The No-Brainer Menopause Treatment Nobody Is Talking About – Oprah Mag

There is a quiet crisis brewing in womens health, and it goes by three little letters: GSM. Genitourinary syndrome of menopause, a mouthful of a term, affects millions of women each yearas many as a whopping 84 percent of women during and following the menopausal transition.

GSM encompasses a series of chronic, progressive symptoms that affect the vagina and vulva as well as the bladder and urinary tract. A direct result of decreased estrogen, GSM can cause

Left untreated, GSM wreaks havoc on U.S. healthcare costs, too, costing the system billions. A recent study showed that collateral medical expenses for older Medicare patients who experience recurring UTIs could balloon as high as $22 billion.

Given that we are in a watershed moment for menopauseand given the growing public recognition that systemic menopausal hormone therapy offers myriad collateral benefits to bone, brain, and heart healththe marginalization of GSM is even more striking, and demands an immediate course correction.

In part, this is because all of the above fallout could be avoided with a simple, affordable solution: vaginal estrogen. Applied directly to the vaginal area in gel, cream, suppository, or ring form to replenish local estrogen levels, it is effective and safe for most women because it works with minimal absorption into the bloodstream. This is true even for those who cannot take systemic hormones. Another beautiful thing about vaginal estrogen is that it is both preventative and restorative: If women start using it early in their menopause journey, it can help prevent many of the immediate symptoms of GSM, as well as its longer-term impacts.

Even better, vaginal estrogen is available as a generic drug, which in theory should make it widely accessible. Freedom from patent protection means it can be produced without market dynamics that typically drive up the price of prescription medications.

So why are so few women asking for or using vaginal estrogen, or even aware of its life-changing benefits? Its a menopause tale as old as time.

Sadly, its often ignorance, plain and simple, that keeps many MDs from prescribing vaginal estrogen. Perhaps this is unsurprising, given the startling dearth of training: Only one in five ob-gyns report having been taught about menopause. But compounding that is the persistent silence and shame around sexual and urogenital health, which hinders open discussion and access to treatment.

Calling out risks like dementia, cancer, and cardiovascular disorders, the FDA-mandated warning on local estrogen isnt just infuriatingly inaccurate; it is rooted in a decades-old push and pull with the government. Back in the 1970s, a surge in use of the Pill and systemic estrogen treatment for menopause led consumer activists and feminists to demand FDA labeling that warned about the risks of all estrogen products.

As new research emerged in the 1990s, the FDA was poised to loosen the wording, but progress came to a screeching halt in 2002, when the Womens Health Initiativeand the organizations now widely debunked public announcement linking a single formulation of systemic hormone treatment to increased health risksupended modern menopause care. As for the FDA, it did an about-face and required a more stringent label. The resulting boxed warning (formerly called black box warning) was never appropriate for localized vaginal estrogen, which wasnt even part of the WHI study, nor does it align with what the science says today.

Out of pocket, prices vary wildly. You can pay up to $300 for a months supply of vaginal estrogenwhich is ludicrous, given the failure of insurance companies to routinely cover all forms of it. And even if it is covered, a single prescription can run from $30 to over $100.

Unfortunately, even on a good day, changing medical standards is a Sisyphean task. Formal guidelines are much slower to update than daily practice, often lagging behind research and failing to reflect new standards of care. Given how few doctors are fluent in menopause, it is no wonder vaginal estrogen is left behind. Never mind the fact that erectile dysfunction medications are widely available and affordable, blanketing the airwaves, and treated with urgency despite known side effects.

This trifecta of politics, sexism, and bad medicine should enrage us. Not only has womens health been vastly under-researchedwe werent even required to be included in clinical studies until 1993, causing significant gaps in understanding and treatmentbut systematic neglect can be traced to nearly every aspect of public investment (or lack thereof) in our well-being and lives.

What will it take to turn the tide? Here are four changes to policy and healthcare practices that can help spread the word about vaginal estrogen and ensure its widespread availabilityand ways you can join the fight.

Insurance must routinely cover all forms of menopause hormone therapy, including vaginal estrogen (and especially estradiol cream). While Illinois became the first state to mandate insurance coverage for certain systemic menopause therapies in very limited circumstances, the Louisiana legislature just passed an expansive law that goes into effect on August 1, 2024, requiring Medicaid and private health insurance plans to cover perimenopause and menopause treatments in general. To demand coverage in every state and for every patient who needs menopause treatment in whatever form they choose, contact your state-level representative (all 50 can be accessed here) and urge them to get on this bandwagon.

The FDA should drop the current label on vaginal estrogen and instead accurately reflect its safety and efficacy. In addition to pressure from medical experts, it will take a nationwide groundswell of fed-up womenall of us!to convince the FDA to act, just as it did in the 1970s. Coauthor Jennifer Weiss-Wolf serves on the Lets Talk Menopause working group organizing a citizens petition to the FDA; visit the campaign landing page to learn more.

While more research is needed to explore all aspects of menopause, including how providers are trained, there is exciting traction on Capitol Hill: A new White House Initiative on Womens Health Research, signed by President Biden in March 2024, calls for $12 billion to spur this agenda; members of Congress introduced four new bills that back the executive order. To keep up the drumbeat so that these bills become law and budget dollars are strategically allocated, call your elected representatives in the U.S. Senate and House so they know this is a priority.

No more putting up with medical gatekeeping and a pink tax on an essential medication. We need to improve access to menopause-certified providers, pharmacists, and specialized telehealth companies that are up to speed on the latest evidence for vaginal estrogen and understand that nearly every woman is eligible. One of those companies, Evernow, at which coauthor Suzanne Gilberg-Lenz, MD, is an affiliated medical expert, provides vaginal estrogen free of charge for those who enroll in its patient care membership. Advocating in your workplace for access to telehealth provider programsas well as coverage of all forms of menopausal hormone therapy in company insurance plansis a simple way to raise awareness and get better care to more women.

Finally, remember that knowledge is power. The more we all know, the mightier the movement will becomeand the faster we will achieve the care we all deserve.

Suzanne Gilberg-Lenz, MD, is a Diplomat of the American College of Obstetrics and Gynecology and the author of Menopause Bootcamp: Optimize Your Health, Empower Your Self, and Flourish as You Age.

Jennifer Weiss-Wolf is executive director of the Birnbaum Womens Leadership Center at NYU Law. She is the author of Periods Gone Public: Taking a Stand for Menstrual Equity and the forthcoming Period. Full Stop. The Politics of Menopause (NYU Press, 2025).

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The No-Brainer Menopause Treatment Nobody Is Talking About - Oprah Mag