Dr. Rachel Rubin

And it was one urologist in the room, my mentor, Erwin Goldstein, who said, wait a minute, the word urinary must be in this name.

And they called it genitourinary syndrome of menopause.

Okay.

And those are the signs and symptoms that happen with a low hormonal state.

So it's not just vaginal dryness, which is what everyone thought of it as, but it's actually change in arousal and orgasm.

It is dryness.

It is decreased lubrication.

It is pain with intercourse.

But it's actually a very serious urologic condition, which causes urinary frequency, urinary urgency, leakage, and urinary tract infections, which can and do kill our patients.

Right.

So let's break it down.

How does low estrogen states cause the urinary symptoms?

Yeah.

And one clarification is it's not just estrogen.

And the guidelines that we put together, the American Urologic Association is so historic because the word androgen is all over that guideline.

Because actually, it's just a low hormone state, right?

And that's a challenge because women are told all the time by their OBGYNs, because those are the only people talking to these women, right?

And they say, well, you're normal if your periods are normal.

Well, you're normal.

You're not having a hormone problem if your periods are normal.