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Estrogen, commonly thought of as the "primary female hormone", is actually a group of sex hormones responsible for normal sexual and reproductive development in women, and is comprised of three major structures - estrone (E1), estradiol (E2), and estriol (E3). These estrogens exhibit varying degrees of estrogenic activity/potency and serve as the primary form of estrogen in different stages of life: 
Estradiol is the most active form (reproductive years) > estrone (menopause) > estriol (pregnancy) is the weakest.
When estrogen levels decrease, the tissue inside the vagina is unable to produce sufficient natural lubricant, and the lining becomes thin, fragile, and inflamed. This combination of a delicate lining with a lack of lubrication can lead to vulvovaginal atrophy (dryness, irritation, itching, soreness, and pain during intercourse) and concerning urinary symptoms like increased frequency, urgency, and incontinence. Approximately 50% of postmenopausal women develop one or more of these symptoms, leading to intimacy and relationship issues. However, symptoms of vulvovaginal atrophy and vaginal dryness are not limited to menopause and may cause significant emotional and physical distress in women of all ages.
This delicate topic can be difficult to discuss with your partner or best friend, let alone healthcare providers you barely interact with. Unfortunately, many providers hold negative views that are not scientifically established about hormone replacement therapy for women, or lack knowledge in treatment options and simply follow a "one-size-fits-all approach" - leaving millions of women to suffer in silence. The good news is that, at Optim U, we take a personalized approach to explore ALL options, FDA-approved and off-label, to create a treatment plan tailored specifically to YOU!
 
Estradiol vaginal cream stimulates the tissue inside the vagina to restore the vaginal lining and increase lubrication. Estriol may also be combined with estradiol to create custom Biestrogen vaginal creams which provide dosing personalized for your body and lower potencies. Compared to estradiol pills, vaginal creams exhibit less systemic actions and limited side effects, making them the treatment of choice for women with localized vaginal symptoms. Sometimes, vaginal creams may be added in women who continue to experience genitourinary symptoms while on systemic estrogen therapy.
 
Progesterone is a natural hormone produced by the corpus luteum in the ovaries, that is responsible for regulating the menstrual cycle and supporting pregnancy. All women with an intact uterus require the addition of a progestin to their systemic estrogen therapy to prevent endometrial hyperplasia, which may be a precursor to endometrial cancer. Women who have undergone hysterectomy should not receive progestins, as there are no other health benefits other than prevention of endometrial hyperplasia/cancer. In most cases, women taking only low-dose vaginal estrogen do not require progestin.
Oral progesterone, which is bio-identical to progesterone produced by the body, is the preferred choice for progestin therapy. Natural progesterone is believed to have fewer side effects, and be safer for cardiovascular and breast health compared to other synthetic progestins (i.e. levonorgestrel). Although oral progesterone can be taken in a cyclic regimen (12 days/month) to mimic the premenopausal menstrual cycle, most women prefer a continuous combined regimen with estrogen (100 mg daily) to avoid monthly withdrawal bleeding. Women who are not able to tolerate oral progestins, or those in whom oral progestins are contraindicated, may use vaginal progesterone.
 
Although estrogen and progesterone are the primary female sex hormones, testosterone is produced 3-4 times more by the ovaries than estrogen and is the most abundant biologically active sex hormone throughout the female lifespan. Testosterone and other androgens serve as the immediate precursors to estrogen synthesis in the body and have crucial roles in libido, maintaining muscle mass and bone density, mood and energy levels, and fertility in women. Although decreasing serum testosterone levels in men is well-documented, far less attention has been given to declining levels in women, who experience steep drops in serum testosterone much earlier than their male counterparts. Androgen-deficiency in pre- and post-menopausal women is often misdiagnosed and treated with estrogens as a consequence of symptoms analogous to estrogen-deficiency: hot flashes, night sweats, decreased libido, vaginal dryness, difficulty reaching orgasm, irritability, anxiety/depression, fatigue, a decreased feeling of well-being, poor memory, poor focus/concentration, insomnia, muscle weakness, joint pains, thinning hair, urinary complaints, and incontinence. In addition to the age-related decline in testosterone, oral estrogens increase levels of sex hormone-binding globulin (SHBG), dropping free testosterone concentrations even lower. Unfortunately, androgens have commonly been associated with "masculinity", male features, and bodybuilding, which has contributed to negative and innacurate perceptions regarding the role testosterone in women. The stigma surrounding testosterone has left women in the United States without any FDA-approved testosterone treatments, despite being used to treat women in other countries for nearly a century. Growing evidence has emerged which supports the use of testosterone therapy in women for sexual function and desire, osteoporosis prevention, brain protection, and breast protection. Recent studies have proven that intravaginal testosterone significantly improves frequency of sexual satisfaction, libido/desire, arousal, pleasure, orgasm, stimulation, vaginal dryness, and pain with intercourse, without raising serum hormone levels. 
 
At Optim U, we understand that every woman's body is unique. Finding the right treatment may require adjustments in dosage and/or formulation. We offer a variety of vaginal creams and doses to help you find a treatment specific for your body and needs:
Estradiol (E2)
Estradiol + Progesterone + Testosterone
Estradiol + Testosterone
Biestrogen (estriol:estradiol)
Biestrogen (estriol:estradiol) + Progesterone
Biestrogen (estriol:estradiol) + Testosterone
Biestrogen (estriol:estradiol) + Progesterone + Testosterone​​​​​​​