dr. phuli's blog


Monday, April 28th, 2014

If you’re not enjoying sex and want to, if you’re not having mind blowing orgasms like you used to, but your healthy in every other way, I have good news for you. Your return to a full, lush, and exciting sex life is at hand. Read on.

The vagina can be mysterious- particularly in us women over 50.

As you age, estrogen and progesterone are no longer coursing through your veins and vaginal walls at high levels. Eventually the vaginal walls thin and bladder pipes become more easily irritated. Vaginitis, bleeding, itching, urinary frequency and infections can occur. Orgasms, if you’re lucky enough to have them, lose intensity.

There are a plethora of lubricants on the market but none will actually improve the health of your vagina, and prevent infections. For that you need the bioidentical hormone, Estriol.

Estriol is a very weak, naturally occurring form of estrogen that any doctor can prescribe, using a compounding pharmacist. All women, including women who have had a history of breast cancer can use vaginal Estriol safely without increasing risks of cancer.

Estriol should be used instead of vaginal Estradiol (i.e. Premarin, E ring, or Estrace), because it won’t stimulate the lining of the uterus and cause bleeding or fibroids, and it won’t increase breast cancer. It has been prescribed safely for decades by physician’s worldwide.

How do you get some? You will find Estriol over the counter as vaginal/facial creams (yes it lessens wrinkle too!). In general, these over the counter preparations can work but the doses are usually too low. The typical dose is a 1 mg Estriol suppository, prepared by a compounding pharmacy.

Ask your doctor and, if your doctor is clueless, (1) find a compounding pharmacy in your area and ask them about it and which doctors in your area are prescribing it, or (2) ask your doctor to call the compounding pharmacy and prescribe it and (3) refer your doctor to my book, The Natural Hormone Makeover, (I have lots of references in it), or (4) give your doctor this article reference to read, (Menopause 2009: 16: 978-83).

Never heard of a compounding pharmacist? They are pharmacists, trained to prepare individualized medications. They can make creams, lotions, suppositories in what ever dose your doctor recommends. Compounding pharmacists are in all states. You can locate one in your area from this website: http://www.pccarx.com/contact-us/find-a-compounder

I recommend starting with 1 mg Estriol suppositories daily for 7 to 10 days. Once the vagina and sex is comfortable again, then maintain your vaginal lining by inserting a suppository ever 2 to 3 days.

If you start using vaginal Estriol and orgasms are not as intense as they used to be explore DHEA. Have your doctor measure a DHEA-S blood level, (any lab can do this). The level should be over 150 ug/dL. I’ve posted about DHEA before- but it is a hormone made by the adrenal glands and converts into testosterone. DHEA is available over the counter, but should be monitored by your doctor.

The great news is that DHEA can safely be used vaginally to enhance orgasm. I usually prescribe 25 to 50 mg in a vaginal suppository and have women use ½ to a full suppository before sex or once per week. Its thicker than estriol so if it feels uncomfortably messy use less, or ask the compounding pharmacist to make smaller doses and use it more often. Vaginal use won’t raise your blood level so prescribe both vaginal and oral DHEA if a woman has a low DHEA-S blood level. DHEA definitely improves sex drive and vitality if your levels are low.

Don’t be scared to enter the world of bioidenticals vaginally. Educate your doctors and your friends and enjoy sex again!







17 Comments  |  Permalink  |  Posted in Adrenal Hormones, Estrogen, Hormones, Menopause, Natural Hormones, Sex, sex


There are 17 Comments

  1. Zhanna  |  April 28th, 2014

    Very interesting, however what does one do with the Vivelle Dot patch and 100mg of Progesterone? Switch them out? Or, simply add in the estriol suppositories and possibly DHEA-S?

    Thank you.

  2. Phuli Cohan  |  April 28th, 2014

    Zhanna » Simply add the Estriol suppositories. Many women using hormones transdermally still require vaginal estrogen- they seem to be different “universes.” Your estrogen levels will not rise with vaginal use.

  3. Judy Griffin  |  May 3rd, 2014

    I really appreciate this info as I am a Nutrition and Lifestyle coach focused on guiding women to Hormone Harmony. I just ordered your book and will be sharing your tips with my community.

  4. Phuli Cohan  |  May 4th, 2014

    Judy Griffin » Thanks Judy! Good luck with your project and spreading the word about how to have good health as we women age!

  5. Adrienne  |  January 21st, 2015

    Hello Dr Cohan, I was happy to find reference to you and your book, and this article on your blog. I would like to try Estriol but went to a local “Pharmaca” shop and they had no idea what Estriol is. I will take your article to my Dr. when i can go again, but I dont know how soon that will be. I looked on-line and found a discontinued product, and other products that are not suppositories. Do you know where to find the 1 mg suppositories you wrote about? I am in NM. I need to order some other supplements, and I was hoping I could ad this one on to my order. Hope you are doing well. Thanks for your blog.

  6. Phuli Cohan  |  August 22nd, 2015

    Adrienne » Yes the FDA stopped over the counter sales of Estriol a couple of years ago, but ny good compounding pharmacist can make these. Remember that the bases used by your pharmacist can vary- some are more oily, others more creamy- so talk with your pharmacist if you feel too sticky or oily with preparations- as these can be varied.

  7. Becky  |  March 12th, 2017

    Is estriol ok after hysterectomy foe endrometiral cancer stage 1 a. No further treatment was needed. I use to use estradiol capsules from compounding Pharmcy for my bladder interstial cystitis. I have read estroil would be better.

  8. Phuli Cohan  |  May 17th, 2017

    Becky » Yes Estriol is safe, but let your doctor know.

  9. Lynette  |  August 28th, 2017

    I am under 50 and experiencing the following menopausal systems: severe hot flashes, diagnosed vaginal atrophy, severe dryness, decreased libido, and chronic urinary and yeast infections. I had been on biodentical hormone replacement therapy for 7 months with only relief with hot flash symptoms.
    Three weeks ago, I began using hydration suppositories that include 3.25 mg DHEA and 2mg Estriol and am experiencing promising relief. (Increased libido, reduced dryness) Would you provide a best practice with CONTINUED application of this suppository?

  10. Phuli Cohan  |  August 3rd, 2018

    Lynette » You can use these indefinitely with doctor’s supervision i.e. balanced progesterone

  11. Martha Cannon  |  October 27th, 2017

    My wife is asking if you have a news letter ? or any on going information that is available.
    She just started on estriol 1 mg supository, we are71 & 81 and have always enjoyed a very active sex life. but the past 4 months it has been uncomfortable for her.

    thank you,


  12. Phuli Cohan  |  August 3rd, 2018

    Martha Cannon » I have good results using Tadalafil (Cialis) in women- have your doctor call Capstone Pharmacy (800-286-2014), and inquire about the Shippen protocol for vaginal dryness- works very well. Also vaginal Oxytocin can help orgasms. Compounding pharmacists can help your doctor. I hope to get a newsletter up in 2019!

  13. Debra  |  January 8th, 2018

    I had a hystorectomy 2 years ago. I tried BHRT and discovered that my blood pressure goes up when taking estrogen (BP 160/105). It will even go up if I eat any type of estrogenic foods including soy. I stay away from estrogen and my BP is beautiful (BP 100/70). I do not get hot flashes, night sweats, no mood swings…nothing. BUT, sex is horrible! Vaginal dryness and painful intercoarse is constant. I’ve been using vitamin E suppositories which has helped some. I’ve heard Estriol is an option. Just concerned that my BP will react from it. Is there anything non estrogenic that would work? Thanks

  14. Phuli Cohan  |  August 3rd, 2018

    Yes, I have good results using Tadalafil (Cialis) in women- have your doctor call Capstone Pharmacy (800-286-2014), and inquire about the Shippen protocol for vaginal dryness Debra »

  15. Vickey Khalifa  |  July 13th, 2018

    Estriol suppositories have been a miracle for me, the tissues that were thin and atrophy, are now full and plush…NO more UTI’S…I now have.a super STRONG sex drive, with multiple organisms. …I am going on 62 years young. I am more than pleased….my man CAN NOT keep up…lol.

  16. Patti Bean  |  January 24th, 2019

    I’ve been using Estriol suppositories for nearly 6 years now. They’ve been great. Just like you say, particularly for vaginal dryness. But for the last few months I’ve begun to experience a burning sensation not upon application, but in the 24-48 hours after inserting a suppository.
    That leads me to ask…is there a limit to how many years we can use these estriol suppositories? Any comments about how long they can be safely used? Any other examples of women having problems later?

  17. Phuli Cohan  |  September 5th, 2019

    I would have chat with your compounding Pharmacist about changing to a lotion.

    I often prescribe a combination of E2/E3/Testosterone in a lotion and apply internally and a little bit externally to improve sexual funciton. I use Capstone Pharmacy in PA for this, but any good compounding pharmacist will be able to help you.


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