Current Question: Progesterone Cream for Reduced Libido

Question: Many people talk of vaginal dryness in older women only especially those going through menopause. What about young women that suffer from vaginal dryness?

I am a 31 year old Asian woman who has been suffering from this problem for quite some time and it is putting a strain on my marriage. I also have lost a great deal of my sex drive. I am taking birth control pills, but I have spoken to several friends with a similar problem who do not even take "the pill".

I hear a cream with 2 % progesterone is effective, as per Oprah's show. Is this really true? Will this affect the strength of my pill? What are the risks and benefits of this medication and how is it used? I can't seem to find any information about this type of treatment. Thanks in advance for any help.

Answer: Various forms of progesterone supplements have been around for a long time. Micronized progesterone given orally has long been used as a treatment for premenstrual syndrome. It has produced mixed results, with some enjoying a favorable response and others seeing no difference.

Progesterone cream is the same - it has been used as a therapy for complaints of PMS, decreased libido, hot flashes, skin changes, menstrual cycle irregularities, etc. The theory is that some women may be deficient in progesterone production from the ovaries, leading to a short luteal phase (the phase following ovulation).

I have prescribed progesterone cream to a number of patients and have found that some improve and some report no change in their symptoms. There is no standard dose and no standard regimen for its use - some pharmacists recommend a teaspoon applied to the skin of the forearm or inner thigh daily. There are a few studies showing its efficacy in relieving PMS symptoms. Because the amounts used are so small, there is probably no significant adverse effects.

Vaginal dryness can be seen in young women. Some causes include postpartum and breastfeeding ; oral contraceptive use can be associated because the pill thins the lining of the uterus to decrease menstrual bleeding, but can also thin the vaginal epithelium leading to dryness. Certain soaps, deoderants and frequent douching can also lead to dryness. It can be managed with topical lubricants or moisture replenishing agents and occasionally topical estrogen cream can improve symptoms.

Decreased libido is a very common complaint - many women (and their partners) are convinced it is a hormone problem. In most cases, hormone studies and physical exam are normal. Many women are trying to balance career and family and there are not enough hours in the day to accomplish all that need to be done. It may be difficult to feel sexually aroused after a long day at the office, preparing dinner for the family, doing household chores, etc.

It is certainly worthwhile to see a physician to rule out any medical illness or medication that might be involved, however.

Dr. Angela S. Martin, M.D.
Obstetrics and Gynecology
Womens Medical Group