Genitourinary Syndrome of Menopause (GSM): Improving a DRY Topic w/ Dr. Rachel Rubin | Ep. 117

"This week on BackTable Urology, Dr. Suzette Sutherland and Dr. Rachel Rubin discuss the diagnosis and treatment of genitourinary syndrome of menopause (GSM) with vaginal estrogen.
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EARN CME
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SHOW NOTES
GSM is not only a condition of ""vaginal dryness"", but rather a multi-faceted symptom set including pain with sitting, urinary frequency and urgency, bladder pain, opioid use, and recurrent UTIs. First, the doctors discuss the myths and misconceptions about the use of estrogen creams, suppositories, and rings to treat GSM . However, Suzette and Rachel also discuss the importance of advocating against the misrepresentation of vaginal estrogen in box labeling. They conclude that the benefits of using a low-dose vaginal estrogen far outweigh the risks, and doctors should advocate for better labeling and understanding of this treatment.
Suzette and Rachel also discuss the American Urologic Association (AUA) guidelines for GSM and its importance. Systemic hormone therapy is rarely enough to address GSM symptoms, so screening for GSM symptoms is essential. They also talk about estrogen therapy for special patients, such as those on hormone replacement therapy (HRT) and cancer survivors. Suzette and Rachel emphasize the importance of understanding the general hormone fluctuations of patients particularly oral contraceptives, those with disordered eating, those who are breastfeeding, and those who are transgender. They end the episode by encouraging the production of more research and data to back up treatment options for GSM in premenopausal women.
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RESOURCES
WellPrept
wellprept.com/
Femring
www.femring.com/
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[@christinemarie6976]

OTC vaginal moisturizers did help with my GSM symptoms, but it took like 3 months of use before things resolved.

[@nancyfahrenthold1870]

This podcast was great. I had two years of recurrent complicated urinary tract infections before my urologist recommended vaginal estrogen, and my symptoms finally improved with fewer additional infections. The importance of adding estrogen needs to be emphasized to primary care providers so that women get treated earlier.

[@nataliacastillovillarroel328]

I'm so grateful for listening this podcast. I'm urogynecologist in Chile and here we have the same problems you express. The overuse of antibiotics for recurrent UTI, little importance given to the genitourinary symptoms that our patients express in this stage of life. I'll take your recommendations and start prescribing local estrogen much more than I do

[@stregalilith]

Thank you so much! My elderly mother died from UTI. Now, thanks to you--not my urologist--I won't.

[@vibrantly50]

So glad this is being talked about. This issue of horrific impact didn’t hit me until my late 60’s. Looking back I can recall early signs back into my late 50’s. No one told me. I had to learn through my own research. Having a consult for Fotona Smooth laser next week! Started IntraRosa and added in systemic Testosterone 2 months ago. Feeling hopeful after feeling broken for so long.

[@shaynebetts7243]

Excellent information - Thank you for allowing us to listen in. Keep the information coning, we need this!

[@SuzaVision55]

Fantastic! Very informative. Thank you for advocating for women's health.

[@alexabernard6888]

I love and am grateful for the passion and dedication you both have!

[@Pheediep]

This is so, so good.

[@bethmbuchanan]

What are the options for a 78 year old woman with osteoporosis but healthy? Vaginal estradiol has been a lifesaver for me but do I have any other estrogen options?

[@AnnetteKoweck]

What do you suggest for lichen sclerosis? I use estrogen cream 3 times a day. Can I use it every day?

[@idakate7]

The therapies can be quite expensive if you have to pay out of pocket.

[@sorinastoian7322]

I am on systemic estrogen gel which I rub on my arm every morning. I also take vaginally micronised progesterone before bed time because I don't tolerate it orally. Can I also have vaginal estrogen? Is it gonna interfere with progesteron? Thank you

[@sheri023]

at the 30:00-minute mark she explains that vaginal low-dose estrogen is okay to use in such a case.