As usual, friends, please be mindful of some graphic language and anatomically correct language. This might not be appropriate for those with sensitive eyes/ears.
It’s been a hot minute, but I wanted to give my body some time to see what the ebbs and flows are and write up something instead of a small blog every time I noticed something new.
Overall, I’m still incredibly thankful for having this surgery and the care I received. In November, I definitely felt a shift in my hormones and needed to go back on my anti-depressants, noticed a drop in my libido and the ever-dreaded loss of estrogen and vaginal dryness. I’m sure that the surgery was a shock to the ovaries and was going to require a few months to level out. About 3-4 months ago, I noticed some bleeding after intercourse, though there was no pain and was light. I messaged my surgical team and they wanted to see me sooner rather than later and I went on 3/18/24. The nurse practitioner initially could not find anything but she eventually discovered a small piece of granulation tissue that was getting irritated with penetrative sex. She used silver nitrate to treat it and said that if it persists after four weeks then to return for another treatment but there is nothing unsafe or harmful with what’s going on, just irritating. It has not returned since that treatment.
Regarding the vaginal dryness, she offered estradiol cream, which is a type of estrogen in a cream form inserted vaginally that I would use daily for 2 weeks and then a few times a week. Since I did not know where my estrogen levels were at, I wasn’t keen to try this just yet. As a pelvic health therapist, though, I see where it has made significant changes in my patients’ lives. I also don’t feel that my pelvic floor is atrophying as a result of decreased estrogen and using lubrication takes care of whatever dryness I’m experiencing.
I met with my PCP last month for routine blood work and examination. I fully understand that a blood draw to test my hormones is just a snapshot in time and, as a woman, it will fluctuate throughout the month as they should (hopefully). The blood work came back great. Testosterone, Estrogen, Estradiol and other sex hormones levels were all within normal ranges. She did prescribe Estradiol cream for vaginal insertion to use at night and made other recommendations such as DHEA for libido and vaginal secretion. Here are my thoughts so far with that:
The estradiol cream is messy and incredibly weird to work with. I have to fill up a plunger syringe with the amount of cream prescribed and then insert that vaginally, push the plunger and the cream is then in my vagina. Due to gravity and the nature of the vagina being a self-cleaning organ, this all has to be done laying down or else it will leak out immediately. It will leak out eventually, but the aim is for your body to absorb the estradiol. I keep a towel under me throughout the night when I am using this. I have not been using it long and I don’t like using it, but I actually do think it is helping with the dryness. My current dosage is 1 gram of estradiol per treatment.
The DHEA is new to me and I started with Douglas Laboratories DHEA 25mg Micronized. The micronized part means that the particles have been finely ground to ensure faster absorption by the body. I perceived some pretty immediate effects from this supplement. The number one being my sleep is better. Some people report having really bad nightmares, but I have not experienced that. I do believe that it has also helped my libido, but it’s still a little too early to tell as it’s only been a few days so far.
I’ll end today’s blog by saying that I fully expected a few months for things to “regulate” after the surgery. It wasn’t until the last few weeks that I felt like I was actually going through a cycle. This included some mood swings (tearing up over usual things that normally don’t affect me), breast tenderness and some food cravings. Another caveat is that in November of 2023, I started working at a local hospital as a pelvic health PT. With that job came a significant amount of stress and I had to quit in May of 2024. Though I learned a lot, the physical and emotional toll on me was not worth it and I was getting panic attacks before going into work and my depression worsened. That’s not fair for not just me, but also for my patients as I need to still have joy in my job in order to be an effective PT. I’m looking forward to the future, I need to push past the Imposter Syndrome that can sometimes override my thoughts, and I am very excited about reaching out into the community (here in WA and online) for educational opportunities and other exciting changes. Thanks for following along!
Best,
Kathleen Neal, DPT
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