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

[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.