Painful intercourse is a very common complaint I get from patients going through or have gone through menopause. They do feel awkward speaking of vaginal dryness, especially with their male gynecologists. This is one of the most common symptoms of menopause, second to hot flashes and night sweats.
Menopause is an inevitable course of life that all women will go through. In menopause, the ovaries are going to reduce and ultimately stop making estrogen and progesterone. The average age of menopause is 51.5 years of age. Also, commonly some women have had a complete hysterectomy and oophorectomy which is complete removal of the uterus and ovaries.
This can be due to many health conditions such as Endometriosis, heavy/frequent bleeding, or fibroids. These women will go through what is called, surgical menopause,’ but either way, menopause can have a variety of symptoms.
Unfortunately, dry, painful sex commonly occurs before, during and after menopause. A female may opt to take hormone replacement during menopause, or she might not choose to take hormones because she may not be a good candidate.
This can be due to personal reasons, health conditions, family history, physician recommendations. Whether taking hormones or not for menopause, painful dry intercourse is a common symptom.
It should also be noted that perimenopausal women can also have vaginal dryness. As we get older, our hormones inevitably decline. Even women as young as the late 30’s to early 40’s can have pain with intercourse due to the slight drop in estrogen.
Estrogen feeds the vaginal cells. Immature vaginal cells are called Parabasal cells. Having estrogen in the system will help convert the parabasal cells into mature vaginal cells.
If you have vaginal atrophy, that means you have mainly parabasal cells in your vagina. If you have ever gotten the full report from your last pap smear, you will notice the report will say there is predominantly parabasal cells. The lack of estrogen in menopause is the culprit for painful intercourse and/or dryness.
Personal lubricants are the first line of choice for painful intercourse, which can be helpful. However, in vaginal atrophy, the walls of the vagina can become narrow. You still might experience pain even with the lubricant, or the vaginal tissues are very fragile, and the lubricant cannot protect from the tearing.
The next level of treatment is using estrogen topically. Your ObGyn may give you estradiol or Premarin cream/inserts for vaginal dryness. The problem with this is estradiol and Premarin are both very strong forms of estrogen.
They usually enter the bloodstream if you use them vaginally. Estradiol is ‘bioidentical,’ but it is the most potent form of estrogen we make. So estradiol may not be appropriate for you or intended to be used long term.
Premarin is made from pregnant horse urine and is not bioidentical. The entire ethical implications behind horse/animal treatment and Premarin is a whole other topic itself.
For the appropriate candidate using estriol (E3) vaginally can help hydrate the vaginal cells and make them more resilient to tearing. Estriol is the most gentle estrogen that our bodies produce. Estriol is bioidentical and very helpful for skin and mucous membranes like the vagina.
Unfortunately, your conventional doctor or ObGyn is not going to prescribe estriol for you. Now, this is where I am supposed to tell you: this information is intended for information only. It does not replace medical advice and it just at the disclosure of the reader.
There is a product I like from the company Bezwecken, which is called Hydration Cubes. That is precisely what they do; they hydrate the vaginal tissues by providing bioidentical estriol. It is meant to be inserted vaginally to convert the parabasal cells into mature vaginal cells.
Unlike estradiol, estriol is very gentle and meant only for the vaginal tissues. If you are having very painful and dry intercourse, insert one hydration cube vaginally at night for ten days.
After that, you will only need to use the estriol hydration cubes once to twice a week. Depending on the degree of vaginal atrophy, it should take about 4-6 weeks to take effect.
I hope this information has been helpful to you. If you would like more information on hydration cubes, visit our online store. Also, feel free to reach out and ask us questions or if you have your own personal stories. You can email us at [email protected]
The post Do You Have a Dry Vagina During Sex? | PYHP 034 appeared first on .
Discover the common and unfamiliar symptoms that you might be experiencing. Get access to cases of real women with hormonal conditions.
Are you gaining weight around your midsection during perimenopause or menopause—despite eating the same and trying everything? You’re not alone, and it’s not just about willpower: In this episode, Dr. Valorie and Dr. Maki dive deep into what’s really going on with that frustrating menopause belly. From insulin resistance to estrogen and cortisol changes, they break down the complex hormonal shifts that make weight gain in midlife feel inevitable—and nearly impossible to reverse. Here’s what we cover: ✔️ Why the “unearned weight gain” often starts in perimenopause ✔️ The truth about insulin resistance and menopausal metabolism ✔️ The role of estrogen, progesterone, and cortisol in midsection fat ✔️ Why muscle mass is your best metabolic insurance ✔️ Whether hormone replacement therapy (HRT) or GLP-1 meds (like semaglutide) can help ✔️ Actionable steps to reduce belly fat and improve metabolic health Plus, we’ll share why willpower alone doesn’t cut it—and how biology always wins unless you work with it (not against it). Want more insights like this? Be sure to subscribe to our newsletter for hormone Q&As, educational guides, and real-world strategies to help you feel like yourself again—especially during perimenopause and menopause. If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Health Newsletter Stay Connected Instagram: @drvalorie TikTok: @drvaloried Join the Hormone Community: Click here to subscribe Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode of the Progress Your Health Podcast, Dr. Valorie and Dr. Maki tackle a common yet surprisingly confusing question: When is the best time to test your blood levels if you’re using hormone replacement therapy (HRT)? Lisa, a fellow Washingtonian, submitted a thoughtful Ask the Doctor question about testing estradiol and FSH levels when using a trochee or transdermal cream. Should it be 4 to 6 hours after application? Or 10 to 12? And what do the results actually mean? We’ll break down: The ideal timing for blood draws depending on delivery method (trochee, patch, cream) How estrogen and progesterone absorb differently Why testing too soon — or too late — can skew your results How to interpret estradiol and FSH together (and why context is everything) Why the number isn’t the whole story — and how you feel matters most Plus, Dr. Valorie shares insights from her own hormone journey, including rhythmic dosing tips and lab timing mishaps. If you have a question, please visit our website and click Ask the Doctor a question. Want more insights like this? Be sure to subscribe to our newsletter for hormone Q&As, educational guides, and real-world strategies to help you feel like yourself again—especially during perimenopause and menopause. Join the Progress Your Health Newsletter Stay Connected Instagram: @drvalorie TikTok: @drvaloried Join the Hormone Community: Click here to subscribe Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
Is there really an age limit for hormone replacement therapy (HRT)? What if you’re in your 70s and still feel better on hormones—but your doctor says it’s time to stop? In this episode, we answer a great question from Mary, a 76-year-old woman who’s been on HRT for over 20 years. She’s dealing with weight gain, breast tenderness, and pressure from her gynecologist to quit hormones altogether. We break it down: Why stopping HRT just because of age isn’t always the answer What to consider when switching from a trochee to a cream Why estradiol levels matter more than total estrogen The connection between insulin resistance, weight gain, and hormones How to adjust HRT in your 70s to maintain quality of life without unnecessary risk Whether you’re well into postmenopause or just starting HRT, this is a must-listen if you’re wondering how long is too long to stay on hormones. If you have a question, please visit our website and click Ask the Doctor a question. Want more insights like this? Be sure to subscribe to our newsletter for hormone Q&As, educational guides, and real-world strategies to help you feel like yourself again—especially during perimenopause and menopause. Join the Progress Your Health Newsletter Stay Connected Instagram: @drvalorie TikTok: @drvaloried Join the Hormone Community: Click here to subscribe Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode, we’re answering a thoughtful (and very relatable) listener question from Kari, who’s been struggling with unexpected body pain and inflammation after starting hormone therapy. She wonders if she might be hypersensitive to estrogen—something most doctors don’t talk about. Dr. Valorie Davidson and Dr. Robert Maki unpack why this happens and what to do if you suspect your body is reacting to estrogen differently than expected. In this episode, we discuss: Why some women experience increased pain, fluid retention, or inflammation on estradiol—especially starting at higher doses too quickly. The importance of starting low and increasing slowly, especially for sensitive individuals How Dr. Davidson’s personal experience with estrogen sensitivity helped shape her approach The role of the liver’s phase 1 and phase 2 detox pathways in clearing estrogen metabolites Why form, dose, and timing of hormone therapy (cream vs. patch, AM vs. PM) can affect results What to consider when adjusting your Biest ratio (80:20 vs. 90:10) or Rhythmic Dosing HRT ✉️ Here’s Kari’s full question: “I used Biest 80:20 for 3 years and suddenly stopped absorbing. I’m not sure why, but I do know I didn’t always use it the same time every day. From the moment I went on hormone therapy I’ve had body pain and thought I had fibromyalgia. When my estrogen dropped due to the absorption issue I realized the body pain completely went away. I then went on a patch because my doc said we should change the method. Immediate body pain again and even worse. Terrible. I was on 0.025 and it was tolerable, but after raising it to 0.05 it got really bad. I think I may ask to go on the compounded cream again—maybe change the site that I apply it and be more consistent. I’m very frustrated because no one talks about a subset of people that are very sensitive to estrogen. They only talk about it making joint pain go away. Do you think I should use 90:10 instead? What would you recommend that I do? I’m so sad and frustrated.” If you have a question, please visit our website and click Ask the Doctor a question. Want more insights like this? Be sure to subscribe to our newsletter for hormone Q&As, educational guides, and real-world strategies to help you feel like yourself again—especially during perimenopause and menopause. Join the Progress Your Health Newsletter Stay Connected Instagram: @drvalorie TikTok: @drvaloried Join the Hormone Community: Click here to subscribe Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode, Dr. Valorie Davidson and Dr. Robert Maki respond to a great listener question from April, who’s navigating hormone replacement therapy (HRT) while dealing with a history of endometriosis, polyps, and chronic cramps. April’s experience is all too familiar: spotting, cramping, hormone experimentation, and the frustrating search for symptom relief. So, can women with endometriosis safely use HRT—especially estrogen? The answer: Yes, but it has to be customized. �� In this episode, we cover: Why HRT is absolutely possible for women with endometriosis—but must be individually tailored The difference between static vs. rhythmic dosing and why rhythmic HRT may be better tolerated for some women Dr. Davidson’s personal story of having endometriosis, cysts, and polyps—and how she now uses rhythmic dosing herself without flaring The important role of progesterone in managing endometriosis and minimizing estrogen reactivity How to approach spotting, cramping, and cyst formation during HRT ● Why estrogen isn’t the enemy—but why it must be dosed thoughtfully ✉️ Here’s April’s full question: “Hi—I am a 57-year-old woman in perimenopause. My question is: is it possible for women with endometriosis or adenomyosis to do HRT? I started oral progesterone 2 years ago, got as high as 300 mg, but didn’t get much symptom resolution. Switched to a progesterone troche—50 mg morning and night. About 3 months ago, I added testosterone (0.25 mg once daily, 5 days/week) and Biest 80/20 (1 ml daily, can go up to 2 ml). Everything was good for a while, but now the cramping and spotting have returned. I’ve had heavy bleeding as long as I can remember. My main complaint is menstrual cramps throughout the month—not just during my period. I do not have fibroids, but I’ve had many cysts and polyps over the years and have had many ultrasounds and transvaginal ultrasounds because of this.” If you have a question, please visit our website and click Ask the Doctor a question. Want more insights like this? Be sure to subscribe to our newsletter for hormone Q&As, educational guides, and real-world strategies to help you feel like yourself again—especially during perimenopause and menopause. Join the Progress Your Health Newsletter Stay Connected Instagram: @drvalorie TikTok: @drvaloried Join the Hormone Community: Click here to subscribe Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode, Dr. Valorie Davidson and Dr. Robert Maki dive into a hot topic: Does Hormone Replacement Therapy (HRT) actually slow down aging? While the short answer may surprise you, the real conversation is about something even more valuable—your quality of life. Here’s what we cover: How HRT can support energy, strength, and resilience as we age The role of hormones in brain function, memory, and mental clarity Why estrogen and progesterone matter for muscle tone and bone density ❤️ The powerful connection between hormones and cardiovascular health. Why HRT isn’t about extending your lifespan—but enhancing how you feel through the years Obviously aging is inevitable—but suffering doesn’t have to be. This episode is all about helping you feel more like you again, even as your hormones shift. If you have a question, please visit our website and click Ask the Doctor a question. Want more insights like this? Be sure to subscribe to our newsletter for hormone Q&As, educational guides, and real-world strategies to help you feel like yourself again—especially during perimenopause and menopause. Join the Progress Your Health Newsletter Stay Connected Instagram: @drvalorie TikTok: @drvaloried Join the Hormone Community: Click here to subscribe Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
