Advancing Women's Genitourinary Health - A New Era of Care

We are excited to share some historic news from the world of women's health!

Last month, Dr. Correa attended the International Society for the Study of Women's Sexual Health (ISSWSH) conference alongside her colleagues in internal medicine & gynecology. This gathering brings together physicians and researchers dedicated to advancing women's health at all stages, including menopause.  

At this year's conference, we celebrated a landmark achievement: the removal of the boxed warning from vaginal estrogen products in November 2025. For over 20 years, these safe treatments carried an inappropriate warning that discouraged both physicians and patients from using them. This change represents a major victory for evidence-based medicine and for women who deserve access to treatments that can dramatically improve their quality of life. (Link)

Why Does this Matter?

Menopause brings many changes to the body, including to vulvar & vaginal tissues, that can significantly diminish quality of life. These changes affect more than half of postmenopausal women, yet many suffer in silence. The truth is that effective treatments exist, and carry little to no risk. Vaginal estrogen for all!!

Genitourinary Syndrome of Menopause (GUSM)

What is it?

GUSM is a chronic condition affecting the vulva, vagina, and lower urinary tract caused by declining estrogen levels. It affects around 50-80% of postmenopausal women.

Common symptoms include:

• Vaginal dryness, itching, or burning

• Pain during intercourse

• Urinary urgency or frequency

• Recurrent urinary tract infections

Treatment options:

• Non-hormonal: Over-the-counter vaginal moisturizers and lubricants, pelvic floor physical therapy.

• Hormonal: Low-dose vaginal estrogen (creams, tablets, rings) is safe and effective, improving symptoms in 60-80% of women. Other options include vaginal DHEA or oral Ospemifene. 

Why the boxed warning removal matters:

The FDA removed this warning in November 2025 because vaginal estrogen has minimal systemic absorption and no evidence of increased risks for breast cancer, heart disease, or stroke. The warning was based on studies of ORAL hormone therapy (not vaginal/topical estrogen) and resulted in us all under-treating women with GUSM.

Recurrent Urinary Tract Infection

Many postmenopausal women experience recurrent UTIs related to changes in vaginal tissue and pH. Vaginal estrogen is the first-line preventive therapy, helping restore vaginal health and reduce infection risk. Other preventive measures include adequate fluid intake, behavioral modifications, cranberry products, and D-mannose supplements.

Urinary Incontinence

Urinary incontinence affects millions of women and can significantly impact quality of life. First-line treatments include behavioral modifications, pelvic floor exercises (Kegels), and pelvic floor physical therapy. Vaginal estrogen can help with urgency symptoms. The key is that we do NOT have to accept that incontinence is a normal part of aging. It isn't.

Hot Flashes and Night Sweats

These symptoms affect 50-75% of women during menopause and typically last more than 7 (!!!) years. For women without contraindications, hormone therapy is the most effective treatment, reducing hot flash frequency by approximately 75%. Non-hormonal options include certain antidepressants, gabapentin, and fezolinetant/elinzanetant.

Taking Charge of Your Health

Evidence-based treatments are available. From vaginal estrogen (now without the misleading boxed warning) to pelvic floor therapy to newer medications, we have more tools than ever to help you feel your best.

We're here to help. We're committed to having open, honest conversations about these topics and working with you to find solutions that fit your individual needs. If vaginal estrogen cream is too messy, don't fret - there are about 100 other options to try.

Looking Forward

Removing the boxed warning from vaginal estrogen symbolizes a broader movement in recognizing women's health needs and delivering the evidence-based care we deserve. At ISSWSH and in practices like ours, physicians continue to advocate for women's genitourinary health, ensuring that every person with a vagina has access to appropriate treatments.

We're honored to be part of this movement and to serve as your partners in health, always. 

Aditi Correa, MD, MCSP

Your Partner In Health