His and Her Health

Does anyone have experience with finding the right balance of estrogen, progesterone, and testosterone for post-menopause HRT? My new doctor has taken me off synthetic hormones and put me on bio-identicals, with the units of est/progest/test being 1.5/1/2. Oddly, I'm having trouble staying lubricated during sex, which wasn't a problem on the synthetic hormones, and I also seem to have lower libido. The doc had tested my hormone levels before prescribing anything and found that my testosterone levels were way below normal, even with the synthetic methyltestosterone I'd been on. Now I'm wondering if 2 units of the bio-identical testosterone is enough. How do you go about finding the right balance? I've been on this new formulation for a month. (In case it's important, the estrogen and testosterone are creams, and progesterone is administered orally.)

Red Hot Mamas expert, Dr. Mache Seibel has some advice below. Hope it helps!

Finding the right balance of hormones is a very individualized process. Every shoe doesn't fit a persons foot and every hormone dose and ratio also must be "fitted".

If you were happy on the synthetic HT you were taking, consider going back on it. If one has a uterus, they must take both progesterone and estrogen to prevent the uterine lining from developing uterine cancer. Sometimes testosterone isn't needed, even if the values are low. If libido is good, estrogen and progesterone might be all that is necessary.

If there is a problem with vaginal dryness, consider an over the counter medication called Replens. Use daily for one week then twice weekly. If that is not working (and it will about 80+ percent of the time) then adding a vaginal estrogen might do the trick. but going back to what was originally prescribed might be the surest bet.

FYI- Red Hot Mamas shares information with Menopause Minute readers about testosterone therapy and sexual desire. It looks like several testosterone products are under FDA investigation right now and might be available shortly. Here is the article: http://www.redhotmamas.org/newsletters/newsletter_200806.htm#A1

The progressive loss of estrogen, which happens through the menopause transition, unfortunately tends to cause increasing problems with vaginal dryness. Usage of the vagina by regular sexual activity does tend to promote more pelvic blood flow, so the old adage "use it or lose it' does have some truth to it. There are short acting lubricants which are sold over the counter which may be helpful. However if your atrophic changes are more bothersome after using these products, along with the medication your doctor has prescribed, you should talk to your doctor about treating you with standard therapies, prescription drugs (notably estradiol and conjugated equine estrogens) which are sold in a tube and used with an applicator and are applied intravaginally before bedtime. Your doctor, probably will adjust use of the creams according
to your symptomatology. The pros and cons of prescribed therapies should be discussed with your doctor.There are other products also available by prescription, a silicone ring which provides a slow release of estrogen to the vaginal mucosa. This ring remains in place for 3 months and you can change it yourself. It's very unobtrusive. There are also small tablets of estadiol which can help withatrophic symptoms. Again, these tablets are placed in vagina at bedtime. Some women, even while using these prescribed products, will still require extra lubrication, and products like Replens, Astroglide, KY, all work well for addtional lubrication. As far as the libido issue is concerned, most women who are having pain with sex as a result of vaginal atrophic symptoms, will surely not want to have sex. So, first off, you must talk to your doctor about resolving the dryness issue, then discuss libido and other medical issues which may be going on, i.e., thyroid issues, as well as other medications you are using, which may, or may be not, creating libido issues. Also, make sure you are in touch with good compounding pharmacies, and discuss with this pharmacy, what products they typically prepare for dryness and libido issues. Most compounding pharmacies will be willing to discuss this with you and many women find it helpful to give them a call. I do hope this information is helpful and that you will continue to write to us to let us know how you are doing. Good luck, and I look forward to hearing from you again.