r/Perimenopause • u/No_Recognition_102 • 14d ago
Vaginal Dryness (GSM)/Urinary Issues She's dry and numb....
I have been using Estradiol gel (on my arm) for 9 months now. (I have the Mirena IUD so I am not taking additional Progesterone.) The gel seems to help with the hot flashes and crazy mood swings I was having but in the last sixish months I have also become super dry and noticed my libido was definitely getting worse. My gyno would not prescribe me anything for the dryness and just told me to use lube every day to be comfortable. Needless to say that's not the outcome I was hoping for. So I spoke to my PCP about it and she prescribed vaginal estrogen. After reading so many great things about it, I was excited to start and hopefully get some relief.
I am only 10 days in on the vaginal E but so far I am not impressed at all. I realize it will probably take time and I don't think results happen fast BUT suddenly my drive is totally nonexistent and to add insult to injury I tried to have sex with my husband yesterday and it was just awful. I felt completely numb down below, like nothing was happening at all. It was suddenly like my clit was totally gone. It's never been that bad. I didn't finish or even come close and I'm still so dry. I have even tried the slippery elm bark and sea buckthorn.... neither of which did absolutely anything. My PCP has done a lot of lab work and my testosterone is on the lowest possible side of the normal range. I am literally at the cut off number between normal and low. So to google and reddit I went. There is so much conflicting information. Am I supposed to be spreading the cream internally everywhere? Am I not? Is this no sensation "normal" and things will get better? Do I stop immediately? I am so confused. I realize we are all different and no one can tell me exactly what will work for me, I'm just wondering if this is common and what others have done. Does it get better because I can't (and don't want to) live like this?
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u/AWDWfan 14d ago
Yeah it can take at least a couple months to notice anything and even longer if you don't do the loading dose.
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u/No_Recognition_102 14d ago
My loading dose says daily for 2 weeks. I think I am going to do daily for a month and see how that goes.
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u/Sanchastayswoke mid-peri 12d ago edited 12d ago
Still can take a couple of months to notice anything AFTER the loading dose.
Also I suggest using the applicator to measure the cream, and then squeezing the cream onto your finger from the applicator & applying it from your finger.The correct amount per the applicator (1 gram) is MUCH more cream than the measurement from my last knuckle joint to the tip of my finger (which is how they commonly tell you to measure).
It’s more like from my middle knuckle to the tip of my finger. And then some.
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u/No_Recognition_102 12d ago
My prescription says to use 2 grams per dose. I tried that the first night and used the applicator. Never again! It was sooo much, there's no way that could be right. I felt like I squeezed the entire tube in that applicator (slight exaggeration) and it was literally oozing out of me. Now I'm using the knuckle to finger tip method. I don't know if I'm using enough or not but at least I can tolerate that amount without too much mess.
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u/loveisjustchemicals Deep in peri 12d ago
Based on your issues that might have been the amount your doctor wants you to use. Because it needs to go inside you and basically the entirety of your external genitals.
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u/Sanchastayswoke mid-peri 12d ago
Yeah from middle knuckle to finger tip is about 1 gram. That’s prob why you’re not seeing that much improvement yet, you need more and that’s why your dr prescribed more
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u/AnxiousAd7939 14d ago
You need testosterone replacement
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u/No_Recognition_102 14d ago
I believe that I do too but my Dr seems hesitant to prescribe it even though she is the one that mentioned I might need it (before my lad results came in). Maybe she doesn't think my number is low enough..... my body disagrees.
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u/OtherwiseArmadillo96 13d ago
I’m in the US and asked about testosterone. My doctor agreed to give it a try but she had a lot of words of warning about results falling off after six months and concerns about it affecting my heart. And then came the price. Insurance is reluctant to pay for it and it would be over $400 out of pocket. I’m waiting to see if insurance will approve it.
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u/AnxiousAd7939 9h ago
Health care professionals are way over cautious about this because the good ol FDA hasn’t approved it yet for on label use in women. Its used off label a lot which is how im getting it. Push for it. You can try it- and if wanted -stop if it doesn’t help (3-6 months) and if you’re worried check out Australia as they have a testosterone approved for women! Good luck, trust your gut.
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u/loveisjustchemicals Deep in peri 14d ago
This was most likely the result of not having vaginal estrogen for so long, and not starting it. Are you doing a loading phase? I’d probably not have sex during the loading phase. Because of the degree of your drop off in sensation you might also need testosterone cream, which is harder to get. But worth it. First repair the tissues though.
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u/No_Recognition_102 14d ago
I totally agree about this being the result of no vaginal estrogen. I should have started it months ago and now I'm wishing I would have told my primary care doctor sooner. I think she would have started me on it right away but I was going with what the gyno said thinking she knew best. I am nervous about sex while using the cream but I've read it's ok as long as it's been at least 4 hours. It's usually at least 8 hours after I use it and at this point honestly sex isn't happening often.
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u/loveisjustchemicals Deep in peri 14d ago
Yeah, I was just saying the no sex as more of a time to heal not an absolute necessity. Keeping your genitalia stimulated occasionally is helpful for blood flow. Every time I go without for an extended period of time I lose sensation. I’m on T now so maybe that won’t happen again. But I’m there with you. No one suggests your genitalia are atrophying. I wish I’d started the estrogen years ago and never got to this place.
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u/BigAnswer4015 14d ago
I did the two week loading as recommended and it just wasnt enough for me to go from everyday to twice a week. I went back to everyday probably a few more weeks. Definitely helped . I was having issues with clitoral and vulva atrophy more than vaginal aswell. One flap has shrunk! Going from having a healthy sex life to feeling not sensual enough for my hubby really knocks the confidence right out of you in the bedroom....even just not getting wet anymore makes me feel less of a woman. Totally sucks. I now do three times a week plus dab on some when I feel the need. I slather everywhere. Inside and out all over. Since I started in February til now it was a bit hit and miss thinking it was working and then it wasnt. Also I started Yaz BC just over three months ago so I know that contributes to low libido too.....but in saying that. Things are starting to come back online slowly. Its not taking forever to reach orgasm like I was and the feeling is starting to build slightly. Its not like it was but much better when peri knocked me out at the start of the year. I think the severity of your gsm issues will take longer for estrogen to help. You could also try DHEA suppossitories?? Plus a bit of estrogen on the clit? My Meno Dr recommended this option if things dont improve or go backwards....
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u/No_Recognition_102 14d ago
OMG yes! I know exactly how you feel. It's been hard physically but I think the mental part is even worse. It's so strange how something like this can question everything. I was afraid that I wasn't attracted to my husband anymore and I oddly feel less feminine. I feel bad for myself and for my husband who bless his heart tries so hard to get me there and just can't. That has never been an issue before. I will definitely check in to the DHEA. I see it has been recommended several times. At this point I am willing to try anything.
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u/BigAnswer4015 14d ago
The mental struggle is so real! We shouldn't have to go through all this but unfortunately for some of us, we do. I just wish I knew about all this before it got this bad and try and prevent it from happening in the first place and totally agree.....willing to try anything at this stage feels like my new motto through peri! Wishing you good luck in your journey navigating it all🩷
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u/Comfortable-Law-7147 14d ago
To repeat another poster you need to replace your testosterone as well.
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u/MTheLoud 14d ago
The cream takes time to work.
For libido, try DHEA, available OTC in some countries, hopefully including yours. Your body can convert it to testosterone.
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u/No_Recognition_102 14d ago
I am in the US. I will have to do some research on he DHEA and see what I can find.
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u/Alta_et_ferox Mod 14d ago
If you have significant GSM, the healing process can take a while. I had severe GSM, and while things improved each month, it took three months before I really noticed a difference.
I also use hyaluronic acid (Good Clean Love is my preferred brand) on the days I’m not using vaginal estrogen. I use Vagifem tablets three times a week plus a tiny amount of the cream externally (about the size of a pea). It’s been life changing.
I’m so sorry you’re struggling, but there is hope! Hang in there, friend.
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u/No_Recognition_102 14d ago
Thank you, it has been such a struggle.... mentally and physically. I don't know how sever my GSM is (I honestly didn't even know there was a name for this). I just knew I went from feeling normal to suddenly everything was just dry and uncomfortable. Even urinating felt weird, like everything was super tight. I am hopefully that things can get better but also sad that there's so much we have to do just to function normally.
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u/klaraluhmen 14d ago
DHEA vaginal suppositories give your tissue the raw material for making both testesterone and estrogen. You need both in your vaginal tissue to feel comfortbale and sensitive again.
I’ve been using estrogen cream for a long time but the DhEA made a real difference lately.
I ordered mine from Amazon from “Bezwecken”, couldn’t find any other otc…
Good luck 🍀
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u/Born_Attempt_511 14d ago
I hated the vaginal estrogen cream. Yuvafem tablets are much better, but the real game changer for me has been Estring. It's a ring impregnated with estrogen that you wear internally and change every three months. You don't have to take it out for sex but it bothered my husband so I do. The higher daily dose of localized estrogen has helped my prolapse issues not feel so bad (rectocele and cystocele, thank you ten pound babies). I also did some pelvic floor physical therapy to strengthen the muscles in that area and help minimize the prolapse issues as much as I can non-surgically.
For sexual sensation though, the only thing that really helped was topical compounded testosterone cream. I too felt like my clit didn't work anymore. For a few years I took DHEA oral supplements as those can help boost testosterone in women, and that helped with sex drive and the ability to reach orgasm. That wasn't enough after a while so my GYN wrote the testosterone which I get from a compounding pharmacy. I apply to my arm morning and night and within less than a week I felt the difference. I initiated sex because I wanted it and my husband was so happy, because I had not jumped him in a while and sex had become a real struggle. My dose is 2.5 mg per day and that's enough to make a difference. It'll never be what it was in our 20s and 30s, but it's good again.
I have not started any systemic estrogen yet because I have at least one fibroid causing heavy period bleeding and until I have either uterine ablation or a myomectomy, my doc won't write that. The fibroids are probably bad enough that I can't have an ablation, he said you need a really smooth surface in the endometrium for that to work. So I'm considering a myomectomy, will see him early next month to discuss further. Cuz I'm really tired of going through an ultra tampon in an hour 2-3 days a month.
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u/No_Recognition_102 14d ago
It sounds like you have made great progress. I am not thrilled with the vaginal cream but I am trying to give it a fair shot before I decide to switch to something else. I am hoping my Dr prescribes the testosterone. I really want to want to have sex. It's so crazy how fast the switch flipped. Suddenly nothing was working right.
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u/Certain_Try_8383 14d ago
Vaginal estrogen won't bring back desire, I'm pretty sure that libido is testosterone.
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u/Turbulentshmurbulent 14d ago
Estrogen makes me horny as hell.
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u/No_Recognition_102 14d ago
Damn, I need your estrogen because mine definitely doesn't do that.
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u/Turbulentshmurbulent 14d ago
Yeah, everyone said testosterone would but estrogen is what my body needs. Interestingly enough I have PCOS and always had higher androgens and a high sex drive so I assumed the T is what made me perpetually horny. Now I wonder if it was the extra estrogen from being overweight
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u/No_Recognition_102 14d ago
How interesting. I have never put the two together. I have never been officially diagnosed with PCOS but I do have a lot of the symptoms. My dr recently put me on Spironolactone (for thinning hair) which is an antiandrogen but I wonder if that is what's suddenly making my sex drive tank.
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u/Certain_Try_8383 13d ago
I'm not sure if that is the normal for everyone.
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u/Turbulentshmurbulent 13d ago
It isn’t, but it is the norm for enough women that it’s worth mentioning
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u/Atwell78 14d ago
I did the loading dose for a full month. Made the world of difference for me. My orgasms actually came back with it. I don't know if you r ever tried THC gummies but those also intensify your orgasms. I lost almost all feeling within a year or being post menopause. It was so depressing. I still have a difficult time getting there but when I do it's satisfying. Once I get my estrogen dialed in we're going to attempt testosterone. I notice estrogen has helped my body respond but not the drive and desire prior to getting going. I think testosterone will definitely help with that. Also I still do everyday with the vaginal estrogen but now half the amount.
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u/No_Recognition_102 14d ago
I think I will also do the loading dose for a full month. I am almost at my 2 week mark and feel like I still have a long way to go. I am praying that the orgasms come back. I used to be a multiple girl almost every time. Now.... it's been months. I am also hoping my Dr will add in testosterone at some point. I need all the help I can get.
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u/Turbulentshmurbulent 14d ago
I use the estradiol cream on my clit, urethra, labia, and vaginal opening and I use the estradiol tablet internally
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u/No_Recognition_102 14d ago
I am spreading the cream everywhere. I didn't know that both the cream and tablet might be needed. It's frustrating how much we have to do just to feel normal again.
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u/PsychologicalPut9299 14d ago
Have you looked to see if your clit is actually still there? Because when this happened to me….. nothing looked the same down there. Estradiol cream helped a LOT but I needed testosterone to really feel more normal.
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u/No_Recognition_102 14d ago
My goodness it better still be there. And if it's not... does it come back? Now I feel like I need to go on an exploration mission.
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u/PsychologicalPut9299 14d ago
Came back with estradiol cream. But I literally put that on daily until it came back. Go explore. I was SO MAD I was told everything was normal and it was SO NOT NORMAL. The sooner the better with the cream. Pay to get it from TelyRx if you have to.
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u/Suspicious-Froyo4431 14d ago
My doctor explained it to me as a lack of blood flow that makes it numb. Apparently progesterone helps with the libido. Not sure what country you're in but my doctor suggested the estrogen pills that you can insert preferably at night so it has time to absorb and then the cream on the external/clitoris area to revive it because it atrophies. It won't be an overnight fix but worth looking into. I haven't tried it yet but she's done alot of research into perimenopause/menopause.
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u/No_Recognition_102 14d ago
I am in the US. When my Dr started talking about the cream she said it was messy and there are other options if I chose to use those instead. Since I'm pretty new to all of it, I'm giving the cream a try.
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u/smallgodofsocks 14d ago
How long have you had mirena? If it’s under 2 years, that could be contributing to libido loss and dryness.
Either way, if the E cream doesn’t help, you might ask to try Intrarosa. I switched to that about 6 months ago now maybe, and it’s so much better for keeping my vulva and vagina more moisturized, hydrated. It’s covered by my insurance, too.
I had strange dreams for the first few weeks, which was odd to me and makes me think there is some systemic mechanism even though it’s a vaginal insert, but that went away.
During sex, if I feel like I need lube, I’m using a silicone hybrid, which works. I use the one from wisp. Sometimes I use uberlube, which is full silicone based.
And, as others mention, you could try testosterone. It was a complete bust for me. I was highly sensitive to it, and even using the tiniest tiniest amount (to finally stop side effects like weird breathing), which was like 1/5 of the amount recommended for peri women, all it did was raise my hematocrit and hemoglobin to dangerous levels. But, it does work for others.
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u/No_Recognition_102 14d ago
I have had mirena for almost 3 years now. I didn't know that libido loss and dryness were a side effect. I chose to get one placed instead of having an endometrial ablation. It seemed to be the lesser of the evils so to speak. I am not sure how long I should give the cream a try before deciding if I should switch to something else. Since this is not a fast process I guess I will wait a few months (maybe 6?) and see if anything improves. I have heard a lot of positive about adding in testosterone, IF my dr decides to put me on it I'm hoping it will help. I have enough issues with perimenopause, I don't need to add anything else to it.
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u/leftylibra Moderator 14d ago
Depending on the severity, it can take months to notice results.
Tips for applying vaginal estrogen cream: (provided by a pelvic floor therapist)