Pellet Hormone Replacement FAQ

We know that Hormone Replacement Therapy is essential for managing severe menopause (or “manopause!”) symptoms, and hopefully there is an easy way to deliver it, right? Fortunately, there is! IntimMedicine offers an easy outpatient procedure to place a bioidentical hormone pellet under the skin. Outta sight, outta mind, and you get to start living your life again!

What is it?

Pellets are compounded bioidentical hormones for women (our team of experts will determine exactly what’s right for you – the right amount can help you regain your hormonal balance). Pellet therapy is actually FDA approved for men, as well. Pellets are typically naturally occurring hormones that are pressed into a solid, little insert, about the size of a grain of rice.

How does it work?

Your pellet will release a small amount of your hormonal regimen straight into your bloodstream, similar to what your ovaries or testes would normally have produced in your younger years. Research shows that pellets are able to deliver a consistent level of hormones to your body, unlike some creams, gels, or pills which are also compounded. Pellets also reduce the risk of blood clots (venous thrombosis) associated with oral hormone replacement therapy because the hormones released from pellets enter the bloodstream directly and do not cause changes in blood clotting factors made in the liver the way oral medications can. It’s a win-win!

How is it used?

Hormone Replacement Pellets are used like any other Hormone Replacement Therapy to help our bodies regain some of its hormonal balance, which will improve everything from the emotional roller coaster to hot flashes. The pellet is just a convenient delivery method! It’s not for everyone, but getting your hormones “just right” no matter the method is critical.

How long does the procedure take?

It is a quick and painless (with numbing medication) outpatient office procedure. We will insert the HRT pellet right into your hip, abdomen or buttock area, and you’ll be on your way and back to your life!

How long till I see results?

It will only take 7-10 days for you to notice your HRT Pellet working on your symptoms.

How long will my pellet last?

HRT Pellets typically last 3-6 months for men and women.

How can I make an appointment? Call us at 202.293.1000 or email us to set up a consultation appointment with one of our specialists here in Washington, DC. Don’t wait to get back to living your normal life – call us today!

Let's talk about IT - MonaLisa Touch

Let’s Talk About IT

Introducing MonaLisa Touch, a groundbreaking vaginal treatment for menopausal women.

“IT” is vaginal discomforts, including dryness, burning, itching, and painful sex, all which fall under the umbrella term, “vaginal atrophy.” Vaginal atrophy can occur after vaginal childbirth and/or during menopause. Around 40% of menopausal women suffer from vaginal atrophy, but these women rarely talk to their gynecologists about it. If you’re one of them, it is time to stop suffering in silence and get back to enjoying your sex life!

We at IntimMedicine Specialists are very happy to offer you a vaginal laser procedure called MonaLisa Touch from our office here in Washington, DC. MonaLisa Touch is a painless and minimally invasive therapy that requires 1-3 treatments over the course of a few months. We know you have questions – we have answers!

Who is MonaLisa Touch for?

MonaLisa Touch is for any woman who wants to prevent or treat vaginal symptoms related to a decrease in estrogen, which can occur during menopause, after childbirth during breast feeding, or after many different cancer treatments, especially following breast cancer. If you are looking for a treatment that does not require hormones or surgery, MonaLisa Touch might be your answer!

How does MonaLisa Touch work?

MonaLisa Touch is a laser treatment that reactivates the production of collagen and rebalances the conditions of the superficial vaginal tissues. It does this by gently acting on the vaginal walls. This is a safe and painless process that only takes a few minutes.

Does it hurt?

MonaLisa Touch is completely painless! Patients have reported feeling a slight vibration, and some say that it feels no different than getting a pap smear. For extremely sensitive patients, a form of “Novocaine” can be topically applied without injections to eliminate any discomfort of the procedure.

How long is the recovery, and how long does it take to start working?

We recommend refraining from vaginal intercourse for 3-4 days after each treatment, but you’ll start to notice a positive difference almost right away! More treatments may be recommended depending on the severity of symptoms, but typically 3 sessions are needed for best results.

How long does the treatment last?

Treatments can last for at least a year, depending on the severity of symptoms and your age and lifestyle. We can revisit the need for additional treatment sessions with you after a year or if symptoms recur.

We can help you restore your vivacity! If MonaLisa Touch vaginal therapy sounds right for you, give us a call at 202.293.1000 or email us to make an appointment for a consultation at IntimMedicine in Washington, DC.

Congratulations to the New ISSWSH President

The International Society for the Study of Women’s Sexual Health (ISSWSH.org), the preeminent organization focusing on the biopsychosocial aspects of women’s sexuality, welcomes Dr. James A. Simon, M.D., Clinical Professor of Obstetrics and Gynecology at The George Washington University School of Medicine in Washington D.C., as its new president.

Dr. Simon’s goals for his two-year term presidency include doubling the ISSWSH membership by expanding the knowledge of physicians (gynecologists, urologists, internists, and other primary care givers), advanced practice nurses (nurse practitioners, midwives, etc.), physician assistants, mental health providers (e.g., psychiatrists, psychologists, psychiatric social workers, certified sexual health counselors and educators), and pelvic floor physical therapists in the oft-neglected field of sexual medicine, a discipline with similar quality of life impact as arthritis, chronic obstructive pulmonary disease, asthma, and irritable bowel syndrome. Further, Dr. Simon vows to pressure the FDA into removing sexually discriminatory barriers to the development of new medications focused on improving women’s sexual health.

Dr. Simon served most recently as the president-elect of ISSWSH. He is also a past president of the North American Menopause Society, and The Washington Gynecological Society.

Dr. Simon is a prolific clinical researcher, holding distinctions for his involvement in reproductive endocrinology and infertility, the earliest advancements of in vitro fertilization, menopause, osteoporosis, and sexual medicine. Dr. Simon’s research has been supported by more than 360 research grants and scholarships from a wide range of sponsors, including the National Institutes of Health, The American Heart Association, The Heinz Foundation and the pharmaceutical industry. He is an author or a co-author of more than 550 peer-reviewed articles, chapters, textbooks, abstracts, and other publications, including several prize-winning papers. Dr. Simon is coauthor of the paperback book “Restore Yourself: A Woman’s Guide to Reviving Her Sexual Desire and Passion for Life.” A short list of his other honors and achievements includes being selected to “Top Washington Physicians,” “America’s Top Obstetricians and Gynecologists,” and “The Best Doctors in America.” Dr. Simon and his care team continue to treat patients from all around the world in his private practice in Washington, D.C.

Have questions regarding medical or women’s sexual health issues? Contact his office at (202) 293-1000.


 
 

For media/speaking inquiries, contact:
Nancy Rose Senich
Rose4Results.com (Agency)
Phone/Text: 1-202-262-6996
Email: nancy@rose4results.com

Personalized Care

Any medical treatment should be considered specific to the needs and hormone concentrations of each individual patient. This is why we share our full breadth of knowledge about endocrinology, medical safety, and treatment efficacy in addition to treating gynecologic function and overall wellness.

 

So we were dismayed to read that the U.S. Preventive Services Task Force (USPSTF) final recommendation statement on the use of menopausal hormone therapy in post-menopausal women, citing health risks such as breast cancer, heart attack, dementia, and stroke. The key words are post-menopausal. The USPSTF recommendations did not address the overwhelming evidence that hormone therapy (HT) greatly benefits women who are going through the menopausal transition (aka with menopausal symptoms) and who do not have additional health problems. The USPSTF again failed to highlight the population of women who need hormones the most and are most likely to benefit from taking them (see Part 1 of this two-part blog). We can agree with their statement that women who START on their hormone therapy when they are older than 60, or more than 10 years following their last menstrual period, shouldn’t use hormones for the prevention of most diseases. But it doesn’t apply for the women a decade younger; that is, the patient population most often experiencing the symptoms that need treatment (hot flashes, night sweats, vaginal dryness, painful intercourse, mood swings, etc.). The safest time to use HT is during the so-called “estrogen window,” which is the decade-long time-frame between the ages of 50 and 60, or 10 years from the time of menopause (where menopause is defined as the start of at least 12 consecutive months menstrual period-free.

 

Hormone Therapy (HT) Is Effective for Hot Flashes, Night Sweats, and More

The North American Menopause Society’s most recent position statement (2017) concludes that HT remains the most effective (italics are mine) treatment for hot flashes and night sweats and the genitourinary syndrome of menopause (vaginal atrophy, painful intercourse, recurrent urinary tract infections, etc.), and it has been shown to prevent bone loss and fractures (osteoporosis). The risks of HT differ depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen or progesterone is used. Treatment should be individualized to identify the most appropriate HT type, dose, formulation, route of administration, and duration of use, using the best available evidence to maximize benefits and minimize risks. Also, check-ups with each patient during this time to evaluate benefit should be ongoing.

 

Where the Women’s Health Initiative (WHI) Erred

The WHI hormone studies have increasingly come under fire for the way they were designed, most importantly for the inclusion of women up to age 79, and results reported as if all women are the same. The results of these studies have reverberated through the medical community, causing changes that may have been both too broadly applied and, in some cases, simply incorrect (see commentary by David. L. Katz, MD, MPH, FACPM, FACP on such overgeneralizations. The findings that hormone therapy was putting many women at risk for conditions like breast cancer and cardiovascular conditions caused many women to go off their hormone-replacement therapy “cold turkey” without knowing how to address the consequences and not fully understanding the risks versus rewards. For example, some of the patients in the WHI study were already at increased risk for cancer or cardiovascular disease because of lifelong smoking, being overweight and the age at which they started hormone therapy (> 60 years, and up to age 79). However, otherwise healthy women should be able to use these therapies to ward off the symptoms that affect sleep, mood, sexual health, pleasure, etc.

 

We’ve Done Our Homework

In wanting to help my patients find effective ways to treat their symptoms, I analyzed a database of 13 million patients to investigate whether two forms of estrogen therapy (oral versus transdermal) differed in how patients experienced negative effects, particularly focusing on heart attacks, strokes and deep vein thromboses (blood clots in the veins) (see: Simon JA, Laliberté F, Duh MS, Pilon D, Kahler KH, Nyirady J, Davis PJ, Lefebvre P. Venous thromboembolism and cardiovascular disease complications in menopausal women using transdermal versus oral estrogen therapy. Menopause. 2016 Jun; 23(6): 600-10). I concluded that patients who used transdermal estrogens had significantly fewer blood clots in their veins, pulmonary emboli, and heart attacks than those who took an oral estrogen (i.e., pills). Stroke risks were also slightly lower for transdermal estrogen users.

 

I used this information to hypothesize just how different the WHI results would have been had that study used transdermal estradiol and micronized progesterone (see: Simon JA. What if the Women’s Health Initiative had used transdermal estradiol and oral progesterone instead? Menopause. 2014 Jul; 21(7): 769-83.). Those investigations showed that HT type, dose, formulation, route of administration, and duration of use can be tailored to maximize benefits while reducing or eliminating risks. “One size doesn’t fit all,” as the USPSTF suggested.

 

Key Points

  • HT benefits in early menopausal women include reduced coronary heart disease and all-cause mortality.
  • Randomized trials in women initiating HT after age 60 have shown benefit primarily for osteoporosis and fracture but overall increased harm.
  • Reassessment of clinical trials in women initiating HT treatment close to the onset of menopause and newer studies and meta-analyses now show benefit and rare risks.
  • More studies show benefit with estrogen alone than with estrogen plus progestogen.
  • No available medication except HT has demonstrated prevention of osteoporotic fractures in women not previously identified as having osteoporosis.
  • The effects of reduced cardiovascular disease and mortality in women initiating therapy around menopause (the “estrogen window”), and the beneficial effects of HT on the skeleton at any age, together suggest a role for hormone-replacement therapy in disease prevention.

 

Stop Suffering, Start Living

Please contact our office at (202) 293-1000, and make an appointment to get your questions answered and determine the best course of HT treatment that is specifically tailored to you.

We unequivocally support the use of menopausal hormone therapy to mitigate menopause symptoms and prevent disease for a variety of patients. Let’s review the facts of the case. THIS IS NOT FAKE NEWS!

 

When our institutions fail us, it’s time to openly and directly say so. No, this is not a political rant. I’m talking about the United States Preventative Services Task Force (USPSTF), a well-meaning, highly educated group of 12 so-called experts (no endocrinologists, no reproductive endocrinologists, and no menopausal specialists), consisting of two pediatricians, a PhD specialist in health management and public policy, four internists, four family physicians, and our token Ob/Gyn (who isn’t a menopause or hormone therapy expert). Yes, this is the same group (some different players) who recommended every-other-year mammography — and you may remember the backlash and public outcry over that suggestion. (FYI, the major organizations in women’s healthcare didn’t accept that recommendation.)

 

Well, this group is at it again, this time over postmenopausal hormone therapy. Last month (December 2017), the group gave a “D” recommendation for the use of postmenopausal hormone replacement therapy for disease prevention in both naturally menopausal women and women who have had a hysterectomy. A “D” recommendation means: recommends against the use of combined estrogen and progestin (in women with a uterus) or estrogen alone (in women who had a hysterectomy) for the primary prevention of chronic conditions in postmenopausal women. You can read their recommendations for yourself.

 

So, what happened? First, let’s be clear. Experts looking at the same scientific information can disagree on its meaning. But that’s not what happened here. I know this because a real group of menopause and hormone therapy experts replied to the draft recommendations of the USPSTF, attempting to explain the errors of their draft recommendations (see: Langer RD, Simon JA, Pines A, Lobo RA, Hodis HN, Pickar JH, Archer DF, Sarrel PM, Utian WH. Menopausal hormone therapy for primary prevention: Why the USPSTF is wrong. Menopause. 2017 Oct; 24 (10):1101-1112. doi: 10.1097/GME.0000000000000983., Or Langer RD, Simon JA, Pines A, Lobo RA, Hodis HN, Pickar JH, Archer DF, Sarrel PM, Utian WH. Menopausal hormone therapy for primary prevention: Why the USPSTF is wrong. Climacteric. 2017 Oct; 20(5): 402-413. doi: 10.1080/13697137.2017.1362156. Epub 2017 Aug. 14.).

 

These two publications are essentially the same. One was meant for the U.S. audience of menopause and hormone therapy experts, the other for the international menopause and hormone therapy audience. These same recommendations were sent to and received by the USPSTF during their comment period. Nothing from our suggestions was incorporated into the USPSTF documents. One conclusion could be that the USPSTF didn’t care, they had their minds made up, and no amount of scientific information was going to change their opinion. That’s not what happened, in my opinion.

 

The USPSTF opted to do two things to support their forgone conclusions:

  1. They so severely limited the evidence they were willing to consider that they made their judgement based only on the evidence in support of their opinion
  2. They made simplified judgments to apply to every menopausal woman as if they were all the same.

 

This first tactic is prime territory for every lawyer. You define the evidence in such a limiting way as to exclude all evidence not in support of your client. The USPSTF, by excluding so much of the scientific information available, was left with only a few important studies … the usual suspects, the Women’s Health Initiative (WHI) being so large and all encompassing, that it overwhelmed any analysis of the other studies considered.

 

The second tactic, treating all menopausal women as if they were the same, fits well into tactic 1, since the WHI Investigators initially reported on their study “overall” (Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J; Writing Group for the Women’s Health Initiative Investigators. JAMA. 2002 Jul 17; 288(3): 321-33.), lumping together women aged 50 through 79 as if they were all the same. And that was 15 years ago (prehistoric in scientific years).

 

These two errors in judgment are elegantly summarized by David. L. Katz, MD, MPH, FACPM, FACP who published another paper showing that NOT taking estrogen therapy following a hysterectomy actually resulted in a minimum of 18,601 — and as many as 91,610 postmenopausal women — dying prematurely because of the avoidance of estrogen therapy (ET) over a 10-year span, starting in 2002. Prevention of death is what I would call the ultimate prevention of disease. (See: The mortality toll of estrogen avoidance: an analysis of excess deaths among hysterectomized women aged 50 to 59 years. Sarrel PM, Njike VY, Vinante V, Katz DL. Am J Public Health. 2013 Sep;103(9):1583-8. doi: 10.2105/AJPH.2013.301295. Epub 2013 Jul 18.)

The symptoms of menopause are numerous and we now know that a large part of women’s working memory is affected by menopause. Memory is affected by both the levels of hormones and their fluctuations. As a result, researchers are looking for ways to mitigate memory problems. Thankfully, we are more aware of this risk as more treatments are studied to help women stay as sharp as they were in their pre-menopausal days.

Memory Decline Offset by Estradiol Therapy
A recent study published in the prestigious Journal of Clinical Endocrinology & Metabolism suggests that postmenopausal women who were prescribed estradiol therapy (ET) had better cognition than those who did not take the medication over the course of the study. Estradiol is a naturally occurring, sometimes called “bioidentical” form of estrogen. The research team used word tests to see how patients would be able to recall words at the ends of a sentence during times of stress or no stress, and with or without estradiol.

It should be noted that the 49 women on the study were not already taking any other medications that could affect working memory (e.g., antidepressants, amphetamines, etc.) so that the results would be directly related to taking ET versus the control group, and the women did not have any co-morbid medical conditions such as cardiovascular problems that could have an effect (likely adverse) on the results of the study.

Age, Stress and Working Memory
It’s that “tip of the tongue” phenomenon, when you know a person’s face but not her name, or you know exactly what you want to say but are grasping for the key word to help the sentence make sense. A friend once forgot the word for the season “winter” and said, “You know, a time of snow,” in exasperation when the word escaped her in a moment of poetic forgetfulness.

Cognitive decline as we age is common, but perhaps it doesn’t have to be as fast, or as permanent, and maybe it can even be reversed. Aging has been associated with dysfunction in parts of the brain in response to stress. Such dysfunction can have a snowball effect when people experience chronic stress along with aging and estrogen deficiency. Taken together such circumstances can lead to additional memory problems as well as related health implications.

Although the current study was small, its findings have significant implications, and could benefit from a repeat with a larger patient population. The research team concluded that ET provides relief from menopause-related symptoms, including limiting the effects of stress on working memory. This is good news at a time in history when memory issues appear to be common among the older population. Anything to keep brains as strong as bodies as people enter the third of life, is most welcome. The bottom line is this: estrogen replacement therapy can reduce the stress response, and its “downstream” adverse effect on memory. However, it remains unclear whether such hormonal interventions can fully mitigate the effects of stress on cognition. Further study will help us gain a clearer understanding of just how best to protect memory in postmenopausal women.

Upon hearing a cancer diagnosis a person’s world changes immediately and forever. The person becomes a patient. The patient has to make myriad decisions about treatment plans, and the possibility of surgery, radiation, and chemotherapy. These treatments, while life-saving, are also life-altering. The side effects can modify body image, reduce or end fertility, change sexual identity and sexual function. Approximately 60 percent of cancer survivors have long-term sexual dysfunction. Oncology teams (who may focus more on the life-saving aspects of care) aren’t always taking the time to discuss fertility or sexual health matters as much as they should. But the good news is that our practice can help save a women’s eggs, or a man’s sperm for future use; mitigate and reverse most hormonal changes, and starting in September, we will also offer treatment for men with urological or sexual complaints in our practice. Our newest colleague, Rachel S. Rubin, MD, is specially trained to treat hormonal and sexual dysfunction in both men and women.

Talking about sexual health outside of the bedroom, in the office of a compassionate physician is key to holistic wellness. The emotions of being a cancer survivor can be overwhelming in and of themselves, but to add infertility or sexual dysfunction to the list of health issues can be daunting. We’re here to help you get back on track.

For Men
Following prostate cancer treatment, for example, the ability to have and maintain an erection becomes difficult and for some men, impossible, without help from a medical practice such as ours. Many men may not feel comfortable talking about these intimate issues, but there is help. Our compassionate and caring staff can help men who experiene treatable symptoms. It’s not just about physical symptoms, cancer affects sexual identity and when men are unable to perform as they could prior to cancer treatment, it can have a serious and detrimental effect on one’s psyche. Getting the courage to seek help is the first step to getting back to the “new normal.”

For Women
Breast cancer, when surgery is required, may alter a woman’s body and can hinder sexual identity and function. Breasts, once part of the sexual experience for both partners, are no longer the same. Even when reconstructed, the breasts may feel different, lack the pleasurable sensitivity they once had, or might even be painful and distracting. Sensation might even be completely gone. Partners may also feel hindered by the feeling of the new breasts. This can be uncomfortable for both partners. With any cancer treatment (i.e. chemotherapy, surgical removal of the ovaries or even hysterectomy) a patient may find herself in early/premature menopause with hot flashes, night sweats, disturbed sleep and weight gain. This is also accompanied by vaginal dryness, and pain with genital touching or intercourse. There are options to help enhance the sexual experience that we have available at the office, and that are not available anywhere else.

A wonderful Newsweek article about these issues does a deeper dive from both the patient and physician perspective that we welcome you to read for additional information.

If you are just starting cancer treatment, going through it, or are in the post-treatment phase and are facing future or current fertility concerns, hormonal deficiencies, or sexual dysfunction, we can help. Please call our office at (202) 293-1000 to make an appointment with one of our caring and compassionate members of Dr. James A Simon’s team.

If you’re in the New York City area on April 7-9, 2017 join me and colleagues at the The Westin NY at Times Square for our annual Survival Skills for Today’s Gynecologist program. It’s a great time to catch up with friends and hear discussions about the latest in gynecologic patient care. Each day starts with breakfast and includes time for Q&A to deepen the knowledge-share among us.

Along with Steven R. Goldstein, MD who serves with me as Program Co-Director, we have a terrific faculty who will present on leading-edge therapies and topical issues. You might be interested in the most recent recommendations about cervical cancer screening or are wanting more information about HPV education, VVA treatment, hysterectomy procedures, urogynecology, and much more.

On Friday, I will discuss the following topics:

  • Menopausal Hormone Therapy: Primary Prevention of Disease or Not?
  • Office Management of Female Sexual Dysfunction: You CAN do this.
  • Flashes, Flushes, and Night Sweats: New and Non-Hormonal Approaches

My topic for Saturday is Pelvic Floor Biofeedback/Physical Therapy: Should I Offer This in My Office?

The treatment of our patient population is ever-changing, as new treatments and options become available. The business of medicine is changing too. Don’t miss this great CME opportunity, learn some Survival Skills, and thrive in the years to come.

View the entire course or to Register at www.WorldClassCME.com or by phone at (888) 207-9105, M-F 8:30 am – 5 pm EST

Hope to see you there!

The phases of a cancer diagnosis might be compared with those of dealing with the death of a loved one: denial, bargaining, anger, and eventually acceptance. Fortunately for many, there IS life after cancer. A sexual life too, that part of one’s life may have been put on the back-burner during cancer treatment. The statistics on survivorship are astounding, creating a “before” and “after” picture for many.  It is important to understand both of them. Progression-free survival rates indicate no new tumors have formed. Whereas disease-free survival rates refer to remission, cancer free. The death rate from breast cancer has fallen 34% since 1991. Following the grueling chemotherapy, radiation, and/or surgery, it might not immediately occur to patients and their partners to re-connect through sexual activity.  I would encourage you or anyone you know in the survivorship phase, however, to make it a priority. Absent sexual activity, all genital tissues (skin, mucus membranes, and muscles), suffer from disuse atrophy. The good news is this: with the intention to connect or reconnect with your partner, and the use of various products available (if necessary), solutions to sexual activity may result in your “new normal.” Your body image, to the degree it suffered during cancer treatment may need a boost and a re-boot. A renewed sexual life can often help.

Sexual Healing
Whether due to cancer, certain medications that interfere with sexual response such as antidepressants, or menopause, sexual response changes during a lifetime. Menopause can be a premature consequence of cancer treatment. Both chemotherapy and pelvic radiation can result in menopause regardless of a woman’s age. Lubricants and vaginal moisturizers are readily available, but I caution you to look at the ingredients, as some may be irritants to those delicate tissues. Ingredients such as those found in spermicides, benzyl alcohol, and materials such as latex can cause discomfort for some.

With the sudden onset of menopause from surgery, radiation or chemotherapy, many women find that they experience intense vaginal dryness, and pain with sex (usually at the time of penetration). To mitigate this issue, vaginal moisturizers which are used on a routine basis whether one is having sex or not, can help to bring water into the vagina. Think about vaginal moisturizers like the moisturizer you use on your skin…you don’t just apply it when you are getting your picture taken. You use it on a regular basis. And lubricants (they aren’t the same as moisturizers) which come in oil, silicone, water-based, and mixtures of each of these can solve the dryness and lack of natural lubrication missing after some cancer treatments. Lubricants are used at the time one is having sex. They help the vagina operate as it once did naturally, and can make sexual activity more pleasurable by easing friction and lessening pain.

Enhance Sexual Pleasure
The marketplace has been flooded with sex-positive devices to enhance the sexual experience for both men and women. Toys, vibrators, dildos, and much more have piqued the curiosity of people who want to try something new. A medically accurate fantastic and friendly site middlesexmd.com/ can help educate you and your partner about new products, techniques and “tools” to keep your sensual side smoldering. Our office stocks a variety of such sexual aids and can help with proper selection, especially when sexual function is hampered. Keeping an open and honest discussion with your partner about your needs and interests, as they change in the “new normal” can alleviate anxiety and further build on a relationship that has endured and surpassed, the diagnosis of cancer. Get personal. Have fun. Explore.
To learn more please call the office at (202)293-1000 or email the practice at info@intimmedicine.com.

healthy middle aged woman stretching outdoors

In different ways, cultures around the world celebrate when young girls become women around the time of their first menstrual period, but few celebrate the milestone of menopause. Why is that? Perhaps because we focus on the negative aspects of menopause, the effects that leave some women experiencing hot flashes at inopportune moments, and so we view this process in a negative light. But it can be perceived and experienced positively, according to medical experts.

Understanding Study Outcomes
As clinical professor of obstetrics and gynecology at the George Washington University in Washington, DC, and a Past President of the North American Menopause Society (NAMS) I’ve studied these issues closely. I revisited the menopausal hormone therapy research in the Women’s Health Initiative (WHI) first reported in 2002, which was loosely translated to mean that all forms of estrogen, and all types of progesterone were risky for all women, always. But when looking more closely at the patient population in that study, it showed that some of the women were already at high risk health issues and underlying disease.

“Be aware that the findings for the two WHI hormone studies should not be compared directly because of differences in the women’s characteristics at the time of their enrollment. For example, those in the estrogen-alone study had a higher risk of cardiovascular disease than those in the estrogen-plus-progestin study. Women in the estrogen-alone study were more likely to have such heart disease risk factors as high blood pressure, high blood cholesterol, diabetes, and obesity,” according to the National Institutes of Health (NIH).

Mitigating Symptoms
In wanting to help my patients find helpful ways to treat their symptoms, I analyzed a database of 13 million patients to investigate whether two forms of estrogen (oral versus transdermal) differed in how patients experienced negative side effects, particularly focusing on heart attack, stroke and deep vein thrombosis (blood clots in the veins). I concluded that patients who used transdermal estrogens had significantly fewer: blood clots in their veins, pulmonary emboli, and heart attacks than those who took an oral estrogen pill. Stroke risks were also slightly lower for transdermal estrogens.

“The women who were using transdermal estrogens had a lower risk of blood clots in the legs deep vein thrombosis (DVT), had a lower risk of pulmonary embolism—those blood clots in the legs traveling up to the lungs—and a decreased risk of heart attacks” I said in a video on My Menopause Mag, run by Editor Mache Seibel, MD., former 20-year veteran of Harvard Medical School faculty. I caution though, that patients who are at risk for blood clots may need to talk with their doctor to weigh the benefits versus the risks of all estrogen therapies.

Questions to Ask Your Doctor

  • When does menopause begin?
  • How long does it last?
  • Should I take hormones?
  • What kind of hormones should I take and for how long?

Available Resources
Great online resources such as this website help educate women to know more about how menopause effects the whole person and how to navigate this new time in life.

“Women don’t learn about menopause until they are going through it. I think if we as young women know about it and understand it, then we’ll be much more equipped.” from the trailer for the movie, “Hot Flash Havoc” available on local PBS stations. I have a cameo appearance.

In addition, this website:  www.mymenopausemag.com answer a lot of these questions women have, understanding that there is no one-size-fits-all model for making the transition.

Understanding Perimenopausal Symptoms
Women commonly experience the following perimenopause symptoms:

  • Hot flashes
  • Lower sex drive
  • Irregular periods
  • Difficulty sleeping
  • Mood swings
  • And many others

Many of these symptoms often continue into menopause. Women in menopause may also experience:

  • Vaginal dryness
  • Urinary problems, including incontinence and/or urgency
  • Night sweats
  • Weight gain and slowing metabolism
  • Thinning hair
  • Loss of breast fullness
  • And others

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