Can Probiotics Help Prevent Urinary Tract Infections in Premenopausal Women?

Posted on December 2, 2025 by drlesliegreenberg

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.

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A New Option for Hot Flashes: Elinzanetant (Lynkuet)

Posted on November 25, 2025 by drlesliegreenberg

I have some exciting news for women going through menopause: a new medicine called Elinzanetant has just been approved by the FDA to help treat hot flashes and night sweats. It is expected to be available November 2025 with an average wholesale price of $12.50 per pill. We will need to wait for pharmacy pricing and insurance rules for coverage.

This approval was announced right before new safety data were presented, and the audience—mostly doctors and researchers—broke into applause. Why? Because this medicine offers relief for women who can’t or don’t want to take hormones.

What Is Elinzanetant?

Elinzanetant (brand name Lynkuet) is a non-hormonal pill taken orally once a day. It is approved for women who have moderate to severe hot flashes and night sweats caused by menopause, including those who have had breast cancer or who are on endocrine (hormone-blocking) therapy.

It works in the thermoregulatory zone of the brain—the area that controls body temperature. During menopause, this zone becomes extra sensitive to changes in estrogen. Elinzanetant helps calm those signals.

It does this by blocking two types of receptors in the brain—called neurokinin-1 (NK-1) and neurokinin-3 (NK-3) receptors. Blocking both seems to give stronger, faster relief than blocking one alone.

How Well Does It Work?

In large clinical trials, called OASIS-1 and OASIS-2, women who took 120 mg of Elinzanetant daily had fewer and milder hot flashes within just one week. Improvements continued through six months of use.

Women also slept better and said their quality of life improved. On average, women in the studies had more than 50 hot flashes per week, so the results were meaningful and life-changing.

Studies also show that Elinzanetant may help even more than another non-hormonal option, fezolinetant (Veozah), which blocks only the NK-3 receptor.

Is It Safe?

Elinzanetant has been shown to be well tolerated. The most common side effects were headache (10% of patients), fatigue (7% of patients), and sleepiness (5% of patients). No serious liver problems or hormone-related side effects were reported.

Because it is non-hormonal, this medicine is a great choice for women who cannot use estrogen—such as those with a history of breast cancer or blood clots.

The Bottom Line

Elinzanetant (Lynkuet) is a new, once-daily, non-hormonal pill that offers real relief for hot flashes, night sweats, and poor sleep during menopause.

If you’re struggling with these symptoms, talk to your doctor about whether Lynkuet might be right for you. You don’t have to suffer in silence—help is here, and it’s safe.

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The FDA Is Removing the Black Box Warning From Estrogen Products: What This Means for Women

Posted on November 18, 2025 by drlesliegreenberg

In 2002, the Women’s Health Initiative (WHI) study reported increased risks of breast cancer, blood clots, stroke, and heart disease in women taking combined estrogen + progestin. The media coverage was intense, and many women stopped hormone therapy overnight. In response, the FDA issued a boxed (black box) warning in 2003 for all systemic estrogen products (pills, patches, gels, sprays, and rings).For many years, estrogen medicines used for hot flashes and night sweats have carried a black box warning. A black box warning is the strongest safety warning the FDA puts on a medication. This warning caused worry for many women and their physicians, and many avoided treatment even when their symptoms were affecting sleep, mood, work, and quality of life.

November 2025 the FDA announced that it will remove the black box warning from estrogen-containing menopausal hormone therapy products. This includes more than 20 pills, patches, and creams used to help with menopause symptoms such as hot flashes, night sweats, and vaginal dryness.

Why the Warning Is Changing

Newer research has shown something important:
Hormone therapy is safest and most helpful when it is started within 10 years of menopause, or before age 60.

Studies show that for many women in this age window, estrogen may actually have long-term health benefits, including:

  • Better sleep
  • Fewer hot flashes and night sweats
  • Improved bone health
  • Better quality of life

The older warning did not reflect this newer science. It was based on older studies that included many women who were more than 10 years past menopause, which is a time when the risks are higher. The updated labels will give more age-specific guidance to help women and doctors make informed decisions.

What This Means for Women

The removal of the black box warning does not mean hormone therapy is right for everyone. It means:

  • Decisions should be individualized
  • Benefits and risks should be discussed based on age, health history and risk factors, and symptoms
  • Women in early menopause may have more benefit from menopausal hormonal therapy and lower risk from hormone therapy compared to women who start it many years later

Women with a history of breast cancer, blood clots, stroke, or certain other medical conditions will still need careful evaluation.

The Bottom Line

This change is a major step forward in women’s health. It recognizes what many menopause specialists and newer research have shown:
For the right woman, at the right time, hormone therapy can be safe, effective, and life-changing. Additionally, there are non-hormonal options for women who have contraindications to systemic estrogen.

If you are struggling with hot flashes, sleep disruption, or other menopause symptoms, please reach out. We can talk together about whether hormone therapy may be a safe and helpful option for you.

I hope this helps.

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A Healthy Mouth Can Protect your Heart and Blood Sugar

Posted on November 11, 2025 by drlesliegreenberg

As a family doctor I believes that good health starts with the basics—what we eat, how we move, and yes, how we care for our teeth and gums. I ask every patient at their wellness visit who they see for their eye and dental care. The mouth is important. (And, who wants to go blind?!)

You may not realize it, but the health of your mouth can have a major impact on your heart and your blood sugar. Scientists have found strong links between gum disease and serious conditions such as heart disease, stroke, and diabetes.

What the Research Shows

A recent study found that people with gum disease and cavities had an 86 percent higher risk of stroke. Even those with gum disease alone were 44 percent more likely to have a stroke.

Large studies involving millions of people have found the same pattern. People with gum disease have about a 24 percent higher risk of serious heart problems such as heart attack or stroke, and a 31 percent higher chance of dying early from any cause.

These findings tell us that brushing, flossing, and seeing your dentist regularly are not just about keeping a bright smile—they can truly help save your life.

Why Gum Health Matters

Your gums are filled with tiny blood vessels. When gums become infected or swollen, germs and inflammation can enter the bloodstream. This can damage blood vessels, increase blood pressure, and make blood clots more likely—all of which raise the chances of heart attack and stroke.

Gum disease and diabetes also affect each other in both directions. People with diabetes are two to three times more likely to develop gum disease, and gum infections can make blood sugar harder to control. Treating gum disease can even lower blood sugar by about 0.3 to 0.4 percent, which makes a meaningful difference over time.

How to Keep Your Mouth and Body Healthy

  1. Brush twice a day with fluoride toothpaste.
  2. Floss daily to remove plaque between teeth.
  3. Visit your dentist at least twice a year.
  4. Do not smoke or vape; both damage gums and blood vessels.
  5. Eat plenty of fruits, vegetables, and whole grains while limiting sugar.
  6. If you have diabetes, keep your blood sugar under control and tell your dentist.

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Why So Many Women Don’t Ask for Help with Menopause — And Why They Should

Posted on November 4, 2025 by drlesliegreenberg

What Is Menopause?

Menopause is a natural part of aging. It usually happens between ages 45 and 60, when a woman’s ovaries stop making as much estrogen and periods stop. The definition of menopause is one year after the last menstrual period.

This change can bring a lot of body and mood changes — some mild, some pretty uncomfortable.

What a New Study Found

A large study from the Mayo Clinic looked at almost 5,000 women aged 45–60 and asked about their menopause symptoms and whether they got help.

Here’s what they found:

  • Over 80% (more than 4 out of 5) did not seek medical help.
  • About one-third said their symptoms were moderate to very bad.
  • Most common problems were:
    • Trouble sleeping (55%)
    • Weight gain (52%)
    • Changes with sex or vaginal dryness (43%)
    • Feeling tired or worn out (40%)
    • Achy joints and muscles (37%)

Even though many women were struggling, only 28% were getting treatment. Most said they were managing on their own (65%), and some were too busy to see a doctor (37%).

Why So Many Women Don’t Seek Care

It’s easy to understand why:

  • Many think menopause is “just part of life.”
  • Some feel embarrassed to talk about hot flashes, mood changes, or sex.
  • Others are busy caring for kids, parents, or work — and put themselves last.
  • Some have heard confusing or scary stories about hormone therapy.

But here’s the truth: you don’t have to suffer.

What Doctors Can Help With

As your family doctor, I can:

  • Explain what’s normal and what might need attention.
  • Offer safe treatments such as lifestyle steps, non-hormonal options, or menopausal hormone treatment if appropriate.
  • Check for other causes of tiredness, weight changes, or mood shifts. Thyroid labs may be ordered to confirm that it is not the root issue.
  • Help you sleep better and keep bones and heart healthy.

Simple Ways to Start Feeling Better

Even before seeing a doctor, small steps can help:

  • Stay active. Walking, stretching, and light weights help energy and bones.
  • Eat colorful foods. Fruits, vegetables, lean proteins, and whole grains support hormones.
  • Limit alcohol and caffeine. They can worsen hot flashes.
  • Sleep hygiene. Go to bed at the same time each night; keep the room cool.
  • Mind care. Deep breathing, journaling, or talking with friends can reduce stress.

If symptoms still bother you, that’s the time to check in. You deserve to feel good in your body again.

Let’s Change the Story Together

Menopause shouldn’t be a silent struggle.
If you are losing sleep, feeling unlike yourself, or just unsure what’s normal, please reach out. You’ve spent years taking care of everyone else — now it’s time to take care of you.

I see patients at University Health 745 West Moana in Reno, NV. To make an appointment call 775 657 2025.

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Understanding Menopause Health Disparities

Posted on October 23, 2025 by drlesliegreenberg

I am loving the part of my practice where I care for peri- and menopausal women. I am acutely aware that every woman’s menopause experience is different.

While menopause happens to all women, the way it feels can be very different from person to person. Studies show that women of color often start menopause earlier and go through a longer perimenopausal transition. For example, Latina and Black women report more hot flashes, mood changes, and trouble sleeping. Asian women tend to have fewer or milder symptoms. These differences are not only about biology—they also come from things like genetics, where someone lives, culture, and access to healthcare.

Menopause doesn’t happen by itself. It’s part of a woman’s life story. Things like money, stress, culture, and even the air she breathes can all make a difference. Women with lower incomes or less access to good housing, healthy food, and doctors may start menopause earlier and have stronger symptoms. They may also have higher risks for heart problems. Women who speak little English or have trouble understanding health information can also face challenges, since most menopause materials are written only in English.

Being an immigrant can make things harder too. Many immigrant women in the U.S. can’t easily get the care they need. Research shows that the longer they live in the U.S., the more stress, sadness, and sleep problems they may experience. Racism, discrimination, and trauma add to these problems. Black women often face more stress and unfair treatment but are less likely to get help for hot flashes, depression, or high blood pressure.

Habits and environment matter too. Eating a lot of junk food, not getting enough sleep, or smoking can make menopause symptoms worse. Not being active can lead to tiredness and mood changes. People who live in areas with little green space or more pollution often go through menopause earlier and have more health issues. These patterns reflect long-standing inequalities in race, money, and city planning.

A woman’s health and reproductive history also play a role. Starting periods early, having fewer pregnancies, or not breastfeeding can lead to earlier menopause. Getting regular checkups and having insurance can help women get treatments that ease symptoms. Women without insurance often have stronger symptoms and fewer options.

Doctors can help by listening and showing care. Menopause is a chance for women and their doctors to work together—talking openly about symptoms, needs, and choices. Teaching both patients and doctors about menopause, culture, and bias helps make care fairer and more personal.

In the end, menopause care should fit each woman. Understanding how race, culture, environment, and stress affect menopause helps doctors give better, kinder care. Every woman’s story matters, and every doctor visit is a chance to close the gap in menopause health.

I am seeing Menopause patients at our University Health office in Reno, Nevada. Call 775 657 2025 for an appointment with me.

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Testosterone therapy for women: What you should know

Posted on September 17, 2025 by drlesliegreenberg

I am a 30-year board-certified physician and Menopause Society certified physician. A lot of my patients are asking about testosterone…

When people think of testosterone, they often think of it as a “male hormone.” But women also make small amounts of testosterone, and it plays a role in energy, mood, and sexual health. Some doctors and patients wonder if giving testosterone to women could help with certain health problems. The American College of Obstetricians and Gynecologists (ACOG), a group of doctors who are experts in women’s health, has clear rules about when and how testosterone should be used. Let’s break down what they say in a way that is easy to understand.

When is testosterone used for women?

According to ACOG, testosterone therapy should only be used in women who have gone through menopause and who are struggling with something called hypoactive sexual desire disorder (HSDD). HSDD is when a woman has very little or no interest in sex, and it causes her stress or problems in her life. Before starting treatment, women should be carefully checked by a doctor and evaluated for other conditions. Estrogen vaginal cream can help with vaginal dryness and pain with intercourse. Pelvic floor physical therapy can also help with physical sexual issues. Patients are then advised about the risks, since the long-term effects of testosterone therapy in women are not fully known. Some side effects from testosterone are male-pattern hairloss, dark facial hair, cliteromegaly, and anger issues.

Is there an FDA-approved testosterone for women?

Right now, there is no FDA-approved testosterone medicine made just for women in the United States. This means that if a woman needs testosterone, medicines made for men can be prescribed in a dose 1/10 the male dose or have a pharmacy make a special version, called a compounded medicine. But these choices can be tricky. The dose may be too high, or the medicine may not absorb well, which can cause side effects. That’s why caution and close follow up is needed.

What about other uses for testosterone?

Some people wonder if testosterone might help with things like stronger bones, sharper thinking, or better energy. But ACOG does not recommend testosterone for these purposes. They also do not support using DHEA (a hormone supplement) for sexual symptoms, except in its approved vaginal form.

How is testosterone given?

Doctors usually recommend a low dose of testosterone, just enough to bring levels back to what they would normally be in younger women. This might look like a compounded cream with a pea-sized amount rubbed into the skin on the ankle.

Oral (pill) forms are not recommended because they can cause bad cholesterol changes and don’t absorb well. The exact dose should be personalized, and doctors adjust it based on lab tests and how the patient feels.

What about lab tests?

Lab tests are an important part of therapy, but ACOG says that a blood testosterone level alone cannot diagnose HSDD. Instead, the diagnosis is based on symptoms and a full evaluation.

  • Testosterone levels are checked at 3–6 weeks after starting treatment.
  • After that, tests are done every 6 months
  • The goal is that testosterone levels stay in a safe range (20–80 ng/dL).

When to stop?

If a woman does not see any benefit after 6 months, or if she has any side effects, therapy should be stopped. The goal is always to use the lowest dose for the shortest time that helps.

The bottom line

Testosterone therapy for women is not a “one-size-fits-all” solution. It is only recommended for certain postmenopausal women with HSDD, and it requires careful monitoring by a doctor. Safety always comes first, and ongoing follow-up is key to making sure the treatment helps without causing harm.

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Kratom: What is it? And, lots of other details….

Posted on September 10, 2025 by drlesliegreenberg

I attended a medical student presentation recently and learned some interesting facts about kratom.

What is it?
Kratom is a natural substance derived from the Mitragyna speciosa tree, native to Southeast Asia. Its main active compound is 7-hydroxymitragynine (7-OH), an opioid. In 2020, about 2.1 million people in the U.S. reported using kratom. It is more commonly used by adults than adolescents, and more by men than women. Some individuals try it to manage opioid withdrawal, and it is sold in smoke shops and convenience stores without a prescription.

Why use kratom?
Kratom has been used for centuries in religious ceremonies, social rituals, and as a visitor gift. At low doses, it can act as a mild stimulant; at higher doses, it produces pain relief and euphoria. Use often escalates over time. A 2020 study reported that 90% of users take it for pain relief, 60% for anxiety, 40% for opioid withdrawal, and 25% for depressive symptoms.

Legal status
Kratom’s legality varies by state. In 2016, the DEA proposed classifying it as a Schedule I substance, but this did not pass. In 2018, the FDA categorized kratom as an opioid. The Kratom Consumer Protection Act (2019) aimed to provide consumer safeguards, but regulations differ widely. In Nevada, buyers must be 18 or older. More than 10 states have no protections, and 6 states have outright bans.

Forms
Kratom is available as powdered leaves, capsules, teas, extracts, gummies, or even ice cream. It contains 25 alkaloids, with four responsible for most effects. Traditionally, leaves were chewed. Red vein kratom has the highest mitragynine content with strong opioid effects. Green strains are more associated with pain relief, while white strains fall in between.

How does it work?
Mitragynine binds to mu-opioid receptors, similar to morphine or heroin but in a slightly different manner. Naloxone (Narcan) may be less effective for kratom overdoses compared to traditional opioids.

How long does it work?
Effects begin within 1–2 hours, and the half-life is about 23 hours, so it may remain in the system for more than a day. Kratom does not appear on routine urine drug screens.

Side effects
Kratom decreases GI motility, leading to constipation and nausea. By affecting serotonin receptors, it can cause euphoria but also dizziness. Reported risks include liver injury, seizures, coma, lung or cardiac complications, and in pregnancy, neonatal withdrawal. Contamination with heavy metals or additives has also been documented. Physicians may be unaware of a patient’s use unless specifically disclosed.

Patterns of use
A local Reno physician notes that typical users are 20–40-year-old white males self-treating fentanyl or heroin dependence. Many spend large sums on kratom and may dose every hour to control symptoms.

Kratom use disorder and withdrawal
Stopping kratom can be difficult. Withdrawal begins 12–48 hours after cessation and lasts 1–3 days. Symptoms include aggression, irritability, restlessness, nervousness, mood swings, delusions, lethargy, insomnia, hot flashes, GI upset, hepatitis, and cardiac arrhythmias. Some patients require hospital admission for safe withdrawal. Always tell your doctor if you use kratom—include the dose, frequency, and duration.

Important note
Kratom should not be used to treat opioid withdrawal. Far safer and more effective medications exist to support recovery from opioid use disorder.

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Posted on September 3, 2025 by drlesliegreenberg

Sometimes I am asked by patients “What should I do with medication that I no longer need?” I tell them that pharmacies have specific days that they accept medications back.

That time is soon! National Prescription Fall Take Back Day Announced

When? On October 25, 2025 the DEA and its federal partners will team up for the 19th bi-annual National Prescription Drug Take Back Day!

How? Find a pharmacy near you at https://www.dea.gov/takebackday

Why is this important? National Prescription Drug Take Back Day is a vital opportunity to safely dispose of unused or expired medications. Keeping leftover prescriptions at home increases the risk of accidental ingestion, misuse, or abuse, especially among children and teens. Flushing medications or throwing them in the trash can harm the environment, contaminating water supplies and wildlife. Returning drugs to a pharmacy or official collection site ensures they are destroyed responsibly, protecting your family and community. By participating, you help reduce the opioid crisis, prevent accidental poisonings, and keep our environment healthier. Safe disposal truly saves lives.

I hope this helps.

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Breast Cancer Screening: What you need to know

Posted on August 19, 2025 by drlesliegreenberg

Breast Cancer Screening: What You Need to KnowBreast cancer is one of the most common cancers in women. Finding it early can save lives. A mammogram is a special kind of X-ray that can show changes in breast tissue before you or your doctor can feel them.

https:flickr.com/photos/seniwati/3179821198

When to Get a Mammogram

The American Family Physician guidelines say most women who are at average risk for breast cancer should start talking to their doctor about mammograms between ages 40 and 50. For many women, screening every two years from ages 50 to 74 is recommended. If you are younger but have a higher risk, your doctor may suggest starting sooner or having mammograms more often.

Why Screening Matters

A mammogram can find breast cancer early, when it is small and easier to treat. Early treatment often means less aggressive care and a better chance of recovery. Mammograms can sometimes find changes that are not cancer, so follow-up tests may be needed.

Who Is at Higher Risk?

You may have a higher risk for breast cancer if:

  • You have a close family member (mother, sister, or daughter) who had breast cancer.
  • You have certain genetic changes, like BRCA1 or BRCA2.
  • You had breast cancer before.

No cost BRCA1 and BRCA2 Genetic Screening in Northern Nevada

The Healthy Nevada Project offers no cost genetic screening for BRCA1 and BRCA2 to patients in Northern Nevada. These genes help protect you from cancer, but if they have harmful mutations/changes, your risk for breast and ovarian cancer is much higher. Knowing your genetic status can help you and your doctor make a plan for screening and prevention.

If you live in Nevada, you can sign up online at https://healthynv.org/  The test is a simple saliva sample or blood test, and your results are confidential.

I hope this helps.

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