Wednesday, October 31, 2012

Menopause and Pain on Intercourse

Menopause causes the ovaries to decline in function.  Hormones diminish, and this includes estrogen, progestin, and testosterone.  Since a woman's body is complex, there are a multitude of symptoms that can result.

I have noticed, for example, that a postmenopausal woman can be talking to me at night, and indeed let's make that a ~ cool ~ night with a breeze.  Her upper lip and forehead are covered with sweat.  In fact, her upper eyebrows and neck glisten in the moonlight.  I ask (during our conversation on menopause), "Do you get hot flashes?"

She says, "No, I never get hot flashes."

So I ask, "Do you have pain with intercourse?"  Well, no big response there.  I persist, "Do you enjoy sex?"  She scoffs, "I could take it or leave it.  I just have sex to make my husband happy, but if it was up to me, I wouldn't even have sex.  And I would not miss it."  She smiles ever so gently.  

So I back up again, "Well, why don't you enjoy it?"  She thinks.  She hesitates.  I wait, patiently.  "Well, I guess that it just doesn't feel good."  

Results are in from Menopause, The Blog, which you can Click Here to Read.  While millions of women in the USA may have vaginal atrophy from a decrease of estrogen production after menopause, only about an estimated 7% are getting treatment.  This is simply astounding to me!  

It could be that a woman does not realize that she has vaginal dryness.  The change could have happened so gradually that she does not realize that she actually has pain on intercourse, or dyspareunia.  Other women say without hesitation that "It feels like a knife blade", to have sex with their husbands.  So let's just step back a moment and realize that vaginal dryness, vaginal atrophy, and pain on intercourse ~ all these things can happen.  It's ok.  

We just need to realize, like the perspiring woman who says she does not get hot flashes, that our bodies are changing. We need to continue to be attuned to our bodies, as we can spend fully one-third of our lives in menopause.  So we'd better get 'good' at being IN menopause, yes?  Let's do!


Other Articles by Dr. Margaret Aranda

Tuesday, October 30, 2012

January 4, 2013: I'll be a Guest with Stephanie Riggs Talk Radio!

Stephanie Riggs has a talk radio station, Divine Calling, out of Denver, CO.  She has interviewed so many Authors that I just have to send you to her FaceBook page: Click Here.

What a blessing!

I will be discussing my book, No More Tears:  A Physician Turned Patient Inspires Recovery.

Sunday, October 28, 2012

Surgical Menopause and Testosterone for Women

There is a common misconception that only men need testosterone.  The idea that women naturally produce testosterone, that they need testosterone, and that they can take testosterone supplementation to correct a testosterone hormone deficiency needs to be defended.

In women before menopause, about 300 mcg, or 1040 nmol of testosterone are produced each day.  Half of the testosterone production comes from the ovaries.  The other half comes from the adrenal glands.   If you are having a hysterectomy, this is one huge thing to think about before removing the ovaries, too.  Especially if your ovaries are normal.

Some women undergoing a hysterectomy are still being told:

"You don't need your ovaries any way."

Studies show that if you have not gone through natural menopause, and you have a hysterectomy and the ovaries are taken out, too, you could experience a 50% decrease in testosterone production and an 80% decrease in estrogen production.  The ovaries can continue to produce hormones for up to 10 years after the onset of menopause. 

When checking testosterone hormone levels in the blood, it is important to know that there are three possibilities:  
Free Testosterone (pg/ml) 
Bioavailable Testosterone (ng/dl)
Total Testosterone (ng/dl)

Also, an increased sex-hormone binding globulin level leads to a decrease in free testosterone. Related testosterone-pathway hormones that may also be checked include dihydrotestosterone, dehydroepiandrosterone (DHEA), estrone, and estradiol.  So how much of these does a normal pre-menopausal women have in her body?  Here are the normal levels:

DRUG                                                                  NORMAL VALUE*                UNITS
Free Testosterone                                                       1.3 - 6.8                                 pg/ml
Bioavailable Testosterone                                          1.6 - 12.7                               ng/dl
Total Testosterone                                                       14 - 54                                  ng/dl
Sex-hormone binding globulin                                   36 - 185                                 nmol/l
Dihydrotestosterone                                                  4.4 - 20.4                                ng/dl
Dehydroepiandrosterone (DHEA)                             60 - 255                                 mcg/dl
Estrone                                                                       32 - 159                                 pg/ml
Estradiol                                                                     34 - 225                                 pg/ml

There are many variables that go into deciding whether to remove the ovaries at the time of hysterectomy.  If your ovaries are normal, their estrogen, progesterone, and testosterone production may serve to protect you from heart disease, bad moods, insomnia, vaginal dryness, fatigue, losses in bone density, and hot flashes, to name a few.  

If you are at increased risk of ovarian cancer, most doctors would recommend that you do get your ovaries removed.  How do you know if you are at an increased risk?  Family history of ovarian or breast cancer may put you at risk.  If your ovaries have been popping eggs out every month all your life and you have never had a baby or breastfed, this may put you at increased risk but that also depends on your age.  It's more complicated than that, but those are the basics.  If you are at increased risk and you are getting your ovaries out, you may be considered for estrogen and testosterone replacement; many doctors also check the thyroid gland at this time.

Keep your ovaries unless you are at increased risk of ovarian cancer: 
It may be that this is the general word.

Talk to your doctor about what is right for you.
Every woman is different, and you should get a Second Opinion from a different surgeon on the matter of a hysterectomy.

Oh.  And treatment with higher doses of testosterone in women after hysterectomy and oopherectomy have shown marked improvement in both psychological well-being and sexual function.  So don't enter your operation for a hysterectomy wondering whether or not to get your ovaries removed, as the general sentiment today has to do with "ovarian conservation".   

Your ovaries could be your future quality of life.

Medical Disclaimer:  Nothing in this blog is meant to give an individual specific medical advice, treatment,  or recommendation.  Each medical decision must be made between a women and her doctor.  

* = Endocrine Sciences, Calabasas, CA

Full Disclosure:  Dr. Margaret Ferrante is an Institute Physician with Cenegenics Medical Institute, which practices Age Management Medicine components of diet, exercise, hormones, and a balanced lifestyle. She may be contacted at for a Free Consultation.


Abraham GE.  Ovarian and adrenal contribution to peripheral androgens during the menstrual cycle.  J Clin Endocrinol Metab 1974;39;340-6.

Davis S., et al.  Testosterone enhances estradiol's effects on postmenopausal bone density and sexuality.  Maturitas 1996;21:227-36.

Shefrin, J.L., et al.  Transdermal testosterone treatment in women with impaired sexual function after oophorectomy.  N Engl J Med; Sept 7, 2000;  Vol. 343 (10); 682-8.

Shefrin, J.L., et al.  Incidence of sexual dysfunction in surgically menopausal women.  Menopause 1988;5:189-90.


Tuesday, October 23, 2012

Low Sexual Desire: Is it HSDD?

Hypoactive Sexual Desire Disorder (HSDD) is a term used to describe a decrease in sexual desire in women.  How do you know if you could have HSDD?

First of all, the diagnosis is a term describing sexual dysfunction.  There is a lack or complete absence of sexual fantasies, and a lack of desire for sexual activity.  The diagnosis comes from a clinician, not the patient.  No 'partner' is required to make the diagnosis.  Requirements include that the patient has distress or relationship problems.  It has to be a perceived problem.

The topic of female sexuality is of paramount interest for not only 'the female', but for all females. By default, it is also a topic of mental health, quality of life, Family Matters, Marital Relationships, procreation, and aging through menopause. There is one main fact that seems to stand out amongst all: #1) women are reluctant to volunteer information on sexual dysfunction, and #2) doctors are reluctant to ask women about sexual dysfunction.

Think of females and their sexual health. Now think of female sexual disorders. What is the most common female sexual disorder? It is Low Desire, with Laumann et al  estimating a stunning prevalence of 30% (1) in a 1999 study done in the United States of America.

In an earlier blog, we mentioned Masters and Johnson as being one of the first to describe a female model of the sexual response. Their paramount study was done in 1966 (2). It categorized, in a linear fashion, four stages of the sexual response: Excitement, Plateau, Orgasm, and Resolution. In 1977, Kaplan added Sexual Desire to this scenario (3).

Today's nonlinear description by Basson takes into account: physosocial and psychocultural matters, relationship satisfaction, emotional intimacy, and sexual stimuli (4).

The American Psychiatric Association classifies female sexual dysfunction into these categories:
Desire, Arousal, Orgasm, or Pain. We aim to focus on Desire, specifically Low Sexual Desire. But before we leave this item, we retain the stance that another reclassification is perhaps under way. Brotto suggests that Desire and Arousal be more of a 'combined' issue of Sexual Interest/Arousal Disorder (5).

To get to our final point here, what is low sexual desire? Both the WHO and the DSM-IV have similar descriptions for Hypoactive Sexual Desire Disorder, or HSDD. It is a recurrent or persistent absence or deficiency of sexual fantasies and desire for sexual activity, causing marked distress or interpersonal difficulty (6, 7).

So, it can be that:

(A) Decreased Sexual Desire  + (B) Problems  ~  HSDD.

(A) = No sexual fantasies, recurrent lack of sexual fantasies, no sexual desire, and/or recurrent lack of sexual desire;

(B) = Personal Problems/Distress, or Relationship Problems

How big is this problem? In the 2006 Women's International Study of Health and Sexuality ((WISHeS), HDSS was determined across the USA, Canada, Germany, Italy, and France.

In America, the prevalence of HSDD ranged from 9% to 26% (8).
In Europe, the prevalence of HSDD was from 6 to 16% (9).
Age and menopause mattered.

While many of the studies on female sexual dysfunction were done by telephone interview, this is to suggest that such anonymity is the result of ongoing female discomfort in talking face-to-face with her health care provider(s). So if a personal relationship or marriage is encountering difficulties due to 'mismatching' of sexual drive, low libido, chronic illness, or other matters having to do with sex, what is the doctor to do? First, let us provide encouragement that the patient needs to feel comfortable telling her doctor about sexual issues.

And if you are a female with low libido or a partner whose sex drive far succeeds yours, and this is causing you marriage or relationship problems, perhaps you do not know that you could have a diagnosis of HSDD. Talk to your doctor about it.

Let's open the door to some frank discussion.

It is time.

Medical Disclaimer: Nothing in this content is meant to advise, diagnose, treat, or cure any medical condition whatsoever. Please speak to your health care professional for medical advice. 
Full Disclosure: Dr. Margaret Aranda Ferrante is an Institute Physician with Cenegenics Medical Institute, specializing in Age Management Medicine.

(1) Laumann  EO, Paik A, and Rosen RC. Sexual dysfunction in the United States. Prevalence and Predictors. JAMA Vol 281(6), pp 537 - 544; 1999.
(2) Masters WH and Johnson VE. Human Sexual Response. Little, Brown & Co.; Boston, MA. USA (1866).
(3) Kaplan HS. Hypoactive Sexual Desire. J. Sex Marital Ther: Vol 3 (1), pp 3 - 9; 1977.
(4) Basson R. Using a Different Model for Female Sexual Response to Address Women's Problematic Low Sexual Desire. J. Sex Marital Ther: Vol 27(5); pp 395 - 403; 2001.
(5) Brotto LA. The DSM Diagnostic Criteria for Hypoactive Sexual Desire Disorder in women. Arch. Sex Behav. Vol 39(2), pp 221 - 239; 2010.
(6) World Health Organization. International Statistical Calculation of Diseases and Related Health Problems, 10th Revision. World Health Organization, Geneva, Switzerland; 1992.
(7) Basson R, Leiblum S, Brotto L, et al. Definitions of Women's Sexual Dysfunctions Reconsidered: Advocating Expansion and Revision. J Psychosom. Obstet. Gynaecol Vol 24(4), pp 221 - 229; 2003.
(8) Leiblum SR, et al. Hypoactive Sexual Desire Disorder in Postmenopausal Women. US Results from the Women's International Study of Health and Sexuality (WISHeS).  Menopause Vol 13(1), pp 46 - 56; 2006.
(9) Dennerstein L, et al. Hypoactive Sexual Desire Disorder in Menopausal Women: A Survey of Western European Women. J. Sex. Med. Vol 3(2), pp 212 - 222; 2006.


Other Articles by Dr. Margaret Aranda

Monday, October 22, 2012

What do Telomeres Tell about You?

Have you heard of Telomeres?

In 2009, Anti-aging mogel Elizabeth Blackburn et al won the Nobel Prize for their work on telomeres. 

A telomere is a molecular timepiece that resides on the end of a chromosome.  It's like a tail.   Some liken it to a plastic bit on the end of a shoelace.  Studies show that each time a cell divides to replicate itself, the telomere shortens.  It simply shortens and shortens until eventually, one day, it can no longer replicate because the telomere is too short.  The cell then either becomes inactive, or it dies.    Telomeres are linked to aging healthy.

Figure.  The telomere.   The end-portion of the chromosome replicates such that long telomere lengthmay act as a barometer to predict whether a person will or will not remain healthy.

In his quest for immortality, Bill Andrews, also known as The Man Who Would Stop Time, probed for twenty years to understand the mechanisms of aging.  On his 57,648th try, he discovered the gene that turns on the telomerase enzyme that makes telomeres.  And, he discovered that if normal cells are supplied with a continual source of telomerase, they will continue and continue to divide without dying.  Telomerase consists of two key components:  one is the RNA that stays there to serve as a continuing template for further synthesis, and the other is a protein that synthesizes the DNA needed to keep the genetic chromosome replicating over and over again. 

Aging has to do with telomere shortening.  If you have longer telomeres, then you are more likely to live healthy beyond 60 years old.  Studies have shown that if you are 60 or older and have short telomeres, you are more likely to get diagnosed with the big killers:  cardiovascular disease, diabetes, and cancer.  You also are more likely to get diagnosed with Alzheimer's Disease.  

Patients with aplastic anemia and shorter telomeres do not survive as well as their counterparts with longer telomeres.  The possible links between telomere biology and the risk of various cancers have been described.  Patients from lower socio-economic groups have been shown to have shorter telomeres than their twins.  

The following items can increase telomere length, and it's good news that many of these are the same lifestyle, supplement, or healthy living choices that we promote at Cenegenics:  diet, exercise, an appropriate body composition, vitamin D, antioxidants, multivitamins, fish oil, and others.  Enter TA-65.    And longer telomere profiles are associated with better lipid profiles, better cognition, a decreased risk of hypertension, type II diabetes, and metabolic syndrome. 

TA-65 is in a class of drugs called telomerase activators.  It is the first and only drug of its class, licensed to TA Sciences.  Some believe that TA-65 will transform traditional medicine's practice of treating disease once it occurs, and instead focus on preventive medicine's focus of discovering disease susceptibility before it gets a chance to become realized. 

Don't believe that you will gain the same benefits as the next person on this drug.  The very nature of TA-65 is that you may have shortened telomeres in one organ system, and this may differ from the next person.  So what TA-65 does is hone in on the shortest telomeres in a person's organ system, individualizing treatment because of the nature of this beast.

Effects of TA-65 include but are not limited to:  increased energy, increased stamina, decreased hours of needed sleep, improved productivity, increased libido, increased joint flexibility, improved skin appearance, improved visual acuity.  Laboratory findings may include increased bone density, improved T-cell count and improved immune function. 

Side effects:  none reported to date. 
Drug interactions:  none reported to date. 

So, it may be appropriate to start with a new compliment:

"My!  What long telomeres you have!"


Cherkas, LF, et al.  The effects of social status on biological aging as measured by white-blood-cell telomere length.  Read Article Here. Issue
Aging Cell

Aging Cell

Volume 5Issue 5pages 361–365October 2006

Contie, Vickie.  Telomere length linked to outcomes in aplastic anemia.  NIH Research Matters.  September 27, 2010.  Read Article Here.

Genes that Protect the Chromosome Tips may Boost Longevity.  NIH Research Matters.  November 23, 2009.  Read Article Here.

Hooper, Joseph.  The Man Who Would Stop Time. August 2, 2011.   Read Article Here

Telomere Biology and the Risk of Cancer.  Read Article Here.

Full Disclosure:  Dr. Margaret Aranda Ferrante is an Institute Physician with Cenegenics Medical Institute. For more information, a Free Consultation, or to make an appointment in the Beverly Hills Office, please email  her here: