PHILADELPHIA — Robyn Faye, an authorized menopause therapist, left her job as a midwife over a decade ago to give attention to menopause, sexual health and gender-affirming care. In 2015, she became only the second physician in Pennsylvania to be certified as a sexuality counselor by the American Association of Sexuality Educators, Counselors and Therapists (AASECT).
Faye said she decided to return to high school to grow to be a sexuality counselor on the University of Michigan because a lot of her patients were having trouble with intimacy. “I realized I had no one to ask when it came to sexual health,” Faye said.
Faye spoke to The Inquirer concerning the hormonal lava lamp inside us, how we enjoy intimacy as we age, and the recommendation she once received from the late sex therapist Ruth Westheimer, “Dr. Ruth.”
This conversation has been edited for length and clarity.
Women with symptoms – hot flashes, night sweats, difficulty concentrating, mood swings and insomnia – often complain that they’re “going through menopause”, but that just isn’t entirely true. Can you explain?
Menopause is once you don't have a period in any respect for 12 months. Menopause only lasts a 12 months, so it's a misnomer to say, “I'm in menopause.” Most women come to my office during perimenopause, which normally starts five to 10 years before menopause. That's the transition period, the difficult time when your hormones are like a lava lamp. You're all tousled, and that's the worst time. The average age that perimenopause starts is 51 or 52, but symptoms can start even earlier.
What is hormone substitute therapy (HRT)?
We actually call it hormone therapy because we're not replacing the precise dose of hormones you had as a young woman when your ovaries were working at full speed. Hormone therapy uses estrogen and progesterone. The mostly used estrogen is estradiol, which is certainly one of the estrogens your ovaries used to provide. We use a natural progesterone called prometrium, which is comprised of peanuts, unless someone has an allergy. We also use testosterone, which is a sex hormone produced by your ovaries and adrenal glands, and production declines as you age. When we start hormone therapy, I don't start with all three – estrogen, progesterone, testosterone. I see how someone is doing symptomatically by giving just estrogen and progesterone. The foremost reason for hormone therapy is to alleviate vasomotor symptoms like hot flashes and night sweats.
Would you recommend it? Some women fear that their risk of breast cancer will increase.
You've been taking estrogen all of your life, so what's the danger? Studies have shown that for each 1,000 women treated, there's one extra case of breast cancer per 12 months, and for five years of taking it, there's three extra cases. The risk is analogous to drinking two drinks a day and never being very energetic. In fact, the danger could be very small. The bottom line is that it makes perfect sense to take it in the course of the 10-year window that begins when someone starts having irregular periods. For quality of life, it's definitely price taking it.
Does it help with brain fog? How are you able to tell brain fog from dementia?
Hormone therapy just isn’t really useful for stopping or slowing cognitive decline. But if someone actually tells me, “I have all these other symptoms, including brain fog,” I've found that I can successfully alleviate their symptoms. But if the one symptom is brain fog and there's a family history of dementia, I'm more concerned that there's something else happening. I’d try hormone therapy for 3 months, but when it doesn't improve, I'll send them to a neurologist.
What do you recommend to women that suffer from vaginal dryness?
We discuss moisturizing and lubrication. Once you undergo menopause, you lose the natural ability to retain moisture. We have over-the-counter moisturizers and prescription vaginal estrogen, which is best since it's also been shown to scale back the danger of urinary tract infections (UTIs). Lubricants, that are a complete different thing, can prevent painful intercourse. Lubricants must be either water-based or pH-balanced. You have to have a look at the label. I even have to offer them a complete lecture on it. I ask them, “Who buys your lubricants?” they usually say, “Oh, my husband,” and I ask, “Do you let them buy your bras?” Yes, he was in chemistry class, but he doesn't know what the pH of the vagina is. If he knows, then mazel tov, but more often than not he doesn't.
What do you consider the recent study that shows toxic metals in tampons? Should women stop using them?
I'm really excited by that. Most of my patients use menstrual cups and never tampons. That's really scary, but like several study, more studies should be done. I’d advise people to make use of fewer tampons, possibly only on heavy menstrual days. I don't think I'm going to say outright, “Oh my God, everyone stop using tampons.” There definitely should be more studies done before we panic.
You focus on women in transition. Can you explain that in additional detail?
I treat transgender people in my practice. I offer hormone treatments to gender diverse people. I prescribe sex hormones and supply gender reassignment care. These are medications for female-to-male hormone therapy. There are other ways to do that—I can prescribe an oral pill, an injection, an implant, or a patch. Not everyone has abdominal surgery, so that they still should be seen by a gynecologist even in the event that they are actually male. I still do breast exams and annual Pap smears, and prescribe mammograms when needed. We also discuss protected sex and contraception. I advocate for inclusive, considerate, and affirming look after transgender patients. Patients must find a way to are available in and ask questions and never feel like someone is judging them.
Tell me concerning the time you were on a Zoom call with “Dr. Ruth.”
I had emailed her to ask her an issue, and he or she was kind enough to talk with me over Zoom in May 2020. The query was something about sexual dysfunction and how you can talk over with my older ladies about sexual health. I even have ladies of their 80s coming in from The Villages in Florida (a 55+ community known for, um, romance). They come every six months and have the most effective sex ever. But certainly one of them was struggling and was a little bit more prudish than her friends. I assumed, “You know what? You should ask Dr. Ruth.” She was awesome and told me to talk over with them the way in which you talk over with your 60- or 40-year-olds.
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