Vaginal Hormone Therapy For Genitourinary Syndrome Of Menopause: Practical Guidance For Urology

Diane K. Newman, DNP, ANP-BC, FAAN, FAUNA, BCB-PMD, Urology and Pelvic Floor Nurse Specialist, University of Pennsylvania, Philadelphia, Pennsylvania, Adjunct Professor of Surgery Division of Urology, Perelman School of Medicine Emerita, introduces Rachel Rubin, MD, Assistant Clinical Professor of Urology at Georgetown University, Washington, DC, an expert in Genitourinary Syndrome of Menopause (GSM). Dr. Rubin opens with a bold message: GSM is not minor—it contributes significantly to recurrent urinary tract infections (UTIs), sepsis, morbidity, and healthcare costs (estimated at $6–22 billion/year). Dr. Rubin champions immediate action using simple, low-cost vaginal estrogen therapies. Her primary recommendation is to prescribe generic vaginal estradiol cream (~$13/tube) at 1g twice weekly. For patients averse to creams, 10 µg vaginal estrogen tablets are equally effective. She stresses that vaginal estrogen is not experimental—it’s evidence-based and essential, endorsed in the 2025 AUA/SUFU/AUGS Guideline on GSM. She urges clinicians to screen actively, diagnose confidently using history, exam, and pH testing, and initiate shared decision-making. Dr. Rubin also describes her advocacy efforts—including confronting misleading FDA black-box warnings—and her role in the rapid development of the AUA guideline. She provides a QR code with a direct link to a webinar on how to provide GSM therapy. She underlines that vaginal hormones are safe, preventive, therapeutic, and life-saving. Don't forget to join the GRU Community: https://grandroundsinurology.com/regi... Follow us on Twitter/X: https://x.com/GRUrology And like and subscribe to us here on YouTube!