the libido hot and spicy, and maintain overall energy. However, too much testosterone can cause problems like acne and hair loss. Testosterone typically spikes in relation to estrogen and progesterone during perimenopause, predisposing you to some of these symptoms. After menopause, your testosterone will decline. It’s the last sex hormone to decline and is associated with aging, NOT perimenopause. And, it ain’t just us - the men in our lives also have declining testosterone with age. Testosterone replacement is not yet FDA-approved for women, but there are options for us.

DHEA (Dehydroepiandrosterone, say it 10 times fast) - This is an important hormone produced primarily in the adrenal glades but also slightly by the ovaries. I like to call this an “ingredient hormone” meaning that it is one of the ingredients used to make other hormones such as estradiol and testosterone. Guess what ingredient DHEA is made from? Cholesterol!

Follicular Phase - This is the first half of your menstrual cycle when your estradiol estrogen is rising and your body is preparing for ovulation. Think “follicular",” think “first part of the cycle.” Because of estrogen, you may be more social, more talkative, and feel smarter during this time of the month. During perimenopause, you may or may not prepare and release an egg and you may or may not bleed. It’s a crap shoot.

Luteal Phase - This is the second half of your menstrual cycle after ovulation. Think “luteal,” think “last part of the cycle.” Estradiol is coming down from it’s peak right before ovulation and progesterone is rising. Because of progesterone, you may feel more like pulling out your bunny slippers and cozying up on the couch. In perimenopause, if you haven’t ovulated, you won’t make progesterone. See this issue? It will be estrogen gone wild!

Estrogen Dominance - This means that your ratio of progesterone to estrogen is off balance leaving estrogen the dominant hormone. Progesterone is the first hormone to decline in perimenopause which lets your estrogen run amok without being balanced by progesterone. There are things you can do to regain the balance. Estrogen dominance can also be caused if you have too much estrogen in general. This can be caused if you don’t have a good detox system to eliminate used estrogen. Again, there are things that can be done and I have lots of resources.

HRT (Hormone Replacement Therapy, now called Menopause Therapy [MT] or Menopause Hormone Therapy [MHT]) - Why the name change? Because using the word replacement is incorrect. Doctors are not trying to replace the hormones lost during perimenopause. The amount of estrogen and progesterone in these drugs is just enough to keep the brain believing that it is still getting estradiol. We’re talking amounts like .05mg for the estrogen patch - a teeny, tiny amount, even less than what is in low-dose birth control pills.

HRT is only available as a prescription. HRT is FDA-approved for hot flashes and the prevention of bone loss and comes in a variety of delivery methods such as patches, gel, spray, and a vaginal ring. There is also an oral option, but topical (via the skin) is the preferred route. There are also several non-FDA delivery methods, such as compounded creams and pellets. FDA-approved HRT has gone through an extensive process to check for effectiveness and safety. NOTE: Most insurance companies will only cover FDA-approved HRT, and some insurance won’t cover it at all or will only cover generic versions. Check coverage before you go to your doctor if you’re considering going on HRT. HRT will be a hot topic on this site as well as transitioning to the new terms of “MT” and “MHT.”

Body Part-y

Crotch - Sorry, I just like this word. Crotch, crotch, crotch. Also known as “down there,” “down below,” “down south,” “down low,” and “down under.” See vagina, vulva, and labia for the medical terms.

Vagina - Hold the presses! A vagina is not the entire female anatomy. It is only the canal connecting the vulva (the outside area) to the cervix and uterus. When the medical community speaks of a vagina, this is what they are referring to, but as non-clinical people, we just call the whole thing a vagina. That’s okay; we know what you mean. When it’s important for me to be clear as to which part I’m talking about, I will use the medical terms, otherwise I’ll just say vagina.

Vulva - This is the area outside of the vagina that you can see with a mirror. Go on, take a peak. This area consists of the outside female genitalia, including the “lips,” also called the “labia minor” (inner lips) and “labia major” (outer lips). It also includes the urethra, your pee-pee hole.

Labia - See Vulva. See your female parts for an image.

Vaginal Rugae - Rugae are folds in the vaginal canal skin similar to an accordion that allows the vagina to be flexible and expand as needed during sex and baby delivery. It increases the surface area of the vagina so that it can expand instead of being stiff like a plastic PVC tube. Estradiol estrogen keeps our rugae healthy and happy. During the menopause transition, our rugae can become stiff and inflexible, which can make for difficult orgasms, vaginal discomfort, and painful sex. Your GYN can confirm the health of your rugae, just ask next time you are getting a pelvic exam, and can prescribe topical medicine if you are having issues.

Pelvic Floor - This is your female powerhouse comprising of muscles, ligaments, nerves, and connective tissue located in your pelvic cavity, “down there.” The pelvic floor physically supports the bladder, uterus, and bowel. Picture it as a hammock holding everything in place. It helps with urination, sexual activities (orgasm, anyone?) and pooping. These muscles can get tight or weak, which restricts their ability to perform properly. It’s very common to have issues with your pelvic floor during perimenopause from years of not giving it the love and attention it needs.

Uterus, Cervix, Ovaries and Fallopian Tubes - Body parts that make up female reproductive anatomy. Do we need a birds and the bees conversation here? The uterus is your baby oven, and the lining of it, which makes a nice cushy pad for a growing baby, is called the endometrium. You will most likely have one ovary on each side of the uterus attached by a fallopian tube. This is the tube that the egg travels down on its way to the uterus upon ovulation. As it travels, it hopes to be fertilized by sperm; as women, we may not want the same thing. The ovary is the keeper of all of your eggs since you were a baby in your mother’s womb. The cervix is a cushy round group of tissue that is at the end of your vaginal canal before the entrance of the uterus. It relaxes a bit during ovulation to allow sperm to enter the uterus. When the doctor yells out during a delivery, “Dilation at 8cm!” she is referring to the size of the cervix opening. Now you know.

Body Chemicals

Cortisol - Is a stress hormone made by the adrenal glands. It works together with adrenaline (adrenaline is released first) to buffer the effects of adrenaline on your body. Cortisol is not the enemy the internet would like you to think. It’s necessary and serves many functions to protect our body. It becomes a problem when cortisol is released constantly and chronically, which will dysregulate your cortisol production (it will be higher or lower than it should or it will be released at times that it shouldn’t be) and will raise your baseline cortisol levels until you burn out your adrenals (which makes cortisol) and it crashes. Cortisol is a protector against the effects of adrenaline, but when too high or not on the correct release schedule can be very inflammatory. Cortisol is released as a part of the fight or flight response system. You don’t need a bear to chase you, any stressor can cause the release of cortisol - even harmful critical self-talk, a hurtful email, or being told something negative.

Adrenaline - Is the first chemical released during stress and is made in the adrenal glands. It’s an energizer that mobilizes you to action. It gives you a quick hit of energy and protects against pain. Taylor Swift knew what she was talking about when she wrote the song “Shake it Off.” The best way to process adrenaline out of your body is movement - shake it off. Cortisol is released after adrenaline to balance the effects of the adrenaline - edgy, feeling like you’re going to jump out of your skin, wired.

Neurotransmitters - They are chemicals that allow the brain and the body to communicate. Examples include serotonin, acetylcholine, and dopamine.

Mood

Anxiety - The type of anxiety described by women during perimenopause is slightly different than what you would expect with anxiety. It’s not so much a worry sensation but more of a “I can’t cope with anything” feeling. Panic attacks may start showing up out of nowhere, even if you’ve never dealt with them before. Read my article Just Not Feeling Like Myself for more information.

Depression - Depression in perimenopause can show up in many ways, such as losing your lust for life, feeling like you lost your get up and go, sadness, crying, fatigue, losing interest in caring for yourself, and feeling like there is a heavy weight on you.

Medical Terms for Common Perimenopause Symptoms

Dyspareunia - painful sex

Urinary Incontinence - leaking urine

• Stress Incontinence - leaking during when doing something that causes pressure to the bladder like coughing, sneezing, or exercise

• Urge Incontinence - a sudden and immediate urge to urinate that may cause leaking

Nocturia - frequent urination overnight

Polyuria - frequent passage of urine at larger amounts

Dysuria - painful urination

Pollakiuria - frequent urination

Metabolic Syndrome - includes high blood pressure, high blood sugar, too much body fat around the waist, or unhealthy cholesterol levels

Lipid Profile - your cholesterol numbers (Total, high-density lipoprotein HDL, low-density lipoprotein LDL, and triglycerides)

Tinnitus - ringing in the ears which can include other phantom sounds as well

Bacterial Cystitis - Urinary tract infection (UTI) caused by bacteria

Other

Compounding Pharmacy - These are pharmacies that can prepare customized prescription medicines. Compounded drugs are not FDA-approved. Some doctors (MDs/DOs) will not work with compounding pharmacies, but some will for certain reasons, such as being allergic to an inactive ingredient in an FDA-approved prescription drug that you would buy at a regular pharmacy like CVS. Compounded medicines are not covered by insurance and tend to be expensive, but they are necessary for certain populations of people. Some compounding pharmacies also prepare HRT, but, again, it’s not FDA-approved so not covered by health insurance. My advice is to pick a reputable compounding pharmacy if you need to work with one.

FDA - Food and Drug Administration - Among other things, the FDA is responsible for ensuring that Americans have medicines that have been reviewed for safety, effectiveness, and quality. Pharmaceuticals sold in a regular pharmacy like CVS, have gone through rigorous clinical and quality testing by both the pharmaceutical company and the FDA. The FDA does not review or test compounded pharmaceutical products as of June 2024. This may be changing in the future.

“I ain’t from around these parts.” - My Invented Terms

Perimenopause Spiral - The cascading avalanche of worry often caused by playing a game of “what if? what if? what if?” with yourself, ruminating on worse-case health scenarios, or playing mental tennis trying to decide between two options. Once you get into the spiral, it’s important to take measures to get out of it. You’re basically triggering your fight-or-flight stress response when you do this.

You can also put yourself in the spiral by trying to figure out if you’re feeling awful because your estrogen is high or low. The exact hormone levels do not correspond to the symptoms.² The symptoms are due to the fluctuating and unpredictable hormones, not necessarily the level. This is why the Menopause Society does not recommend testing hormones in perimenopausal women (keep in mind your doctor may practice differently). Plus, when blood is drawn it only measures hormones as of that one teeny moment in time. Now, if someone were to invent a continuous estrogen monitor like a glucose monitor, we could have something to go on, but it’s not yet possible.

Elder Peri - I made up the term “Elder Peri” to describe me being an older perimenopausal woman as a nod to Iliza Shlesinger’s stand-up comedy special called “Elder Millennial.” I am well beyond the average menopause age of 51 and thus am older than most of the women going through perimenopause today.

Hungry Horrors - Those moments or days when you want to eat everything in the house and eating doesn’t stop the feeling. For me, this is caused by several things including hormones (who would have thunk), if you haven’t eaten enough calories recently for your body or level of activity, if you’re restricting carbs, or if you’re not getting enough protein.

Rest to Mt. Everest - Also known as Couch to 5slay. Starting an exercise program during perimenopause is a great way to manage your symptoms, build muscles, and improve your heart, but it’s important to begin low and slow. It’s not a good idea to tax our bodies by jumping into intense exercise when we aren’t used to it. I always suggest starting with a walking program for a month and slowly working up your intensity from there. Yes, it takes time, but you’ll be much better off than starting with too much and then not being able to continue.

Cracked Period. - A period with blood in which you didn’t ovulate (release an egg) in that cycle. You won’t necessarily know if you’ve released an egg or not in that cycle, but if you’re in tune with your body, you might. I always knew when I was ovulating. A clue that you didn’t ovulate is a shorter cycle length than normal³. If you didn’t ovulate that means your progesterone production is way down. Low progesterone = sleep issues; another clue. Cracked periods occur frequently during perimenopause especially the further in you get. You don’t really need to know if you’ve ovulated, but it’s sure fun to say “I think this is a cracked period.”

Phantom Period. - When you have all of the feelings like you’re going to get a period, but then nothing shows up.

Vampire Period. - This period arrives unexpectedly with no warning signs.

Check back often; more terms are added as I write each article.

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1. Louann Brizendine, MD. The Upgrade. Harmony, 2022.

2. Lisa Mosconi, PhD, The Menopause Brain, Avery/Penguin Random House, 2024

3. Louann Brizendine, MD. The Upgrade. Harmony, 2022.