Ekene Enemchukwu, MD, on underutilization of vaginal estrogen for GSM

Vaginal estrogen may be underutilized among female Medicare beneficiaries with genitourinary syndrome of menopause (GSM)-related conditions, according to findings from a recent study.

The study, “Advancing Women’s Health: Addressing Gaps in Genitourinary Syndrome of Menopause,” was presented at the Society of Urodynamics, Female Pelvic Medicine, & Urogenital Reconstruction 2025 Winter Meeting in Rancho Mirage, California. Overall, data showed that of the 1.9 million patients with a GSM-related condition, only 9.1% filled a prescription for vaginal estrogen during the study period.

In an interview with Urology Times®, Ekene Enemchukwu, MD, MPH, FACS, URPS, offers her thoughts on the significance of this finding as well as potential barriers that may be contributing to the trend.

“Given the rates in epidemiologic studies and surveys showing that up to 70% of women are symptomatic, we were surprised to find that only 9% [filled] a prescription,” she explained. “That’s why we need more studies on this and [why] we need to look at this a little bit more closely.”

Enemchukwu is an associate professor of urology, and by courtesy, of obstetrics and gynecology (urogynecology), at Stanford Medicine in Palo Alto, California.

One of the barriers to vaginal estrogen use may be patient-level concerns about its safety, Enemchukwu suggests.

On this point, she noted, “We know that there are now studies, looking at the Women's Health Initiative and looking at other database studies that have been done, that show that there's no association between vaginal estrogen use and cardiovascular disease, endometrial cancer, breast cancer and thromboembolic events. I think collecting more data [and] strengthening that data is going to help sway the public opinion on this.”

Other barriers may include a lack of provider knowledge across multiple specialties, including urology, primary care, gynecology, and others, she explained.