Dr. Rachel Rubin

And it's like finding the staff to do it.

Where does ospemophene, would you think that this...

Yeah, so it's a great point, right?

Because people are really hesitant.

Because again, vaginas come with a lot of feelings and a lot of dirty words and a lot of emotional connection.

And it's a very challenge.

But like if the best way to give it is vaginally, it's kind of figuring that part out.

So can they do a little insert suppositor?

Because locally, it seems to be the best.

I hope companies listening, and I know there are some developing different products that may be able to be better options for our elderly or nursing home populations.

Ospemafine is an FDA-approved product that's a pill you take by mouth that helps with the genitourinary syndrome of menopause.

I think it needs to be studied in the older populations because my concern is when you do a systemic whole body product, and this is a CIRM, an estrogen receptor modulator, I think you do increase, the worry is that you increase a risk for something like a blood clot.

And so putting a woman who's 90 in the nursing home...

who has memory problems on an oral pill that could go through the liver and increase the risk of blood clot, then your risk-benefit discussion might change a little bit.

But yes, it would be lovely to have a pill that could help a vaginal bladder problem and not cause any side effects.

So speaking of side effects, we'll go back to you casually mentioned SSRIs and antidepressants.

I remember looking at the data on when HRT prescriptions hit the tank.

So before the WHI, the Women's Health Initiative, which we've discussed on this podcast ad nauseam, but in case you've lived under a rock, after this data was released from the Women's Health Initiative,

About, we guess, 30 to 40% of women were on some form of systemic HRT, and that dropped to almost nothing.

So as of two years ago, FDA-approved formulations were at about 4%.