The Mel Robbins PodcastThe Most Important Conversation You’ll Ever Hear About Women’s Health | Dr. Rachel Rubin
CHAPTERS
- 0:00 – 3:28
Why this episode matters: the women’s health “PSA” Dr. Rubin wants everyone to hear
Mel introduces Dr. Rachel Rubin and frames the episode as a potentially life-changing (and life-saving) conversation about hormones, menopause, urinary/vaginal health, and sexual wellbeing. Dr. Rubin immediately signals a central theme: common female health problems are often hormonal and highly treatable, but widely ignored.
- •Episode scope: menopause, HRT, vaginal health, pelvic floor issues, lifelong hormonal shifts
- •Claim: hormonal changes can sharply increase UTI risk—and prevention exists
- •Framing: women’s suffering is common, preventable, and under-discussed
- •Call to share the episode widely
- 3:28 – 5:45
What a sexual medicine urologist does (and why women’s sexual health gets missed)
Dr. Rubin explains urology vs. gynecology and why women often don’t know where to go for urinary/sexual symptoms. She argues that medical training prioritizes reproductive health over sexual medicine, leading to dismissal and misinformation.
- •Urologists treat genitourinary systems in all genders (kidneys, bladder, urethra, vulva, etc.)
- •Gynecology training often excludes sexual medicine; even basic anatomy is under-taught
- •Women’s sexual health concerns often never get asked about in routine care
- •Consequences: misinformation, gaslighting, delayed diagnosis and treatment
- 5:45 – 8:17
Harmful advice women are told about pain, libido, and aging
Mel asks what doctors commonly say that’s wrong, and Dr. Rubin lists pervasive dismissive guidance that normalizes pain and low desire. She reframes libido changes and sexual pain as legitimate, treatable medical issues when they bother the patient.
- •Examples of bad advice: “drink wine,” “read erotica,” “just have more sex,” “it’s just aging”
- •Normalization trap: “this is just how it is” prevents care-seeking
- •Symptoms worth attention: dryness, painful sex, missing orgasms, night peeing, anxiety/mood shifts
- •Low libido can be a medical condition with evidence-based treatments
- 8:17 – 14:35
Hormones across the female lifespan—puberty, pregnancy, postpartum, breastfeeding, perimenopause, menopause
Dr. Rubin walks through how estrogen, progesterone, and testosterone fluctuate across life stages and how symptoms map to biology. She draws parallels between puberty and perimenopause as periods of “hormonal chaos,” and describes postpartum/breastfeeding as a temporary menopausal state for many.
- •Basic cycle physiology: estrogen rise → ovulation → progesterone → drop → period
- •Pregnancy: estrogen can reach very high levels, then crashes postpartum
- •Breastfeeding often suppresses estrogen—“menopause-like” symptoms can appear
- •Testosterone often declines starting in the 30s; perimenopause resembles puberty-like volatility
- 14:35 – 23:55
Recurrent UTIs: treating the infection vs. fixing the root cause (hormones + microbiome)
Dr. Rubin challenges the default approach of repeated antibiotics for UTIs, emphasizing prevention by addressing underlying hormonal shifts. She introduces GSM (genitourinary syndrome of menopause) as a broader umbrella—relevant beyond menopause—and previews vaginal micro-dose hormones as a major solution.
- •Antibiotics treat acute infection but don’t address recurrence drivers
- •Hormone fluctuations (birth control, breastfeeding, endocrine therapy, peri/menopause) can raise UTI risk
- •Concept: hormones influence vaginal/bladder microbiome and tissue resilience
- •Vaginal hormones can cut UTI recurrence by more than half; guideline-backed
- 23:55 – 33:10
GSM explained simply: “the vagina needs hormones like a plant needs water”
Dr. Rubin explains GSM in accessible terms using developmental anatomy and tissue changes. She links hormone loss or suppression to rising vaginal pH, microbiome imbalance, dryness, thinning, burning, painful sex, and “UTI-like” symptoms that are often misdiagnosed.
- •Hormones maintain tissue thickness, lubrication, blood flow, and acidity (pH)
- •With low hormones: pH rises, good bacteria decrease, bad bacteria proliferate
- •Symptoms: dryness, cracking/bleeding, pain, harder orgasm/arousal, urgency/frequency/leakage
- •GSM can affect younger people too (e.g., on birth control or breastfeeding)
- 33:10 – 40:58
Vaginal estrogen options and home tools: pH strips, creams, tablets, rings (cost, dosing, practicality)
Dr. Rubin gets highly practical: how to check vaginal pH at home and what vaginal estrogen products look like, cost, and how they’re used. She emphasizes that these are micro-doses that don’t meaningfully raise systemic estrogen levels and can be life-changing for symptoms and prevention.
- •Home monitoring: vaginal pH paper (goal ~4.5 or lower)
- •Localized therapy: micro-dose vaginal estrogen doesn’t meaningfully change whole-body estrogen
- •Delivery options: cream (often cheapest), tablet/suppository, and 3-month ring (Estring)
- •Typical dosing: twice weekly; benefits often maximize in ~2–3 months
- 40:58 – 47:26
Why Mirena may differ from birth control pills + Dr. Rubin’s ICU story about the boxed warning
Mel and Dr. Rubin discuss how some oral contraceptives suppress ovarian function and lower testosterone, potentially affecting tissue and UTI risk; IUDs may not have the same effect. Dr. Rubin then shares her mother’s ICU experience, illustrating how fear-driven labeling blocked access even in high-risk settings.
- •Birth control pills can suppress ovaries and lower testosterone; IUDs may preserve ovulation
- •Hormone manipulation can have downstream vulvovaginal/urinary effects
- •ICU narrative: barriers to dispensing vaginal estrogen due to misleading warnings
- •Advocacy payoff: FDA removed boxed warnings on vaginal hormone products (after years of effort)
- 47:26 – 1:07:17
Who should consider vaginal estrogen or vaginal DHEA—including lactation (GSL) and cancer histories
Dr. Rubin argues that few people are truly “not candidates” for localized vaginal hormones and stresses shared decision-making. She expands GSM to include lactation (GSL), states that breastfeeding can mimic menopause, and notes data suggesting safety even in breast cancer populations.
- •Symptom-driven eligibility: UTIs, dryness, pain with sex, urgency/frequency/leakage
- •Shared decision-making, including in people with cancer histories
- •GSL: genitourinary syndrome of lactation—breastfeeding can cause menopausal-type symptoms
- •Vaginal DHEA as an alternative/adjunct; access and cost can be limiting
- 1:07:17 – 1:17:31
The HRT controversy: WHI, media hysteria, and decades of lost training + research
Dr. Rubin explains how the 2002 Women’s Health Initiative (WHI) messaging changed prescribing overnight and scared clinicians and patients. She argues the interpretation and media coverage caused a multi-decade gap in clinician education, research momentum, and patient access—affecting far more than hot flashes.
- •2002 WHI press conference and headlines drove hormone prescriptions toward zero
- •FDA boxed warnings generalized risks across diverse hormone products and doses
- •Ripple effects: clinicians stopped learning how to prescribe; research slowed
- •Key distinction: modern HT and localized vaginal therapy differ from WHI-era framing
- 1:17:31 – 1:35:05
The 4-buckets framework + testosterone for women (benefits, safety, why no FDA-approved product)
Dr. Rubin lays out her “four buckets” of hormone care: systemic estrogen, systemic progesterone, systemic testosterone, and localized vaginal hormones. She then dives into testosterone, emphasizing it’s a human hormone, why women often can benefit (especially for libido), and how politics/regulation shaped access.
- •Four buckets: systemic estrogen, systemic progesterone, systemic testosterone, vaginal hormones
- •Testosterone declines often begin in the 30s; not solely a menopause issue
- •No FDA-approved testosterone product for women in the U.S.; global consensus supports use
- •Typical approach: low-dose male gel adjusted for women; monitor symptoms and levels
- 1:35:05 – 1:55:28
Beyond hormones: what medicine ignores about anatomy (mirrors, the clitoris, and clitoral adhesions)
Dr. Rubin argues that basic genital anatomy education is missing in healthcare, then demonstrates why that matters clinically. She explains clitoral adhesions (reported in ~23% of women), how they can affect pain/arousal/orgasm, and how a simple in-office procedure can help.
- •Patients rarely get shown their anatomy; lack of language blocks effective care-seeking
- •Clitoral adhesions: hood cannot retract fully; severity ranges mild to complete
- •Symptoms can include pain with touch/oral sex, reduced arousal, orgasm difficulty
- •Office-based lysis procedure can significantly improve pain and sexual function for many
- 1:55:28 – 1:58:28
Painful sex: the two most common causes (hormones + pelvic floor) and the “vestibule” you’ve never heard of
Dr. Rubin teaches core anatomy (labia, clitoris structure, vestibule) and reframes penetration pain as diagnosable and treatable. She highlights hormonal tissue fragility and pelvic floor over-tightening as the most common drivers, with nerves as a less common third cause.
- •Vulvar vestibule: delicate, hormonally sensitive tissue that can mimic “UTI pain”
- •Pelvic floor tightness can drive pain, constipation, urinary urgency/frequency
- •Common pain drivers: hormonally-mediated tissue change + guarding/tight muscles
- •Treatment often requires both tissue restoration (vaginal hormones) and rehab (PT/dilators)
- 1:58:28 – 2:08:43
How to advocate in a 10-minute appointment + where clinicians and patients can learn more
Dr. Rubin offers scripts and strategies to be taken seriously in short visits, emphasizing a “pit crew” model where the patient is the CEO of their care. She shares learning resources for clinicians and patients, and closes with action-oriented education and follow-up avenues.
- •Advocacy script: ask if the clinician is the right person—or who they recommend
- •Pit-crew model: multidisciplinary care; patient leads and coordinates
- •Resources: Menopause Society, ISSWSH, courses, provider directories, educational materials
- •One action takeaway: educate yourself and use that knowledge to seek the right help
