Dr. Berman Answers Your Sex Questions

You talked a little on The Oprah Show about vaginal dryness. I know I am in premenopause. Is there anything I can take to make me less dry? I always thought if I could somehow find which unbalanced hormones I am missing everything would be ok. Or could it be something else like a chemical inbalance? I don't want to have to use a cream every time. 
— pucksgma 

So many of you are asking, so let's talk about some of the sexual symptoms of perimenopause and menopause. As I discussed on the show, most women start going through perimenopause in late 30s to early 40s and it lasts through menopause, occuring on average around age 51. Women who have had chemotherapy or women who have had their ovaries removed also go through what's called "surgical" or "medical menopause." 

Symptoms of perimenopause include some sleeplessness, moodiness, dryness and low libido. This is all due to dropping hormones. A woman in her 60s has half the testosterone that a woman in her 20s has and it slowly declines throughout our life span. So around the perimenopause, testosterone levels will often be getting low enough to see some of the effects: low energy, low zest for life, difficulty reaching orgasm, low genital and/or nipple sensation (or irritating sensation), and low desire. Also don't forget that chronic stress and hormonal contraceptives can also do a number on your testosterone levels as well. As estrogen starts to drop, women experience dryness as well as loss of pelvic floor tone and thinning/shrinking of the vaginal walls and even the clitoris and labia. 

Now what to do? First of all, you need to get your hormone levels checked. I encourage all women to do this, especially if they are happy with the way they feel and their sex lives because each woman's hormonal needs are as unique as her fingerprint. It can be so helpful to have a baseline to use later if/when you start to have symptoms so that if you consider hormone therapy you'll know what to shoot for. 

Ask your doctor for a full hormonal profile including total and free testosterone. You have to ask specifically for these. Based on your results and your individual history and risk factors you can talk to your doctor about the options. Many doctors are moving toward bioidentical hormones, not only because they are made from natural sources, but that they are processed in your body in an "identical" way to the way your natural hormones are processed. There is some science, but not enough, looking at long term studies of the safety of bioidentical hormones versus "synthetic" hormones. The bottom line is that most doctors agree that if you are going to take hormones it is best to take the lowest possible dose for the shortest amount of time and I think this is why so many prescribing physicians appreciate bioidentical hormones because they can be compounded in a dose specific way. You can then start on the lowest possible dose and work your way up until your symptoms improve. Ultimately it's an individual decision you must make with your doctor. But make sure your doctor is at least open to working with you. Many doctors just unequivocally refuse to prescribe any hormones, but there are many who do so on a case by case basis. These are the ones you will want to seek out.