Hello, I am Leslie Greenberg. I am a family physician in Reno, Nevada. I attended Northwestern University in Chicago, then University of Nevada School of Medicine. I relocated back to my hometown in 2015. I trained and practiced medicine in the Midwest (Indiana and Kansas) for 20 years before moving back West. I consider myself a teacher and educator. I have taught 450 + family medicine residents (and countless medical students), over nearly 30 years. I currently teach at the family medicine residency program in Reno and also see private patients. I care for newborns through elderly patients in both the hospital and office. I love to do women’s health (contraception and menopause care) and procedures: skin biopsies, circumcisions, IUD insertion/removals, paps, colposocopies, and toenail removals. I am a Menopause Society certified physician. I invite you to read my blog. If you would like to become a patient, please call 775-982-1000.
Medical Disclaimer
Please remember that medical information provided by myself, in the absence of a visit with a health care professional, must be considered an educational service only. This blog should not be relied upon as a medical judgement and does not replace a physician’s independent judgement about the appropriateness or risks of a procedure or condition for a given patient. I will do my best to provide you with information that may help you make your own health care decisions.
Genitourinary syndrome of menopause (GSM) is a medical term used to describe a group of symptoms that affect the genital and urinary systems after menopause. The term was introduced by the Menopause Society (formerly the North American Menopause Society) to better capture the range of symptoms that occurs when estrogen levels decline. GSM is very common but often underrecognized and undertreated.
Estrogen plays an important role in maintaining the health of the vaginal and urinary tissues. It helps keep the tissues thick, flexible, well-lubricated, and well supplied with blood flow. During menopause, estrogen levels decrease, causing these tissues to gradually become thinner, drier, and less elastic. These physical changes can lead to a range of symptoms that fall under the umbrella of GSM.
Question: What symptoms tend to fall under the GSM umbrella? Why can these symptoms make sex uncomfortable, painful, or even impossible?
Common symptoms of GSM include vaginal dryness, irritation, burning, itching, decreased lubrication, and pain during intercourse. Some people may also notice small tears in the vaginal tissue during sexual activity or even after wiping. Urinary symptoms are also common and can include urinary urgency, frequent urination, and recurrent urinary tract infections.
Because vaginal tissues become thinner and less lubricated, friction during sexual activity often causes discomfort or pain. Over time, this can make sexual activity difficult or even impossible for some individuals. Without treatment, symptoms often worsen.
Question: Do you see a domino effect happen in patients with GSM? For example, do people begin to develop protective muscle tension or anticipatory pain around sex after experiencing GSM symptoms?
Yes, this type of domino effect occurs. When pain is felt repeatedly, the body may begin to anticipate this discomfort. The pelvic floor muscles can tighten in a protective way, even before penetration occurs. This protective response is a normal reaction of the nervous system trying to prevent further injury or discomfort. However, increased muscle tension can make intercourse even more painful, creating a cycle of fear, tension, and pain.
Question: Why might it be helpful to focus also on the nervous system and pelvic floor responses that may develop after painful experiences?
Addressing the nervous system and pelvic floor is important because pain is not only a tissue issue but also a body response. When repeated pain occurs, the nervous system may remain in a protective state. Pelvic floor physical therapy can help patients relax these muscles, improve circulation to the pelvic tissues, and restore more comfortable movement.
Question: What are the most effective medical treatments currently available for GSM?
Medical treatments for GSM are often very effective. One of the first-lines of treatment and most commonly recommended is low-dose vaginal estrogen. ACOG and American Family Physician both highlight that vaginal estrogen helps restore the thickness, elasticity, and moisture of vaginal tissue while using very small amounts of hormone. This vaginal estrogen acts locally, right at the site that it’s needed.
Another treatment option is vaginal dehydroepiandrosterone (DHEA), also called prasterone. This medication is converted locally within the vaginal tissue into hormones that support tissue health and lubrication.
Question: How do treatments like vaginal estrogen, DHEA, moisturizers, lubricants, or pelvic floor physical therapy work to relieve symptoms?
Vaginal estrogen works by directly restoring estrogen to the localized vaginal tissue, improving blood flow, lubrication, and tissue elasticity. Vaginal DHEA supports similar improvements through local hormone conversion. Vaginal moisturizers help maintain hydration in the vaginal tissue when used regularly, while lubricants reduce friction during sexual activity and can make intercourse more comfortable.
Pelvic floor physical therapy focuses on the muscles surrounding the vagina and pelvis. Therapists are expertly trained to help patients learn exercises and relaxation techniques to reduce muscle tension and improve pelvic floor function. Pelvic floor tone can decrease after childbirth and especially through the menopause transition.
Question: Why might body-based approaches like somatic therapy be helpful for people who experience painful sex after menopause?
Some clinicians are increasingly recommending body-based approaches such as somatic therapy for patients who have experienced pain during sexual activity. These approaches help individuals reconnect with bodily sensations and calm the nervous system. Techniques such as breathing exercises, relaxation practices, and body awareness can help reduce tension and fear associated with intimacy. Involving a sexual partner is also helpful.
Question: Anything else you’d like to add about the intersection of GSM and somatic care?
Menopause is a predictable condition which often causes genitourinary symptoms. The most effective approach often combines medical treatment with attention to the body’s stress and pain responses. When treatments restore the health of vaginal tissue and patients also learn ways to relax the pelvic floor and regulate the nervous system, many people experience meaningful improvement. Addressing both the physical and nervous system aspects of GSM can help patients regain comfort, confidence, and a healthier relationship with intimacy.
Many women worry that menopausal hormone therapy (MHT) might shorten life. A large study from Denmark gives some reassuring news. Researchers found that using menopausal hormone therapy did not hasten death.
This study followed Danish women born between 1950 and 1977. All women were alive at age 45. Researchers began tracking each woman on her 45th birthday and followed her until July 31, 2023. After removing women with certain health problems, the study included 876,805 women.
About 11.9% of the women filled a prescription for menopausal hormone therapy. Over time, 5.4% of the women in the study died. The typical follow-up time was about 14 years.
The main question was simple: Did women who used hormone therapy die sooner?
The answer was no.
After adjusting for many health and social factors, women who used menopausal hormone therapy had a hazard ratio for death of 0.96 compared with women who did not use it. A number close to 1.0 means the risk was about the same. In other words, hormone therapy did not increase the risk of death.
When researchers looked at how long women used therapy, results were similar. Short-term users had a hazard ratio near 1. Longer-term users sometimes showed slightly lower risk. Importantly, there were no clear differences in deaths from heart disease, cancer, or other causes.
The study also looked at women who had both ovaries removed between ages 45 and 54. Among these women, those who used hormone therapy had a 27–34% lower risk of death than those who did not. They also tended to live several years longer.
Even with these reassuring findings, we should be careful. This research was done in Denmark, and many of the hormone products and prescribing patterns began in 1995. Health systems, lifestyles, and medication types may differ from those in the United States today. Because of this, the results may not perfectly apply to modern U.S. women.
The bottom line: In this large Danish study, menopausal hormone therapy did not appear to shorten life. Women should still talk with physician about personal risks and benefits when deciding whether hormone therapy is right for them.
I can recall when I was pregnant with our third child, my husband had whooping cough. Oh my…. what a doozy that was for him. He took antibiotics appropriately and STILL whooped for 6 months (while the cilia in his lungs was regrowing).
Consider getting a Tdap booster. (The T is tetanus, and the P is pertussis/whooping cough.) This is suggested once as an adult, for pregnant women in the third trimester of every pregnancy, or for those who have exposure to infants (like new grandparents) . You can also opt to get a Tdap every 10 years instead of a tetanus booster every 10 years.
Consistent with CDC guidance, most asymptomatic patients without prolonged close contact to a known pertussis case should NOT be tested or treated with antibiotics (e.g., azithromycin).
Asymptomatic Patients (in the setting of increased incidence and widespread community transmission)
Pertussis lab testing is not recommended
Antibiotic treatment or prophylaxis is indicated only in select situations, including:
Household or prolonged close contact with a confirmed case
High-risk individuals or those caring for them
Post-exposure prophylaxis is recommended for:
All household contacts of a person with confirmed pertussis, regardless of vaccination history
High-risk persons:
Infants (particularly those ≤12 months)
Hospitalized neonates and newborn infants
Women in the third trimester of pregnancy
Immunocompromised individuals
Patients with chronic respiratory conditions or other chronic health conditions that may increase pertussis-related morbidity
Persons who have or anticipate having close contact with high-risk individuals, particularly:
Those in contact with infants aged ≤12 months
Healthcare personnel in contact with hospitalized neonates, newborn infants, or patients with chronic respiratory conditions
Other healthcare personnel and close contacts can either receive postexposure prophylaxis or be carefully monitored for 21 days after exposure
Symptomatic Patients
Suspect pertussis in patients with a persistent, paroxysmal cough, often with a characteristic “whoop”
Patients with symptoms consistent with pertussis, and their close contacts, may be treated empirically with azithromycin without testing
Symptomatic patients should:
Isolate for 5 days after starting antibiotics
May return to school or work after 5 days (cough may persist for weeks)
Cough suppressants have limited effectiveness
Healthcare precautions for suspected and confirmed cases is droplet + standard precautions for the same duration.
Provide a regular ear-loop mask for the patient to wear
Additional Notes
Prior Tdap vaccination reduces disease severity but does not eliminate transmission or prophylaxis considerations
Antibiotics are not recommended after 21 days of cough, except for infants and pregnant patients in the 3rd trimester (up to 6 weeks)
Cervical cancer screening helps find problems early, before they turn into cancer. This test has always been done in a clinic by a healthcare professional. Now, some people can also collect a sample at home and mail it in to a lab. A recent study looked at what women think about these two choices—and the answers may surprise you.
What Do Most Women Prefer?
The study found that most women still prefer clinic-based testing. More than 6 out of 10 women (60.8%) said they would rather go to a clinic for their cervical cancer test. About 2 out of 10 women (20.4%) said they prefer to collect a sample at home. The rest were not sure yet.
Why the difference? The study showed that life experiences and personal comfort matter. Some women feel more confident when a clinician collects the sample. Others like the privacy and convenience of testing at home.
Is At-Home Testing Allowed?
Yes—for some people. Medical experts say that self-collected tests are okay for average-risk individuals ages 25 to 65. This means people who do not have a higher risk of cervical cancer can choose this option.
However, there are important rules:
If a self-collected HPV test is negative, the test should be repeated in 3 years.
If a clinic-collected test is negative, it can usually be repeated in 5 years.
If a self-collected test is positive, the person must go to a clinic for a follow-up exam. A clinician needs to collect another sample using a vaginal speculum and a swab.
Also, only certain FDA-approved test kits can be used for self-collection. Not all at-home tests are the same.
Are At-Home Tests Accurate?
Yes—when the right tests are used. Large studies show that self-collected HPV tests can be just as accurate as clinic tests for finding serious cervical dysplasia. This is especially true for tests that use advanced lab methods called PCR tests. Some older types of tests may not work as well, which is why using approved kits is important.
Why Do Some Women Like At-Home Testing?
Many women say at-home testing feels:
More private
Less embarrassing
Less uncomfortable
Easier to fit into a busy schedule
In one U.S. survey, more than 7 out of 10 women were open to self-testing, even if it wasn’t their first choice. Women who were overdue for screening were especially likely to prefer at-home testing.
Does At-Home Testing Help More People Get Screened?
Yes. Studies show that mailing test kits to homes helps more people complete screening. In many studies, screening rates went up—sometimes by a lot. This is especially helpful for people who have trouble getting to a clinic.
The Bottom Line
There is no one right choice for everyone. Many women prefer clinic testing especially if this is incorporated with a wellness visit (where we also review other screening tests, lab tests, and exam, and vaccinations), while others like at-home testing. What matters most is getting screened. Both options can help keep people healthy when used the right way. If you’re unsure which choice is best, a healthcare provider can help guide you.
Cervical cancer is one of the most preventable cancers! That is good news. But people still need to get screened.
I teach medical students, and one lesson I share often is this: medicine changes as research results. What we learned years ago may not always be the best way today.
When I was in medical school, Pap smears were done on every woman after she became sexually active and paps were needed EVERY year. Now we know more. Today, Pap smears begin at age 21, no matter when sexual activity starts. This change came from strong research showing that earlier testing did not improve health and could cause harm from unnecessary procedures. Young adults can clear (get rid of) HPV especially when they contract HPV when they are adolescents.
We have also learned how important HPV (human papillomavirus) is. HPV causes almost all cervical cancers. That is why we now recommend the HPV vaccine for both girls and boys starting at age 9. This vaccine helps prevent cancer before it can ever begin.
Even more exciting news arrived this year. The U.S. Department of Health and Human Services now supports self-collected vaginal samples for cervical cancer screening. This means some women can collect their own sample instead of having a pelvic exam. The Health Resources and Services Administration says this option should be offered to women ages 30 to 65 who are at average risk.
Women ages 21 to 29 should still have Pap smears every three years.The new guidelines recommend an HPV test every five years for women ages 30 to 65. Pap smears are still available, but they are no longer the main test for this age group.
These updates matter because they make screening easier, more comfortable, and more affordable. Insurance plans will be required to cover these tests.
Cervical cancer screening saves lives. Staying up to date with research helps us do it better—for our patients today and for the future.
One common question I hear is: What are the benefits of combination hormonal birth control during perimenopause?
Perimenopause is the time before menopause, when hormone levels change and periods can become irregular. Even though fertility is lower, pregnancy can still happen. Combination hormonal contraceptives—birth control that contains both estrogen and progesterone—can be very helpful during this stage of life.
One major benefit is relief from vasomotor symptoms, like hot flashes and night sweats. If you or your loved one is perimenopausal, you can appreciate how disruptive hot flashes and night sweats are. These vasomotor symptoms happen when estrogen levels go up and down. Combination birth control provides steady hormones, which helps calm these symptoms and improve daily comfort.
Another benefit is that combination hormonal contraceptives help make irregular vaginal bleeding regular. Many women in perimenopause have periods that come too often, too far apart, or without warning. Birth control pills can help make periods more predictable and manageable.
Some women experience very heavy bleeding that feels like flooding or gushing. Combination oral contraceptive pills and progesterone-releasing IUDs are both very effective at treating heavy menstrual bleeding. For many women, bleeding becomes much lighter or even stops completely.
Bone health is also very important during perimenopause. Combination oral contraceptive pills can increase bone mineral density in this age group. A large Swedish study found that women who used birth control pills—especially for many years and during their 40s—had a lower risk of hip fractures after menopause. This benefit is long lasting.
Combination oral contraceptives also have important non-birth-control benefits. They significantly lower the risk of endometrial (uterine) cancer and ovarian cancer. The protection against ovarian cancer is especially strong and can last for up to 40 years after stopping the pill.
Another advantage is flexibility. Women using combination birth control pills can choose when and how often to have a period. Some pill packs are made to allow a period every three months. Others use a standard 28-day pack, and women can skip the placebo pills to skip a period that month. Vaginal contraceptive rings, which also contain estrogen and progesterone, can be used continuously for 28 days without a ring-free week to skip periods as well.
Many women ask how long they can safely stay on combination birth control. If contraception is not needed, such as when a partner is female or has had a vasectomy, pills are often stopped around age 50, and menopausal hormone therapy can be discussed. For women who still need pregnancy prevention, combination birth control can often be continued until age 52 or even 55. By age 55, about 90% of women have reached menopause.
Blood tests are not helpful during perimenopause. Hormone levels change day to day. A test may look high one day and low the next, which can be confusing and misleading. I do not get lab tests if the results are not something that I can address effectively.
Finally, progesterone (levonorgestrel) IUDs are especially helpful during perimenopause. They provide reliable birth control, reduce or stop bleeding, and make it easier to use estrogen safely to treat perimenopausal or postmenopausal symptoms.
Perimenopause can be challenging, but the right treatment can make this time healthier, more comfortable, and easier to manage. I am a Menopause Society–certified provider, and I see patients at 745 West Moana Lane in Reno, Nevada. Call 775 657 2025 for an appointment with me.
I recently attended a lecture about birth control needs for women in perimenopause. Perimenopause is characterized by wide hormone fluctuations and irregular menstrual cycles for 5 or more years preceding and lasts until 12 months of no-bleeding has been achieved. Perimenopause is the time periods may come closer together, farther apart, heavier, lighter, or stop and start again. How frustrating! Even though fertility goes down during this time, pregnancy can still happen.
As women get closer to their final menstrual period, ovulation happens less often. But it does not stop right away. This means pregnancy is still possible until menopause (one year after spontaneous menstrual period) is reached. Studies show that fertility rates change with age. At age 40, about 83% of women can still become pregnant. At age 45, this drops to 45%. By age 50, fertility is lower, but still present, at about 10%.
Pregnancy later in life also carries higher risks. For every 1,000 women age 50 and older who have a live birth, 230 will have an induced abortion. Only teenagers have a higher abortion rate. Women of older reproductive age are also seven times more likely to die from pregnancy-related causes compared to adolescents. Because of these risks, effective birth control is very important during perimenopause.
Many women can safely use combined hormonal birth control, which contains both estrogen and progesterone. This includes combination birth control pills. These are safe for women who do not have certain medical conditions. Examples of conditions where combined birth control should not be used include uncontrolled high blood pressure, history of venous thromboembolism, tobacco use with age 35 or older, or migraines with visual symptoms called aura.
In healthy, nonsmoking women without high-risk conditions, combined hormonal birth control can usually be continued until age 50 to 55.
If a woman has a contraindication to estrogen-containing contraception or heart or blood vessel risk factors, progesterone-only birth control is often a better choice. Options include progesterone-only daily pills, the Depo-Provera shot given every 12 weeks, the Nexplanon implant placed in the arm for up to three years, or an intrauterine device (IUD), which can last up to ten years depending on the type.
It is important to know that combination birth control pills do not increase the risk of breast cancer. They also have added benefits during perimenopause. Because they contain estrogen and progesterone, they can help reduce hot flashes and night sweats, which are common during this stage of life.
Some women in perimenopause have very heavy periods that feel like flooding or gushing. Combination birth control pills and progesterone-releasing IUDs are both very effective at treating heavy menstrual bleeding. Another benefit of combination birth control pills is that they can help maintain or increase bone strength, which becomes more important as women age.
Perimenopause can be a confusing time, but with the right birth control choice, women can protect their health, prevent unplanned pregnancy, and feel better during this transition. Seek out a healthcare professional to help you navigate this journey. If you are in Northern Nevada, I am a Menopause Society certified provider and you can see me at 745 West Moana in Reno! Call 775 657 2025 for an appointment.
One important CDC-recommended adult vaccines is Shingrix. Shingles is caused by the same virus that causes chickenpox. After you’ve had chickenpox, the virus stays asleep in your nerves and can “wake up” years later, causing a painful rash, nerve damage, and can cause long-term nerve pain in the distribution the rash was in (even AFTER the rash goes away). This is called postherpetic neuralgia.
The good news is that there’s a safe and highly effective vaccine that was approved by the FDA in 2017. I have seen patients who have zinging pain in the distribution that there rash WAS even years after their rash goes away. I got my Shingrix the week I turned 50. Getting the vaccine lowers the risk of postherpetic neuralgia dramatically—and new research shows it may even protect your brain. That sounds like a win-win to me.
CDC Guidelines: Who Should Get Shingrix?
According to the CDC, almost all adults 50 years and older should receive the shingles vaccine. The schedule is simple:
Two doses, given 2 months or more apart,
Recommended for adults 50 and older, even if you’ve had shingles before or are unsure whether you had chickenpox.
Adults with weakened immune systems may start the vaccine at age 19 and may receive the two doses 1 to 2 months apart. Shingrix is over 90% effective at preventing shingles and long-term nerve pain.
Immunodeficiency and immunosuppression are NOT contraindications to Shingrix. In fact, Shingrix is specifically indicated for adults aged 18 years and older who are or will be at increased risk of herpes zoster due to immunodeficiency or immunosuppression caused by known disease or therapy. In fact, Shingrix differs from the previous shingles vaccine (Zostavax) which is a live attenuated zoster vaccine, which should not be given to immunocompromised patients.
Shingrix may cause side effects for 2-3 days after the administration. These side effects include injection site pain (78%), myalgia (45%), fatigue (45%), headache (38%), injection site redness (38%), shivering (27%), injection site swelling (26%), fever (21%), and gastrointestinal symptoms (17%). Hang in there! It’s better than long-term nerve pain.
New Research: Shingles Vaccine May Lower Dementia Risk
Beyond protecting against shingles, the vaccine may have another surprising benefit: lowering the risk of dementia.
A large study reported earlier this year showed that getting the shingles vaccine reduced the risk of developing dementia by 20% over seven years. This was an exciting finding, but researchers have now gone even further. A major follow-up study published in Cell adds new insight into how the vaccine may help the brain.
Here’s what the scientists discovered:
Cognitively healthy adults who received the vaccine were less likely to develop mild cognitive impairment, a common early warning sign before dementia.
People who already had dementia seemed to benefit as well. Those who received the shingles vaccine were almost 30% less likely to die of dementia over nine years, suggesting the vaccine may help slow the disease’s progression.
While the exact reason isn’t fully understood, the idea is that reducing inflammation from shingles may also reduce harmful inflammation in the brain.
We now know that HPV (human papillomavirus) causes many different cancers. The HPV vaccine which is given to most preteens at 11-12 years of age can be given up to age 45. Studies have shown that patients view HPV vaccine as a vaccine and not as a license to perform risky sexual behavior. HPV is a very common virus that spreads through skin-to-skin contact. Most adults will get HPV at some point.
Approximately 150 HPV types have been identified, with at least 40 infecting the genital area. These are categorized into two main groups based on their clinical manifestations:
Oncogenic (high-risk) HPV types, particularly HPV 16 and 18, cause the majority of:
Cervical cancer and precancers
Penile cancer
Vulvar cancer
Vaginal cancer
Anal cancer
Oropharyngeal cancer
Persistent oncogenic HPV infection is the strongest risk factor for development of these HPV-attributable precancers and cancers. If HPV is contracted when in the teens or early 20s the body often fights it off and this is not considered “persistent.” The vaccine helps the individual patient NOT contract the HPV types that cause cancer.
Low-risk HPV types, particularly HPV 6 and 11, cause:
Genital warts (condylomata acuminata)
Let’s break down what this means in simple terms.
What Did the New Research Show?
Two huge reviews looked at more than 160,000 people in clinical trials and over 132 million people in real-world studies. That is some of the strongest evidence we ever get in medicine. Here is what the studies found:
The HPV vaccine is very safe.
It works extremely well at preventing HPV infections.
It stops most precancerous changes in the cervix.
It lowers the chance of getting genital warts.
Girls who got vaccinated before age 16 had an 80% lower chance of cervical cancer later in life.
This is a very big deal. An 80% drop in cancer risk is one of the strongest cancer-prevention results we have seen for any vaccine.
How Does the Vaccine Help With Pap Tests?
The HPV vaccine also lowers the number of abnormal Pap test results. These are the results that make us call you back for more testing. Studies show:
Vaccinated women have 36–64% fewer abnormal Pap tests than unvaccinated women.
Getting all three doses gives the best protection. Of note, only TWO doses needed if the first dose is given BEFORE age 15.
In one U.S. group, women had 52% fewer abnormal Pap tests after one dose and 77% fewer after three doses.
Girls who got vaccinated at ages 11–14 had a 64–73% lower risk of abnormal cells later.
What About Real-World Results in the U.S.?
Since the HPV vaccine became available, the United States has seen a 77% drop in early cervical precancers caused by HPV types 16 and 18 in women ages 20–24. This age group has the highest vaccination rates, and we are seeing huge benefits.
Why I Recommend HPV Vaccination
As your family doctor, I want you and your family to stay healthy for the long run. The HPV vaccine is one of the best tools we have to prevent cancer. It works best when given at ages 11–12, but older teens and young adults can still get it.
Can Probiotics Help Prevent Urinary Tract Infections in Premenopausal Women?
Urinary tract infections, or UTIs, are very common in women. Some women get UTIs over and over, even when they drink plenty of water and try to stay healthy. Because of this, many people ask if probiotics can help. Probiotics are “good bacteria” that can support the body in different ways.
New research gives us some helpful clues, but also shows that we still have more to learn.
What Are Probiotics?
Probiotics are healthy bacteria that can be taken in a pill or placed in the vagina. Many probiotic products contain a type of bacteria called Lactobacillus. This is the same kind of bacteria that normally lives in the vagina and helps keep harmful germs away. Did you know that the vagina has a lower bacterial load and fewer bacterial species compared to the mouth?!
What Recent Studies Show
Some recent high-quality studies found encouraging results:
Probiotics can lower the number of UTIs in premenopausal women.
Women who took vaginal probiotics had fewer UTIs than women who took only oral probiotics.
Using vaginal probiotics alone helped just as much as using both vaginal and oral probiotics together.
Vaginal probiotics may also be less expensive and less invasive overall.
These results suggest that vaginal probiotics may help women who get UTIs often, especially if other methods have not worked.
What We Still Don’t Know
Even though some studies look promising, many others show mixed results. Here is why:
Studies use many different probiotic strains, so it is hard to know which one is best.
Sample sizes are often small.
Doses and schedules vary a lot.
Not all studies agree on how much probiotics help.
Because of these differences, experts say that we cannot make strong, one-size-fits-all recommendations yet.
Are Probiotics Safe?
Yes. Most probiotics are safe and well-tolerated. Side effects are usually mild and rare. But we still do not know the best dose, how long to take them, or which exact strains work best.
Some research also suggests that probiotics may work even better when combined with cranberry or D-mannose, but the evidence for these combinations is not strong enough to be recommended as standard care.
The Bottom Line
Vaginal probiotics may help reduce repeated UTIs in premenopausal women. They seem to work better than oral probiotics alone and may be the simplest and most affordable option. But we still need larger, stronger studies before doctors can give firm recommendations.
If you get frequent UTIs, talk with your doctor before starting probiotics. I hope this helps.
Dr. Leslie Greenberg's Blog 
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