Menopause/Sexual Health/HRT

Hormone Replacement Therapy (HRT) involves treating women with systemic estradiol, which is a type of estrogen, and progesterone for perimenopausal and menopausal symptoms. These symptoms include sexual dysfunction, vaginal dryness, hot flushes, night sweats, insomnia, and mood changes. HRT comes in transdermal (through the skin) applications such as a patch, gel, spray, or vaginal ring, and also comes in oral forms.

The current medical guidelines for starting a woman on HRT are: if she feels that her symptoms are intolerable, she is a candidate to start HRT. The goal is to be on the lowest dose for the shortest period of time. HRT has many benefits, but also has possible side effects and risks.

  1. Vaginal estradiol is used to improve vaginal and vulvar thinning that can cause dryness and pain with sexual activity. It also helps to maintain normal pH balance, which can in turn help prevent vaginal and urinary tract infections. Vaginal estradiol comes in different forms that are placed on the vulva or in the vagina: cream, tablets, or a ring. It has a localized effect and is not used as systemic HRT.
  2. Testosterone supplementation is for women with sexual complaints, specifically low libido and arousal issues, who have low testosterone blood levels. Testosterone can be applied transdermally or taken orally.
  3. ThermiVa is a non-hormonal and non-surgical treatment that uses radiofrequency to gently heat vulvar and vaginal tissue to improve blood flow and elasticity, which in turn improves lubrication and orgasm.
  4. Flibanserin is a FDA approved oral medication for premenopausal women who have hypoactive (low) sexual desire disorder. Flibanserin works on a woman’s brain to balance neurotransmitters and restore normal sexual desire. It is recommended to not consume alcohol while taking this medication, as this can cause a significant drop in blood pressure.
  5. Pelvic floor physical therapy can treat the tight muscles of the pelvic floor and local massage with vibrators/dilators or wands can help improve relaxation and blood flow to the area.
  6. Psychological therapy, including couples therapy and sex therapy, is important to help women address barriers to sexual wellness, and for partners to have similar relationship and sexual goals.
  7. Lubricants can be helpful for ease of sexual penetration, and can increase sensation and ability to achieve orgasm.
  8. Zestra is an over-the-counter, topically applied blend of botanical oils and extracts that helps to increase genital sensation.
  9. Education about current modifiable risk factors (such as a possible change of medication), sexual response and anatomy, foreplay and sexual positions, and use of sexual aides.
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