This week’s issue is dedicated to addressing common issues that arise during menopause, triggered by a drop in estrogen levels.

As a reminder, Ajenda partnered with Alloy Women’s Health in November for our Listening Tour in New York City, where we had open, honest conversations about life after menopause—and why it’s SO worth living! Today, Ajenda is partnering with Alloy once again in this week’s issue to continue this important conversation.

Alloy, a smart, women-owned company, is dedicated to frank discussions and practical solutions for navigating menopause. They have done an incredible job bringing expert care and prescription-based treatments for issues like hair loss, skin changes, and vaginal dryness directly to women—without the barriers to accessing providers so often found in traditional healthcare. Many doctors are unfamiliar with prescribing treatments like Minoxidil or estriol cream for the face, leaving patients with responses like, “Sorry, I don’t prescribe that” or “That’s not an option.”

One of the standout benefits of working with Alloy is that all members with an active prescription receive 24/7 asynchronous care with their menopause-trained doctor at no extra charge. Members also gain access to the Alloy community, including support groups led by their Community Manager, Rachel Hughes, where they can connect with other women navigating similar challenges.

Alloy is a one-stop solution for menopause care, offering education, expertise, and safe, science-backed solutions for perimenopause and menopause symptoms, skincare, and sexual health. Treatment plans are customized, everything is delivered with free shipping, and members get unlimited follow-up care with their physician throughout the duration of their prescription.

The key is knowing what options exist, understanding their pros and cons, and deciding if they are right for you.

So, that’s what’s on the Ajenda today: treatment options for some of the most common symptoms of perimenopause and menopause!

TODAY’S DOSE OF HONESTY

The Pros and Cons of Low-Dose Oral Minoxidil for Women

As many of you know, I’ve been on my own thinning hair journey over the past four years. My breakage and thinning were caused by a perfect storm of factors: entering menopause, not getting enough protein in my diet, daily professional styling damage from being on television, having had COVID, and highlighting my hair every three months. Finally, my hair has been revived—but it took throwing everything (and the kitchen sink) at the problem. One thing that helped me was taking a low-dose prescription of oral Minoxidil, recommended and prescribed by my board-certified dermatologist.

Minoxidil, originally developed as an oral treatment for high blood pressure, has long been used topically to combat hair loss. In recent years, low-dose oral Minoxidil (typically ranging from 0.25 to 5 mg daily) has gained attention as an off-label option for women seeking hair regrowth.

Alloy’s low-dose Minoxidil is designed specifically for women, offering a convenient alternative to topical solutions. It also includes vitamin D, which supports overall scalp health and complements the treatment’s effectiveness.

At Alloy, menopause-trained physicians guide women considering low-dose Minoxidil. Through personalized consultations, doctors ensure each treatment plan is safe, effective, and tailored to individual needs. This expert guidance provides an additional layer of confidence for women exploring this option.

Here’s your Dose of Honesty on the pros and cons of Minoxidil for hair loss in women, backed by scientific evidence.

Pros:

1. Efficacy in Female Pattern Hair Loss

   • Several small studies and case reports suggest that low-dose Minoxidil can improve hair density in women with female pattern hair loss (androgenetic alopecia). A 2019 study in the Journal of the American Academy of Dermatology reported increased hair growth and high patient satisfaction with daily oral Minoxidil.

2. More Convenient Than Topical Minoxidil

   • Many women find twice-daily topical Minoxidil messy or irritating, leading to inconsistent use.

   • A once-daily pill is easier to incorporate into a routine.

   • Oral Minoxidil bypasses common scalp issues associated with topical use, such as dryness, flaking, and irritation.

3. Lower Risk of Systemic Side Effects Compared to Standard Doses

   • While high-dose oral Minoxidil can cause significant cardiovascular effects, low-dose regimens appear more manageable. A 2020 review in Dermatologic Therapy found that while side effects can still occur, they are often mild and dose-dependent.

Explore Alloy’s low-dose Minoxidil as an option for those looking for a simplified hair regrowth solution.

Cons:

1. Possible Side Effects

   • Hypertrichosis (Excess Hair Growth): Some women experience unwanted hair growth on the face, arms, or other areas. While frustrating, this is dose-dependent and reversible upon discontinuation or dose adjustment.

   • Fluid Retention & Mild Swelling: Some users report puffiness in the face, ankles, or hands.

   • Cardiovascular Effects: Though rare at low doses, Minoxidil can lower blood pressure or cause palpitations in sensitive individuals.

2. Limited Long-Term Data

   • Although early research is promising, large-scale, long-term studies on low-dose oral Minoxidil in women are still limited. More clinical trials are needed to confirm the optimal dose, long-term safety, and effectiveness.'

3. Off-Label Use

   • Oral Minoxidil is not FDA-approved for hair loss, meaning its use in this context is off-label. Women interested in this therapy should work with a qualified healthcare provider, like those at Alloy, who are experienced with prescribing it.

     Important Note: Women require a lower dose than men, meaning Minoxidil for women must be compounded (i.e., you can’t simply cut a men’s Minoxidil tablet in half—it would still be too high a dose).

     Learn more about Alloy’s compounded low-dose Minoxidil here.

4. Results Vary by Individual

   • As with any hair loss treatment, results differ from person to person. Some women see significant regrowth, while others experience minimal change or intolerable side effects. Additional factors like hormonal imbalances, stress, and diet may also influence effectiveness.

Key Takeaways

• Low-dose oral Minoxidil offers an effective and convenient alternative for women who struggle with topical Minoxidil or prefer a once-daily pill.

• Early studies and clinical experience indicate promising results, especially for female pattern hair loss.

• Side effects—including unwanted hair growth, fluid retention, and cardiovascular symptoms—are typically milder at lower doses but still possible.

• Given its off-label status and limited long-term research, women considering low-dose oral Minoxidil should consult a qualified healthcare professional to weigh the benefits, risks, and potential interactions.

Interested in trying low-dose oral Minoxidil? Check out Alloy’s custom-formulated low-dose Minoxidil for women.

SYMPTOM SOLUTIONS

Estriol & Tretinoin for Perimenopausal & Menopausal Skin

Crepey Skin? If You Know, You Know!

There’s a real physiological reason behind it: collagen in the skin declines by 30% in the first five years of menopause and continues to decrease by 2% each year thereafter. The drop in estrogen leads to:

• Collagen loss

• Decreased elasticity

• Slower cell turnover

• Reduced moisture retention

The result? Crepey, thinning, dry skin.

A while back, I posted an Instagram Live about using vaginal estradiol cream on the face, and my feed blew up. Here’s the truth: Your skin doesn’t know what words are printed on a tube of cream.

While I personally used vaginal estradiol, innovative companies like Alloy are now formulating topical estriol creams specifically designed for facial use. Estriol, a gentler form of estrogen, is the approved form of estrogen in European formulations of vaginal estrogen creams. Alloy’s M4 cream incorporates estriol with additional skin-beneficial ingredients, offering a tailored solution for menopausal skin concerns.

This week’s Symptom Solution is all about Estriol and Tretinoin creams—two evidence-backed treatments that can help improve skin health during perimenopause and menopause.

How Menopause Affects Skin

After menopause, many women experience significant changes in their skin, including:

• Increased dryness & dehydration

• Loss of elasticity & firmness

• Thinner skin & more visible fine lines

• Worsening of sun damage & uneven texture

These changes happen due to lower estrogen levels and natural aging, which slow down collagen production and impair the skin’s ability to retain moisture.

Fortunately, two science-backed topical treatments—estriol cream and tretinoin—have been shown to restore hydration, improve elasticity, and support collagen production.

Estrogen Cream: How It Helps Post-Menopausal Skin

1. Restores Skin Thickness & Elasticity

   • Estrogen & Collagen Production: Studies have linked estrogen deficiency to decreased collagen content in the skin. A 2012 study published in Dermato-Endocrinology found that post-menopausal women using topical estrogen experienced increased collagen density and improved skin elasticity—showing a direct connection between estrogen and skin integrity.

   • Strengthens the Skin Barrier: Alloy’s topical estriol cream helps enhance hydration and reduce moisture loss, combating dryness and flakiness, two of the most common complaints after menopause.

2. Improves Hydration & Texture

   • Boosts Moisture Retention: Many post-menopausal women struggle with dry, itchy skin. Alloy’s estriol cream helps the skin retain moisture, leading to a smoother, more supple appearance over time.

   • Supports Skin Regeneration: Research (Menopause, 2016) suggests that topical estrogen may aid in wound healing and skin repair, further reinforcing its regenerative potential.

3. Considerations & Safety

   • Off-Label Use: While estradiol vaginal creams are FDA-approved for genitourinary symptoms of menopause, using them on the face for skin rejuvenation is considered off-label. Alloy’s topical estriol cream is formulated for facial application, making it a convenient and effective option.

   • No Systemic Absorption: Research suggests that when used sparingly on the face, estradiol does NOT enter the bloodstream in significant amounts—meaning no breast or uterine stimulation and no increase in serum estradiol levels.

   • Potential Side Effects: Some women may experience localized irritation, but side effects are typically mild and manageable.

Tretinoin: The Gold Standard for Skin Renewal

1. Stimulates Cell Turnover & Collagen Production

   • A Powerful Vitamin A Derivative: Tretinoin (retinoic acid) is one of the most well-researched ingredients for reducing fine lines, hyperpigmentation, and improving skin texture.

   • Clinically Proven: Studies in the Journal of the American Academy of Dermatology confirm that tretinoin significantly reduces wrinkles and evens skin tone with long-term use.

2. Fights Photoaging (Sun Damage)

   • Targets Sun-Damaged Skin: Many post-menopausal women have visible sun damage accumulated over decades. Alloy’s tretinoin cream has been shown to reverse signs of photoaging, including blotchy pigmentation and rough texture.

   • Long-Term Benefits: Unlike many skincare ingredients that offer short-term results, tretinoin continues to improve skin over time with consistent use.

3. Considerations & Safety

   • Potential Irritation: Common side effects include dryness, flaking, and redness, especially when starting tretinoin. Using a gentle cleanser, fragrance-free moisturizer, and daily sunscreen can help minimize irritation.

   • Requires a Prescription: Unlike over-the-counter retinol, tretinoin is prescription-strength. Alloy offers access to tretinoin through their platform—so you can get dermatologist-backed care without an in-person visit. Learn more here.

Can You Use Estriol & Tretinoin Together?

 YES—when used correctly!

Combining estriol cream and tretinoin (under medical supervision) may enhance overall results by addressing both hormonal aging and intrinsic aging:

• Estriol helps restore hydration, elasticity, and collagen.

• Tretinoin boosts cellular turnover and reverses sun damage.

However, since both treatments can be potent, it’s best to:

• Introduce one product at a time

• Start with low concentrations

• Monitor for irritation

• Always use sunscreen daily

Explore Alloy’s dermatologist-approved combination of topical estriol & tretinoin here.

Final Thoughts

For perimenopausal and post-menopausal women, estrogen cream and tretinoin are powerful tools for restoring hydration, improving elasticity, boosting collagen, and reducing fine lines.

Want to start a science-backed menopause skincare routine? Alloy makes it simple with their topical estriol & tretinoin treatments —available through online consultation with licensed medical providers.

COMMUNITY

Q: My libido is low and sex can be uncomfortable- what can I do?

A: Attributed to Alloy Women’s Health Medical Advisor/Prescribing Physician, Dr. Corinne Menn.

Changes in sexual health are common during perimenopause and menopause and can include painful sex, vaginal dryness, decreased arousal, low desire, and reduced libido. Many women experience these symptoms, yet far too often, they are not offered treatment options.

Step 1: Address Physical Symptoms First

If sex is painful, your brain—your biggest sex organ—will not desire it! The physical changes associated with menopause-related sexual dysfunction are known as genitourinary syndrome of menopause (GSM) and are primarily caused by the loss of estrogen.

The vagina, vulva, and clitoris are full of estrogen and androgen receptors, and the dramatic decline in hormone levels at menopause leads to profound tissue changes. Just like the vagina, the vulvar and clitoral tissue becomes thinner, receives less blood flow, produces less lubrication, and becomes less sensitive.

Vaginal estrogen, which we offer at Alloy, is FDA-approved for the treatment of GSM. With consistent use, it can restore the health of the vagina, vulva, and clitoris. It is low-dose, not systemically absorbed, meaning it treats only the local tissue where it is applied and is safe for nearly all women.

Non-hormonal vaginal moisturizers and lubricants can also play a role, but they do not replace vaginal estrogen in effectively treating GSM.

Step 2: Address Low Desire & Arousal

Once we alleviate painful sex, we can focus on desire and arousal. There are newer FDA-approved medications, such as Flibanserin and Bremelanotide, as well as off-label low-dose testosterone, that specifically target hypoactive sexual desire disorder (HSDD) in women.

The Clitoral Connection: Why Blood Flow Matters

The clitoris functions similarly to a penis—it requires good blood flow to work properly. While vaginal estrogen can help, we have additional tools like topical sildenafil to further enhance blood flow.

For decades, sildenafil (Viagra) has been available exclusively for men, helping millions maintain healthy erections. Meanwhile, their female partners in menopause have been left struggling with vaginal dryness, painful sex, and decreased sensitivity.

Now, there’s a solution: Alloy’s O-mazing Cream™. This topical cream combines sildenafil (the same active ingredient in Viagra) with pentoxifylline and ergoloid mesylate, which work together to:

• Increase blood flow

• Stimulate natural lubrication

• Heighten physical sensations

• Enhance orgasm intensity

For many women, O-mazing Cream™ can be a game-changer for sexual satisfaction and pleasure.

Step 3: Think Holistically About Sexual Health

Sexual function is influenced by biological, psychological, and social factors. Relationship dynamics, mental health, and cultural attitudes about sex and menopause can all impact desire and libido.

Additionally, managing overall menopause symptoms is key. If you’re not sleeping, experiencing hot flashes and night sweats, or struggling with mood changes, sex may be the last thing on your mind.

Finally, sexual and cardiac health are closely linked. Regular exercise and limiting alcohol consumption can support both heart health and sexual function.

The Bottom Line

Menopause does not have to mean the end of a fulfilling sex life. Targeted treatments like vaginal estrogen, O-mazing Cream™, and FDA-approved medications can help address the physical causes of discomfort and low libido, while a holistic approach ensures overall well-being.

💡 Ready to take control of your sexual health? Learn more about Alloy’s vaginal estrogen and O-mazing Cream™ today!

Special offer just for you!

Click here to learn more about Alloy Women’s Health; if you decide to buy, enter the code AJENDA at checkout for $25 off your first purchase!

ABOUT DR. JEN

In her former roles as chief medical correspondent for ABC News and on-air cohost of “GMA3: What You Need to Know,” Dr. Jennifer Ashton—”Dr. Jen”—has shared the latest health news and information with millions of viewers nationwide. As an OB-GYN, nutritionist, and board-certified obesity medicine specialist, she is passionate about promoting optimal health for “the whole woman.” She has authored several books, including the national best-seller, The Self-Care Solution: A Year of Becoming Happier, Healthier & Fitter—One Month at a Time. And she has gone through menopause…

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