The Mysteries of Being Female – Your 5 Common Questions Answered

Sometimes being a woman can be challenging.  Hormones go up and down then come and go.  We have this amazing ability to become pregnant and deliver a baby out of an area that starts small and grows to 10 centimeters when fully dilated.  We crave, we cry, we cramp, we clean and we console often all in the same day (sometimes in the same hour). We can carry on four conversations at once while updating our Facebook status, cooking dinner and prepping tomorrow’s suit which makes us wonder why we are tired at the end of the day.  We do all this and yet there are times when our body just does not seem to want to cooperate or suddenly veers off course.  Here are some answers to 5 common medical mystery questions about the female body.

1.       Why do I have vaginal dryness (sometimes or all the time)? There are many reasons to consider but the big ones include: not fully aroused, stressed, other things on your mind, on the birth control pill, on clomid (or other fertility medications known to dry up mucus), history of a LEEP procedure on the cervix due to an abnormal pap smear, decongestants (they do not just dry up the nose), dehydration, and hormone changes.

2.       Why are some periods unlike other periods?  Some women have the “fluke” where their period comes early or late (not pregnant), is really heavy, really light, no cramps, severe cramps…etc and this is different from the normal.  Some women alternate months in that one month is an easier period then the next month is a more symptom heavy period. Remember (as I tell my patient’s), your ovaries are sisters not twins therefore “righty” and “lefty” may produce different hormone levels and create different symptoms. Some months may be a “righty” month and others a “lefty” month.  In addition, high stress, grief, flying, major transition, heavy exercise, weight loss, and hormone changes can all affect how your cycle rolls. 

3.       Am I too young for hormone changes?  Nope.  Hormone changes and imbalance can occur at any age from puberty all the way through menopause.  You may be too young for menopause but that does not mean there are not issues with hormone production.  Women who do not ovulate do not make progesterone and progesterone is typically known as the calming, soothing, anti-PMS, pro-pregnancy hormone.   High estrogen contributes to more PMS-type symptoms, heavier periods, weight gain and tender breasts.  Higher testosterone or testosterone sensitivity may create more acne and increased hair growth on the chin, neck, and around the nipples.

4.       Why are my periods irregular or why do I spot and bleed more than seems normal?  First of all, if you are fully menopausal and have not had a period in 12 months and suddenly you start bleeding, please contact your health care provider as you will need additional work up.  If you are peri-menopausal then expect your once regular periods to become very erratic and unpredictable due to the nature of the ovaries changing.  Other reasons for most all ages include hormone imbalances, fibroids, polyps, pregnancy, thyroid problems, being low in iron, having Polycystic Ovarian Syndrome (PCOS) and being on the wrong birth control pill dose.

5.       Where did my sex drive go?  This is tricky.  Some women do not start out with a thriving sex drive and as they go through hormone changes it begins to wane even more.  Those who are used to a higher drive find themselves perplexed when their mojo is gone.  Sex drive for women is rather complicated as it takes into account hormone balance, arousal, stressors, how many things are on their brain, attraction, confidence…and more.  Certain medications are known to lower drive such as the birth control pill and anti-depressants.  Men typically have an “on/off” switch while women have an entire control panel.  Talk with your health care provider about testing for hormones, thyroid, and energy zappers like iron, Vitamin B12 and Vitamin D.  Focus on your stress response, eliminating what is not a priority, communicating with your partner about what you need (A dinner out? The laundry done? Compliments? Forplay?) and do not be afraid to explore and change things up within your comfort zone.  Perhaps this means new lingerie, the addition of sex toys, erotic readings (grey ties anyone?), more date nights, or a mini-couples vacation.

While being a woman is wonderful and empowering (empowher!), please talk to your health care provider if you recognize some of the symptoms above and suspect your particular symptom is more than just a “fluke.”  There may be some true imbalances that require a little tweaking in order to help you feel your healthiest.

References:

1)      Bachmnan, G., and Santen, R. Treatment of Vaginal Atrophy.  Web.  8 June, 2013.

http://www.uptodate.com/contents/treatment-of-vaginal-atrophy

2)      Shifren, J.  Sexual dysfunction in women: Epidemiology, risk factors, and evaluation.  Web. 8 June, 2013.

http://www.uptodate.com/contents/sexual-dysfunction-in-women-epidemiology-risk-factors-and-evaluation?detectedLanguage=en&source=search_result&search=libido&selectedTitle=3%7E131&provider=noProvider

3)      Welt, C.  Physiology of the Normal Menstrual Cycle.  Web.  8 June, 2013.

http://www.uptodate.com/contents/physiology-of-the-normal-menstrual-cycle?detectedLanguage=en&source=search_result&search=irregular+menstrual+cycle&selectedTitle=12%7E150&provider=noProvider

5 Facts About the Hormone Testosterone for Women

When women think of the word testosterone they often think of MEN.  To sum it up, testosterone is what makes a man a man (so-to-speak) while estrogen and progesterone are often more associated with women.  However, testosterone is just as important to women but not in the same high level amounts.  These are five things about testosterone that may have you asking your health care provider for a test.

1)      Testosterone is made from cholesterol (its backbone) and another hormone known as DHEA.  DHEA is made in the adrenal glands and can help with stress, increased energy and low mood.  The more well known DHEA is DHEA-S, which is the one to test for.  Supplementing with DHEA should be done in the morning however; women should use lower doses than men.  The side effects can include increased anger, irritation, acne and inappropriate hair growth often on the face, nipples and chest.

2)      Testosterone helps significantly with energy, motivation, sense of well-being and sex drive in women.  When testing for this hormone, the total and free levels should be evaluated as the ‘free’ is active.  Testosterone has similar side effects to elevated DHEA and should be used with caution only under your health care provider’s direction.

3)      Keep in mind, testosterone is not a ‘magic pill’ for sex drive.  Many women have normal levels of testosterone and still find themselves lacking in desire.  A lot more goes into the libido for women than it does in men.  As women get older, their hormone levels overall change but so do their energy levels, sleep habits and stress which all interfere with their sex drive.

4)      Testosterone is made in both the ovaries and adrenal glands. Women who had their ovaries surgically removed may notice a significant decline in testosterone in the body.

5)      The birth control pill, if used correctly, protects against unwanted pregnancy but can also lower sex drive by lowering testosterone.  The pill increases a hormone known as sex hormone binding globulin that binds up excess free testosterone and gets rid of it from your body.  With less testosterone floating around, the desire for sex is less.

 

Just as a man might need testosterone replacement, so might a women but with significantly lower doses.  Consider asking your health care provider about testosterone and DHEA-S testing if hormone changes, fatigue, mood issues, and lower sex drive are occurring on a regular basis.  Your hormones may truly be out of balance.

References:

1.       Androgen Replacement Therapy in Women.  Web.  2 December, 2012.

http://www.medscape.com/viewarticle/773774_1

2.       Birth Control Pill Could Cause Long-Term Problems With Testosterone, New Research Indicates.  Web.  2 December, 2012.

http://www.medicalnewstoday.com/releases/35663.php