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Dr. Winter highlights the benefits of vaginal estrogen


"So, my takeaway with this part of the conversation is that you can use a 0.01% estradiol cream, 1 gram, twice a week, for any peri or postmenopausal patient, and they can safely take that forever," Ashley G. Winter, MD.

In this video, Ashley G. Winter, MD, highlights the benefits of vaginal estrogen for both patients and urologists. Winter is the chief medical officer of Odela Health in Los Angeles, California.

Video Transcript:

Now a few important points. One, low dose vaginal estrogen does not require any monitoring. You don't have to check somebody's blood levels of estrogen both to start using it, or to continue using it. It does not require use of a progestin or progesterone. So, people who might be educated about HRT or menopause hormone therapy know that if you have an intact uterus you have to add some sort of progestin or progesterone to a regimen. But this is so low dose that it doesn't require that. So, you can just give it on its own. Another really important thing is that all of the data that we have shows that vaginal estrogen doesn't increase the risk of blood clots. It's safe to use in somebody who with a history of blood clots, with a history of coronary artery disease, with a history of stroke. It's fine. It's also never been shown to cause breast or uterine cancer. So, again, you don't have to be worried about liability associated with administration of an estrogen when it's a low dose topical formulation. The way I tell people to think about this really is there's so much morbidity associated with, let's say, taking a high dose prednisone tablet versus a topical anti-itch hydrocortisone cream. It's wildly different. It's the same class of medications, but the amount is so different. I think we really need to reset our heads about the complexity of administering low dose topical hormones and what's in our lane as urologists, because it's so safe, and it's so easy to do.

So, my takeaway with this part of the conversation is that you can use a 0.01% estradiol cream, 1 gram, twice a week, for any peri or postmenopausal patient, and they can safely take that forever. You can set it and forget it. You do not need to do anything else. Nothing else. It is so easy. I believe, and in many countries, this is the case, that it's so safe, it should be over the counter. I think that should give people at least some comfort with prescribing it, because in my mind, it is safer than Tylenol. If you wrote a note telling a patient to take Tylenol, you wouldn't feel like that's a very complex thing to do. You should consider this on par with that, in my opinion.

The other thing I do think is so powerful and so important is that we know for a fact that bladder sensitivity to distention is modulated by estrogen. There are studies showing that when estrogen levels go down, the density of mechanoreceptors in the bladder actually go up. What that means is that in somebody who has a low estrogen state, peri or postmenopausal and overactive bladder, this is also a treatment for that and addresses root cause. So, unlike your anticholinergics for overactive bladder, a low dose vaginal estrogen can address the root cause, can prevent UTIs, can prevent overactive bladder, and it doesn't cause dry mouth, constipation, potentially dementia, all this bad stuff. It's this incredible medication, and once you start using it and using it liberally in your practice, you will notice a dramatic improvement in the quality of life of your patients, and they will be so thankful to you. It's a win-win-win-win-win. Less antibiotics, less urosepsis, less antibiotic resistance, less C diff colitis in response to overuse of antibiotics, less overactive bladder medications, less incontinence. This is why I'm a broken record about this topic. It's easy, it's safe, and it picks at so many things.

This transcription has been edited for clarity.

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