At The Menopause Society Annual Meeting, Caroline Mitchell, MD, MPH, emphasized individualized, evidence-based care and the safety of topical hormones for GSM.
Caroline Mitchell, MD, MPH, associate professor of Obstetrics, Gynecology, and Reproductive Biology at Massachusetts General Hospital and Harvard Medical School, and director of the Vulvovaginal Disorders Program at Mass General, discussed barriers and best practices in managing genitourinary syndrome of menopause (GSM) during a presentation at the 2025 Annual Meeting of The Menopause Society.1
“At least what some of the survey research has suggested is that people think these symptoms are something that have to be endured, that they're inevitable, and that it's just what menopause is, and don't realize that there's treatment available,” said Mitchell. “So they don't bring it up with their doctors, and we don't ask. I think that's probably not asking and not telling are the two biggest barriers.”
When evaluating patients, Mitchell emphasized determining the most bothersome symptoms and their timing. “The first question is really what are the symptoms that are the most bothersome for people,” she said. “If a symptom occurs only with sex, then an event-based intervention like a lubricant might be a perfectly fine intervention, whereas if it's all the time, every day, then something that's more regularly used” may be appropriate.
She also highlighted the importance of understanding patient preferences and comfort with hormone-based therapies. “Some things are non-hormonal, but a cream that you have to use every day or three times a week. Other things are hormonal, and you can use them less frequently,” Mitchell explained.
Mitchell stressed that topical vaginal hormones are safe for most patients, including breast cancer survivors. “Topical vaginal hormones are absolutely safe, even for breast cancer survivors, and there's, at least for the general population, millions of data points to suggest that this is safe,” she said. “For breast cancer survivors, it's in the hundreds of thousands of data points, suggesting that also there's not an increased risk of recurrence.”2
She added that treatment should be guided by patient choice. “At least in one of the randomized trials that we did, moisturizers, estrogen, they all work reasonably the same, and so it really comes down to choice,” said Mitchell. “Choice is wonderful, and it really is what is going to work best for that individual patient.”
Mitchell reports no relevant disclosures.
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