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Archive for the ‘Questions…and answers’ Category

You say you’ve just noticed that one breast seems “much bigger” than the other. It doesn’t have any additional sensitivity and otherwise looks the same as the other, and you had a normal mammogram earlier this year.

You asked. Dr. Barb answered.Most women have breasts that are not an exact match in size, but it’s typically a life-long reality, not a change. Breasts becoming larger isn’t normally a concern, since they change as we gain or lose weight, have children, and grow… more mature. Again, what’s “typical” is that both breasts are affected more or less equally by a change.

If one breast is changing, it’s a good idea to have a clinical exam by your healthcare provider. That’s a noninvasive way to assure that everything’s okay.

Good luck!

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You mention joint pain, weight gain, and food cravings in addition to hot flashes as symptoms of menopause. Menopause has such a variety of symptoms, depending on each individual. Lifestyle matters more; exercise is more important; adequate sleep and good nutrition—all of these have a greater impact to quality of life now than they did previously.

I wish I could tell you there is good data suggesting vitamins have a favorable impact on menopausal symptoms, but the trials looking at the specific supplements you mention and others suggest no benefit greater than placebo. But, hey, placebo has about a 30-percent response rate in any trial, so there is certainly no harm in using them. They provide some general vitamins that will not be harmful, and may help if you aren’t getting them in your diet.

The symptoms you mention could all potentially benefit from hormone therapy (HT). The loss of estrogen is huge for most women, and the loss of progesterone to some extent as well. For many women the only way to address symptoms adequately is to consider HT. More and more data suggests that HT is beneficial for women specifically with weight gain; that was a lead article in one of my journals just this week.

It’s a complicated journey that is nuanced, and each woman needs to assess her own symptoms and goals and determine the best approach to managing through menopause. It’s difficult to address all of the treatment options in a single Q&A. You might find the North American Menopause Society (NAMS) website helpful: menopause.org. They cover many issues related to menopause.

Good luck!

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I’ve got good news and bad news for you. The good news is that you’re just like 75 to 80 percent of women! The majority of women are not able to experience orgasm only with vaginal penetration or stimulation. Most of us need direct clitoral stimulation to orgasm, whether that stimulation is oral, digital, or with a vibrator.

You asked. Dr. Barb answered.A recent journal article on this topic described one factor of influence was the distance between the clitoris and the vaginal opening (read more in this blog post). A few millimeters can make a difference to how orgasm is experienced–and that’s an unmodifiable factor! Since each of us is individually made, the bad news is that if you haven’t experienced vaginal orgasm by now, you’re likely not going to.

There’s one option for you to try: Some vibrators, like the Gigi2 and the Celesse, are shaped specifically to put pressure on the “G spot.” If you’re one of the people for whom orgasm can happen through G-spot stimulation, one of those vibrators can help!

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I’m so sorry to hear of your childhood experience. Women—and men—can definitely move forward successfully from this history, but not without a good therapist. I recommend that you find a therapist as soon as possible specifically to address your molestation history, and a sex therapist would be best.

Your health care provider may be able to refer you to a specialized therapist in your community, or you can go to ASSECT’s (American Association of Sexuality Educators, Counselors, and Therapists) website, where they have a referral directory that lets you specify your location.

You deserve fulfillment in this area of your life, and seeking a professional to help you navigate could be life-changing. I urge you to seek this professional assistance!

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In a sense, the most “natural” replacement for lost estrogen is estrogen, which is a prescription product (like Premarin or Estrace vaginal cream, Estring, Vagifem, or the non-estrogen Osphena).

You asked. Dr. Barb answered.If, for a number of reasons, you prefer not to take that path, the next-best option is to maintain vaginal tissues by using a moisturizer regularly, two to three times a week. Moisturizers are designed to bring more moisture–no surprise–into the vagina to prevent the progressive dryness that occurs in menopause with the absence of estrogen.

Both Emerita and Prevaleaf Oasis are natural vaginal moisturizers.

One more option might be an oral nutritional supplement, Stronvivo, which some research shows improves vaginal moisture. It does this by improving blood flow, and that circulation also supports tissue health.

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Oh, I feel for you. You say you have pain (and no doubt other symptoms—like fatigue and depression) from lupus, fibromyalgia, and Sjogren’s syndrome. You see your lack of interest in sex becoming a larger problem in your marriage as the difference between your sex drive and your husband’s increases.

The first order of business is to find a health care provider with whom you can discuss this aspect of your health. The pain you mention may be generalized pain from the autoimmune conditions you have, or it may be pain with intercourse. Painful intercourse is nearly always a treatable condition, so addressing that if you experience it is critical.

You asked. Dr. Barb answered.The harder issue is the “desire discrepancy” you describe in your marriage. While the situation is not uncommon, your additional health issues add a degree of difficulty. Assuming any issues with painful sex have been addressed, there are some medications that can be helpful for low libido: Addyitestosterone, and Wellbutrin, to name a few. Your health care provider can help you understand if any of these can be an option for you depending on your health history and other medications you’re taking.

For more about low libido, you can read this blog post on the emotional component and this one that includes an overview of the condition and common causes. It could be helpful to read these to have some terminology in mind when you meet with your health care provider.

The situation you describe might best be addressed with a (sex) therapist—perhaps not a dedicated sex therapist but one who has expertise in health-related relationship concerns. (Here are two blog posts on sex therapy: one I hoped would demystify it and one that explains how it works.) Your health care provider is likely to be able to direct you to someone with experience to assist you and your husband as you navigate this significant challenge.

Best of luck in reaching some common ground!

 

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You say that your wife suffers from lichen sclerosus, a condition that creates skin tissue that is thinner than usual (and is a higher risk for postmenopausal women). Warming oils and lubricants, unfortunately, create discomfort rather than arousal for her. I’m not aware of an option in that category that would work for her, since the ingredients that make them effective–usually something minty or peppery–will almost certainly cause an adverse reaction.

Plain lubricants won’t cause that reaction; those we include in our product collection should be well-tolerated by lichen sclerosus patients.

There are a couple of other options you and your wife could explore for arousal. The use of testosterone has been beneficial for 50 to 60 percent of the women in my practice who’ve tried it. Testosterone is by prescription and off-label for women, which means a discussion with her health care provider is required.

Other prescription options include localized estrogenOsphena, or Intrarosa (a recently available FDA-approved choice). Any of these would increase blood supply by “estrogenizing” the genitals, which can improve arousal and orgasm as well.

Congratulations on undertaking this exploration together! Good communication and mutual support are so important to shared intimacy.

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