“We really wanted to give the general urologist the tools to go back to the clinic the next day and say, "I know how to prescribe this. I know where to prescribe it. I know the cheapest options. I know the best deals around and I know how to talk to patients about the risks and the benefits,” says Rachel S. Rubin, MD.
In this video, Rachel S. Rubin, MD, discusses the recent 2023 American Urological Association Annual Meeting course, "Navigating Genitourinary Syndrome of Menopause: Path to Patient Satisfaction.” Rubin is a urologist and sexual medicine specialist in private practice in Rockville, Maryland and also an assistant clinical professor in urology at Georgetown University Hospital, Washington, DC.
We had such a wonderful course. The guidelines chair Melissa Kaufman [, MD, PhD, FACS], Una Lee [, MD, FPMRS], and myself were asked to do this course on genitourinary syndrome of menopause. And really, what it did was give high-yield tools. Anyone can watch it on demand now, and I encourage everyone to do so. We really wanted to give the general urologist the tools to go back to the clinic the next day and say, "I know how to prescribe this. I know where to prescribe it. I know the cheapest options. I know the best deals around and I know how to talk to patients about the risks and the benefits." Because the thing is, this has been around since the 1970s. Urologists have known about this. Everything's a sell. We sell patients on prostatectomies, we sell patients on wildly crazy BPH surgeries that are brand new; we are very good salespeople. But unless we sell vaginal hormones to patients to say, "This will be the foundational treatment to cure your urinary frequency, urgency, and your urinary tract infection, like wearing your seatbelt for prevention, like putting moisturizer on your face or sunscreen on your body, it will only work if you continue to use this. And the tissue needs hormones to be healthy and strong to have a healthy microbiome to prevent infections." And so we teach people how to do it, how to write the prescription, how to warn them about different side effects, how to talk about creams vs inserts vs rings, how cheap they are, what pharmacies to go through. Mark Cuban's pharmacy and GoodRx are the cheapest in town; you can get a tube of estradiol cream for 20 bucks, which lasts 2 and a half months. So barriers that doctors used to have about costs are decreasing. It's really important that we continue to advocate for these products and get insurance companies to know [that if they] want to save money on hospitalizations for urinary tract infections, they should cover things like vaginal DHEA and vaginal estrogen. Medicare charges hundreds of dollars for these products. And that's where the advocacy work absolutely needs to change. And for any advocacy people listening, we really need change at the FDA level because there's box labeling on some of these vaginal hormone products that says, just like Viagra [sildenafil citrate] says it could cause priapism, but we know it doesn't, that it causes stroke and blood clots and heart attacks and dementia. None of that is true. All of that is based on false data. If you took a birth control pill, which vaginal estrogen product is nothing like a birth control pill. And so patients go home, they read the box, they get nervous. But even that is not true data. So we have to go to the FDA level to make change. And so there's a lot of work to be done in this space but actually a lot of lives that we can save. The problem is the marketing out there is, "Oh, it's just a little vaginal dryness. These women are okay, no big deal. Just a little vaginal dryness; use some lubricant or moisturizer." It's not just a little vaginal dryness. It has been the worst PR campaign ever. It is urinary tract infections, pain with sitting, pain with sex, pain with wearing pants. This is where the messaging has to go. But it's not so easy for people to talk about their vaginal pain or their urinary symptoms. And so we really have to get people to make the connection that now you're 70, this is actually due to menopause even though that happened when you were 50. Even 20 years later, these are still the issues of menopause. We have to teach urologists how to work on their sales pitch. And that's really what we tried to do in that course by presenting different challenging cases that you'll see every day in your clinic and how we go about advocating for our patients.
This transcription was edited for clarity.