Achievements

Dascanio, AM1; Zhang, H2; Malacarne Pape , D2; Rodriguez, V1; Yaskhi, G1; Janvier, D1; Chorna, ES1; Glass, M1; Immers, L1; Nussbaum, O1; Zweig, L1; Akbar, A1; Kasoff, M1; Roca, B1; Lleras, C1; Steinhart, A1; Grimes, CL2; Andiman, SE1 1 - New York Medical College 2 - Westchester Medical Center Introduction: Genitourinary syndrome of menopause (GSM) refers to a constellation of localized symptoms associated with estrogen deficiency that ensues with menopause. Vaginal estrogen therapy is widely accepted in the medical community as a safe and effective treatment option for symptoms of GSM. However, vaginal estrogen therapy may be underutilized due to various factors relating to patient perceptions, access to resources, or healthcare systems outreach. Objective: The aim of our study is to characterize the beliefs and opinions held by patients surrounding the use of vaginal estrogen to treat GSM. Methods: A mixed methods qualitative study was performed. Subjects included patients prescribed vaginal estradiol therapy at an ambulatory urogynecology office between October 2022 and August 2023. Subjects participated in a screening questionnaire followed by a 1:1 in-depth interview which was conducted using a pre-determined questionnaire aimed at eliciting candid and detailed responses about patient perceptions and experiences with vaginal estrogen. The data was analyzed in a three-phase coding process using grounded theory methods to perform thematic analysis. Results: Twenty-two participants were recruited. Four major themes emerged, including: desire for symptom relief, barriers to access, relationship with healthcare provider, and concerns about side effects. Overall, patients reported understanding the association between GSM and aging, however they also expressed confusion surrounding what symptoms vaginal estrogen was intended to treat, how it was meant to be applied, and whether it was the same as systemic hormone replacement therapy. Patients reported being deterred by barriers to access such as price and lack of insurance coverage. Fear of side effects and concern about possible association with cancer were also reported. Patients described improved comfort with vaginal estrogen use after provider education. Conclusions: Beliefs and barriers regarding the use of vaginal estrogen therapy to treat GSM were identified. This information may inform and improve provider counseling and patient adherence to this beneficial therapy. Future work should be directed toward improving patient education and patient-provider communication.