Yahir A. Santiago-Lastra, MD, discusses barriers to vaginal estrogen access

At the 2025 American Urological Association Annual Advocacy Summit, Yahir A. Santiago-Lastra, MD, gave a talk regarding the use of vaginal estrogen. In an interview with Urology Times®, Santiago-Lastra provided an overview of her talk.

“The key takeaways from the Advocacy Summit were that there is momentum and interest with regards to this problem that's coming not only from the urology community, but is also coming from the patients themselves. We have a baby boomer generation, generation X, and millennial generation that are all either in perimenopause or beyond. Those are millions of women. They are working and living more than ever before, and they experience genitourinary syndrome of menopause, and so the black box warning affects that ability for them to get access to that critical drug, vaginal estrogen,” said Santiago-Lastra, a urogynecologist and an associate professor of urology at the University of California, San Diego.

During the interview, Santiago-Lastra described the barriers that exist regarding women receiving vaginal estrogen.

“A lot of physicians don't know that genitourinary syndrome of menopause can encompass a lot more than just classic menopause symptoms. It can also include bladder symptoms, urgency, frequency, dysuria, and then it can also include urinary tract infections, and so because there isn't that knowledge base, the lack of prescribing of the medication affects women,” Santiago-Lastra said.

She added, “There are already systemic barriers in place that prevent a lot of patients from receiving important treatments that they need. Prior authorization [is one example]. [In addition, there is] the urologist shortage. So many counties in the United States don't actually have a practicing urologist and menopause/vulvar health/vulvar care is not something that has been widely taught to physicians and honestly, sometimes not even taught precisely to gynecologists or urologists, and you would think that that would be their domain.”

Finally, Santiago-Lastra said, there is the black box warning.

“Historically, there has been some risk assigned to vaginal estrogen that is not evidenced by data. The black box warning applies to all estrogen products, including the vaginal, and it really is a totally different beast with completely different risk,” she said.