Without such treatment, many—probably most—post-menopausal women will experience pain, burning, and soreness during intercourse, particularly if it is prolonged or frequent. (A small percentage of premenopausal women also suffer from this problem.) In our limited experience, the following topical formulation works well: 1/2 to 1 percent testosterone cypionate plus 0.1 percent estradiol dipropionate in any standard lipophilic (compatible with materials soluble in oils and fats) absorption base. This is a prescription drug. It will have to be specially compounded by your pharmacist since we know of no commercial equivalent. Use the minimum amount required; your gynecologist can tell you when your vaginal mucosa is in good condition. About 1/16 teaspoon per day of this salve rubbed into the vagina with a finger has been effective in our experience. This gives a systemic daily androgen dosage of less than 1 milligram and a systemic daily estradiol ester dosage of far less than 50 micrograms. These systemic doses are small compared to the normal endogenous (produced within your body) sex steroid production. Fractional measuring spoons are available in the culinary equipment department of most department stores. For the reasons mentioned above, a topical cream, if available, is preferable to the
sex steroid pills for this purpose. However, a topical cream may not provide enough systemic stimulation to prevent post-menopausal vasomotor instability (hot flashes).
CAUTION: Women, especially those using any form of estrogens, should have a pap smear test at least once a year to detect the presence of possible abnormal cervical cells. Estrogens must not be used in the presence of an abnormal pap smear.
The amount of estrogen needed to prevent hot flashes is individual. We know of one case where the above topical hormone formulation and dosage was adequate to eliminate postmenopausal hot flashes (vasomotor instability) with no additional systemic hormones. In this case, the woman was also using 2.5 milligrams a day of Parlodel® and large doses of Hydergine®, both of which may have contributed to the effectiveness of this approach. Since only about half of the hormones in the salve are absorbed, the daily locally absorbed dose was about 1 milligram of testosterone cypionate and about 100 micrograms (0.1 milligrams) of estradiol dipropionate. The systemically circulated doses of these hormones are considerably lower, particularly for the estrogen. Let us compare these doses to those found in a traditional estrogen replacement oral tablet, Estrace® (Mead-Johnson). The active ingredient is estradiol. The recommended daily dose is 1 to 2 milligrams of estradiol per day for 21 days, then off the hormone for 7 days, then back on for 21 days, etc. There is a commercial vaginal suppository for the topical application of hormones, Test-Estrin Vaginal Insert® (Marlyn Pharmaceutical), which contains 5 milligrams of testosterone and 500 micrograms (0.5 milligrams) of estradiol. The absorbed dose is about half of that applied. The estradiol and testosterone are relatively mobile and rapidly enter the general systemic circulation; however, this topical product exposes the rest of the body to 4 to 8 times less estrogen than the conventional pills. Moreover, adequate testosterone is supplied by this product to help prevent excessive estrogenic stimulation. Our suggested topical vaginal treatment with testosterone cypionate and estradiol dipropionate exposes the rest of the body to 4 – 8 less of timeshe hormone dose of the commercial vaginal suppository, and to only a few percent of the hormone dose of the conventional tablets.
While cyclic (21 days on and 7 days off) use of the topical treatment is most
conservative, it may not really be necessary due to the presence of the testosterone, the very low total estrogen dose, and the extremely low systemic estrogen dose. Follow your gynecologist’s recommendations and have regular pap smears.
The amount of estrogen needed is individual. Birth control pills, such as Ortho-Novum so #21, probably have a hormone balance better than the usual simple estrogen replacement pill. The right dose can be found by starting at the lowest possible dose (say 1/4 the lowest potency tablet), increasing it slowly until hot flashes disappear (Hydergine® and Parlodel® may help with this symptom of vasomotor instability) and having a gynecologist examine the vagina until it takes on a youthful appearance. If you can get a testosterone cypionate-estradiol dipropionate topical cream to take care of the vaginal mucosa, your systemic oral hormone dose can usually be much lower than would otherwise be necessary.
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