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BackTable / Urology / Podcast / Episode #251
Evaluating Hormone Therapy in Menopause Management
with Dr. Yahir Santiago-Lastra
Is one outdated warning label standing between millions of women and safe, effective care? In this episode of BackTable Urology, Dr. Yahir Santiago-Lastra, a urologist specializing in female pelvic medicine and reconstructive surgery at UC San Diego, joins host Dr. Suzette Sutherland to discuss the black box warning on vaginal estrogen, its historical context, and the ongoing advocacy efforts to update outdated FDA guidelines
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BackTable, LLC (Producer). (2025, July 29). Ep. 251 – Evaluating Hormone Therapy in Menopause Management [Audio podcast]. Retrieved from https://www.backtable.com
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Podcast Contributors
Synopsis
The conversation covers the importance of low-dose vaginal estrogen in treating genitourinary syndrome of menopause (GSM), the fear surrounding hormone therapy due to misinterpreted data from the Women's Health Initiative (WHI) study, and the inequities faced in women's health, particularly in the context of hormone replacement therapies. They discuss the legislative and advocacy strategies needed to enact change, emphasizing the role of professional societies, legislative efforts, patient advocacy, and industry support in overcoming the barriers to updating the black box warning
Timestamps
00:00 - Introduction
03:43 - History Behind the Estradiol Black Box Warning
13:44 - The FDA Citizen Petition
18:18 - Gender Inequity in Medicine
24:05 - The Role of Organizational Guidelines in Patient Advocacy
28:51 - Vaginal Estrogen for Genitourinary Syndrome of Menopause (GSM)
32:57 - Medicare Spending and Legislative Advocacy
44:56 - Recap and Future Directions
Resources
(TRAVERSE Trial) Cardiovascular Safety of Testosterone-Replacement Therapy
https://www.nejm.org/doi/full/10.1056/NEJMoa2215025
Systemic or Vaginal Hormone Therapy After Early Breast Cancer: A Danish Observational Cohort Study
https://doi.org/10.1093/jnci/djac112
(ASCO Study) Use of local estrogen therapy among breast cancer patients in SEER-MHOS database
https://doi.org/10.1200/JCO.2025.43.16_suppl.578
Vaginal estrogen use in breast cancer survivors: a systematic review and meta-analysis of recurrence and mortality risks
https://doi.org/10.1016/j.ajog.2024.10.054
The Materials available on BackTable 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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