Great Sex, Naturally (25 page)

If you’re seeking relief from menopausal symptoms, including low libido, you want to begin with the gentlest, weakest, and most conservative measures you can, and gradually move to stronger treatments only if needed. Like some women, you may have low libido but sufficient or borderline hormone levels. These gentle approaches may effectively reduce or eliminate your symptoms, and you may never need any other treatment.

Conventional doctors often jump to the conclusion that if you have menopausal symptoms and a lowered sex drive, you need hormone replacement therapy, largely because their training doesn’t adequately prepare them to explore your other options. Hormone replacement therapy has far more potential side effects than other approaches, and it’s preferable for your overall health and sexuality if you can avoid them. The following are your best “first line of defense” options for treating menopausal symptoms naturally and gently:

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Black cohosh.
The herb black cohosh has long been used to alleviate symptoms associated with menopause, including hot flashes, night sweats, depression, and (as you saw earlier in this book) vaginal atrophy and dryness. Research shows that black cohosh is safe and can be taken for an extended period of time, or until it’s no longer necessary for controlling midlife symptoms. It reduces hot flashes by affecting your estrogen receptors, but doesn’t actually increase your estrogen level; this makes it a good choice if you have a family history, or personal history, of estrogen-related cancer. A study published in the journal
Gynecological Endocrinology
in 2011 found that black cohosh can also help menopausal women who take the drug tamoxifen (often prescribed after breast-cancer diagnoses to prevent future recurrences). Tamoxifen can aggravate menopausal symptoms, but women who took black cohosh in addition had fewer hot flashes, less anxiety, and improved sleep. The recommended dose of black cohosh for reducing symptoms of menopause is 80 mg taken twice daily.

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Maca.
A powerful Peruvian herb, maca contains plant sterols that have the ability to strengthen your entire hormonal system. Maca is effective in treating menopausal symptoms of hot flashes, night sweats, and insomnia because it can stimulate your glands to increase their production of estrogen and other hormones—which makes it a valuable alternative to hormone replacement therapy. Maca has other benefits as well: it supports your adrenal glands, helps lower your stress-hormone level, and increases your sex drive. (It also increases male libido, as you’ll discover later in this book.) The recommended dose for menopausal symptoms is 1,000 mg twice daily.

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Da Bu Yin.
Da Bu Yin is one of the best Chinese herbal formulas for treating menopausal symptoms related to a deficiency of yin, which typically include night sweats, insomnia, hot flashes, anxiety, and increased thirst. The herbs in Da Bu Yin have been used for thousands of years and have no known side effects. The recommended dose of one Da Bu Yin product, called Great Yin (see
Appendix C
), is two to three pills three times daily.

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Two Immortals.
Also known as
Er Xian Tang
, Two Immortals is another traditional Chinese herbal formula for treating menopausal symptoms. It helps to boost libido, balance hormones, relieve hot flashes, and reduce irregular menstrual bleeding and cramping during the years leading up to menopause. It’s made by many companies; dosages vary, so follow the recommendation on the product label. (see
Appendix C
for supplier information.)

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Vitamin E.
You can help reduce hot flashes by taking vitamin E; the recommended dose is 400 to 800 IU daily. (Take with caution if you’re on blood-thinning medication.)

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Soy.
As a food high in plant hormones, or phytoestrogens, soy can have certain hormone-like effects on your body. Ample research shows that women who consume higher amounts of soy foods experience milder midlife symptoms.

Balancing Your Hormones and Sexuality with Hormone Replacement Therapy

If you’ve exhausted the possibilities for treatment with herbs, nutritional support, and foods, and still experience menopausal symptoms that compromise your health and sexuality, you may benefit from hormone replacement therapy. Supplementing your body with the right hormones can help restore your hormonal balance, libido, and sexual enthusiasm, and keep your vulva and vagina hydrated. It can also support your immune system, bones, and connective tissues, and by improving your moods, increase your sense of well-being and receptiveness to pleasure.

Whenever possible, you want to use natural bioidentical hormones rather than conventional synthetic hormones, and use the smallest amounts necessary to achieve the desired effects. Natural bioidentical hormones are considered safer than conventional synthetic hormones because they’re derived from plant sources and have a chemical structure that’s the same as the hormones your body produces over the course of your lifetime (hence the term
bioidentical
). Synthetic hormones can lead to health problems because they rely on forms of hormones structurally very different from those your body naturally makes.

Natural bioidentical hormones are becoming more widely available to help women with menopausal symptoms and low libido—thanks in large part to the alarming results of the 2002 Women’s Health Initiative, a long-term study sponsored by the National Institutes of Health that focused on strategies for preventing heart disease, breast cancer, osteoporosis, and colorectal cancer in postmenopausal women. The study showed that conventional hormone replacement therapy can increase your risk for heart disease, stroke, and breast cancer. When these findings were released, many women chose to throw out their conventional hormone prescriptions and suffer the consequences of abrupt mood changes, reduced sex drive, hot flashes, night sweats, insomnia, and other symptoms.

Since then, increasing numbers of women have turned to herbal remedies to ease their symptoms, or sought out natural bioidentical hormone replacement therapy. Research on natural bioidentical hormones has surged, and the growing consensus among experts is that they may be safer for many women. According to a 2009 article in the journal
Postgraduate Medicine
, “data and clinical outcomes demonstrate that bioidentical hormones are associated with lower risks, including the risk of breast cancer and cardiovascular disease, and are more efficacious than their synthetic and animal-derived counterparts.” But even though natural bioidentical hormones have become holistically minded doctors’ preferred method of hormone replacement therapy, conventional physicians may still encourage you to use synthetic hormones for menopausal symptoms, and especially for decreased libido.

The Women’s Health Initiative found that it was women who took Provera and Premarin—at the time the most popular conventional progesterone and estrogen prescriptions for menopausal symptoms—who were at increased risk for dire health consequences. Provera is synthetic and not bioidentical. Premarin, the most well-studied hormone used in conventional hormone replacement therapy, is considered by some to be seminatural—a questionable claim, because it contains 4 to 8 percent horse hormones—and it’s certainly not bioidentical. (It may be natural and bioidentical for a horse, but not for
you
. Even though Premarin is derived from another mammal, it contains more than 200 different compounds foreign to your cells. Plant-derived hormones, by contrast, contain natural hormone-like substances that are chemically altered in a laboratory to yield compounds identical to the hormones a woman produces in her body.)

Perhaps it was inevitable that trying to trick Mother Nature with synthetic forms of such powerful substances as hormones would eventually backfire. Many women have similarly put their health on the line by taking synthetic hormones in another form—as birth-control pills. Some take them for their entire reproductive lives, even though it has never been clearly established if their long-term use is safe. Birth-control pills, which contain estrogen and progesterone, interfere with a woman’s natural hormone production, suppress ovulation, and can have many other undesirable effects. Some women experience strokes or high blood pressure while taking them, and others develop liver tumors. They may also change the viscosity of your bile, which can lead to the formation of gallstones or have other adverse affects on your gallbladder, resulting in sporadic episodes of painful nausea and vomiting. (For information on natural birth-control methods, see
Appendix H
.)

The hidden risks of synthetic hormones make natural alternatives all the more attractive. Your options for using natural bioidentical hormones to treat menopausal symptoms and enhance your sexuality have improved considerably since 2002. Today you have many effective choices at your fingertips for taking natural bioidentical estrogen, progesterone, DHEA, and testosterone. You may benefit from using one of them separately, or a combination of several of them. Let’s explore your options for therapy with each one:

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Natural bioidentical estrogen.
The two primary estrogens in your body, as outlined in
Appendix E
, are
estradiol
and
estrone
, which converts into
estriol
. Estradiol is the strongest-acting estrogen, and predominant in young women; estrone is weaker than estradiol, and predominant in postmenopausal women. Estriol, which is much weaker than either estradiol or estrone, is the predominant estrogen for supporting and hydrating your vulva and vagina.

As you’ve discovered, estrogen can have a wealth of benefits for your sexuality and health. At the same time, researchers have found that estrogen can increase your risk of certain cancers, especially in the breasts and uterus. How could something normally so beneficial play a role in such health-compromising conditions? To help answer this question, and understand more about the role of estrogen in your health, it’s worth looking at why cancer happens.

Although the ultimate causes may be mysterious, many researchers agree that a person who gets cancer has an immune system that isn’t working as well as it should. Your body produces cancer cells every day, but the powerful surveillance system of your immune cells renders them harmless and unable to multiply and turn into cancerous conditions. This is why you can help prevent cancer with everything you discovered earlier in this book about keeping your immune system in peak form.

Some authorities on the subject of hormones and cancer—including Jonathan Wright, M.D., who helped popularize bioidentical hormones—believe that estrogen doesn’t cause cancer but can act as fuel to a fire if the cancer is estrogen-sensitive. On the other hand, if taking hormones makes you healthier by improving your sleep and your ability to cope with stress, it may help keep your immune system strong, resilient, and able to ward off any type of cancer. And in recent years research has shown that estriol, which is safer than estradiol and estrone, has protective effects against breast cancer.

Your decision as to whether to use bioidentical estrogen, and how much to use, should depend on your individual situation and needs; it’s best to see a doctor who specializes in prescribing it. For some patients with menopausal symptoms, I prescribe only estriol, in doses that may vary, depending on symptoms, from 1.0 to 2.5 mg applied transdermally a few times a week. For others, bi-est (a standard hormone prescription consisting of 80 percent estriol and 20 percent estradiol) is recommended, with daily doses that typically vary from 1.25 to 2.5 mg, also applied transdermally. (see
Appendix F
for information on transdermal hormone applications.)

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Natural bioidentical progesterone.
In this chapter we’ve enumerated the many sexual and health benefits you derive from your body’s natural progesterone production. As you approach midlife, with a decrease in your natural progesterone production, you may experience fewer of these benefits, and you may gain from taking natural bioidentical progesterone. And at midlife, when your ovaries stop producing hormones and your adrenal glands take over the job, it can give your adrenal glands much-needed support.

Inadequate progesterone can exacerbate many symptoms associated with menopause. In addition to diminished libido, you may experience aggravated breast tenderness and swelling, and increased water retention and bloating. In the years leading up to menopause, your symptoms may include increased PMS and menstrual cramps, heavier periods, and insomnia and anxiety during the second half of your menstrual cycles.

If you take natural bioidentical progesterone, you want to begin with a very low dose and gradually build up to the level that works well for you. Taking too much progesterone can have side effects that include nausea, headaches, dizziness, and sleepiness the morning after you take it. As with estrogen, the amount you need, and how long you should take it, depends on many factors and your individual situation. For best results, see a qualified health professional experienced in prescribing natural bioidentical hormones.

For treating exaggerated PMS symptoms in the years leading up to menopause, the recommended dose of natural progesterone is generally between 25 and 100 mg, applied transdermally each night before bed during the second half of your cycle. But if you’re also taking estrogen, make sure you take at least 50 mg of progesterone a day—important to help protect you from abnormal cell changes in the endometrial tissue in your uterus. Back in the 1970s, women who took estrogen without also taking progesterone had a much higher incidence of endometrial cancer. Subsequent research found that when estrogen is taken with progesterone—more in alignment with the balance nature intended—this risk is appreciably reduced. There’s no clinical justification for using estrogen without progesterone, unless for some reason a woman doesn’t tolerate progesterone.

If your uterus has been removed, taking progesterone can still markedly improve your quality of life by providing you with its many libido-and health-enhancing effects. Many medical doctors tend to think that if you’ve had a hysterectomy, you simply no longer need progesterone—as if its sole purpose is to prevent endometrial buildup in the uterus. Again, if you need to take hormones, it’s important to find a physician who specializes in prescribing them.