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BackTable / OBGYN / Podcast / Episode #33

Genitourinary Syndrome of Menopause (GSM): Improving a DRY Topic

with Dr. Rachel Rubin

This week on BackTable OBGYN, 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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Genitourinary Syndrome of Menopause (GSM): Improving a DRY Topic with Dr. Rachel Rubin on the BackTable OBGYN Podcast)
Ep 33 Genitourinary Syndrome of Menopause (GSM): Improving a DRY Topic with Dr. Rachel Rubin
00:00 / 01:04

BackTable, LLC (Producer). (2023, September 18). Ep. 33 – Genitourinary Syndrome of Menopause (GSM): Improving a DRY Topic [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Rachel Rubin discusses Genitourinary Syndrome of Menopause (GSM): Improving a DRY Topic on the BackTable 33 Podcast

Dr. Rachel Rubin

Dr. Rachel Rubin is a urologist and sexual medicine specialist in North Bethesda, Maryland.

Dr. Suzette Sutherland discusses Genitourinary Syndrome of Menopause (GSM): Improving a DRY Topic on the BackTable 33 Podcast

Dr. Suzette Sutherland

Dr. Suzette Sutherland is the director of female urology with UW Medicine in Seattle, Washington.

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.

Resources

Transcript Preview

[Dr. Rachel Rubin]
You know what's so fascinating? I think we went wrong in a lot of ways trying to understand this. I think we went wrong with calling this a little vaginal dryness, right? A little vaginal dryness means it's okay, lady, suck it up, use a lubricant, use a moisturizer. It's no big deal. You're okay. GSM, genitourinary syndrome of menopause is not a little vaginal dryness. It's pain with sitting. It's pain with pants. It's urinary frequency and urgency. It's bladder pain. It's opioid use. It's literally not being able to be intimate with your partner who you love so very much because it feels like shards of glass. It's recurrent urinary tract infections, which can get you with a PICC line needing IV antibiotics because you have resistance, and so this idea of, oh, well, we don't know the dangers of vaginal estrogen.

There is no data showing danger to vaginal estrogen, but there is a lot of data showing how dangerous genitourinary syndrome of menopause can be. Take a medicine like Tamoxifen, okay? We use Tamoxifen. It's another CIRM for breast cancer prevention. It can cause uterine cancer. It can cause blood clots. It can cause osteoporosis and what do we say? Well, it's going to prevent your risk of getting a breast cancer recurrence, so the benefits outweigh the risk. How can we say that about Tamoxifen, but then say that vaginal hormones, the benefits don't outweigh the risk? Oh my God, the benefits outweigh the risk time and time again because no one can show me a paper that shows actual risk, right? That's the part that I can't understand is how this is so obvious. It's so easy. It's so available and has been since the 1970s, but the reason we're not pushing it and doing it, it's because we're not selling it. We don't even find it important enough. That's where the advocacy must come in.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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