Robin Noble, MD, MHCDS, debunks estrogen therapy myths

In a recent interview with Contemporary OB/GYN, Robin Noble, MD, MHCDS, Chief Medical Advisor for Let’s Talk Menopause, addressed the widespread fears and misconceptions surrounding estrogen therapy, particularly focusing on the safety and benefits of local vaginal estrogen.

She emphasized that both patients and even health care providers often mistakenly believe that all forms of hormone therapy—especially estrogen—pose a significant risk of cancer, particularly breast cancer. This misconception frequently leads to fear-driven avoidance of potentially beneficial treatments.

Noble distinguished between systemic hormone therapy, which affects the whole body), and local vaginal estrogen therapy, which targets the vaginal area to treat specific symptoms. She explained that there is overwhelming expert consensus that local vaginal estrogen is very safe, even for women who are long past menopause or are survivors of breast cancer. Despite this, fear persists largely because of misleading FDA black box warnings, which still list concerns such as breast cancer and probable dementia, causing patients to distrust the therapy after reading the medication label.

According to Noble, he consequences of this fear and avoidance are significant. Without proper estrogen therapy, many women continue to suffer from symptoms of genitourinary syndrome of menopause, including vaginal dryness, discomfort, pain during intercourse, urinary urgency, frequency, and recurrent urinary tract infections. These symptoms not only affect quality of life but also contribute to higher health care costs and further medical complications. Noble stressed the responsibility of OB-GYNs to help correct misinformation, both in the exam room and in conversations with other healthcare providers.

She also highlighted the importance of patient education and shared decision-making. Because office visits may be brief, she recommended supplementing discussions with trusted resources, such as The Menopause Society, Mayo Clinic, and Let's Talk Menopause. Providing evidence-based educational materials empowers patients to make informed decisions and helps reinforce the safety of local estrogen therapy.

Noble further dispelled another common fear: the perceived risk of blood clots or strokes from local vaginal estrogen. She clarified that there is no evidence linking this form of estrogen therapy with increased cardiovascular events, stroke, or cognitive decline. Reinforcing this to both patients and medical colleagues is crucial.

In conclusion, Noble urged OB-GYNs to be proactive advocates—initiating honest conversations, clarifying misinformation, and helping remove the stigma around menopause and sexual health. By doing so, clinicians can improve patient outcomes and ensure that women receive the support and care they truly deserve during and after the menopausal transition.

No relevant disclosures.