Skip to content
The Mel Robbins PodcastThe Mel Robbins Podcast

The Ultimate Guide to Women’s Sexual Health, Hormone Replacement Therapy (HRT) & Menopause

Order your copy of The Let Them Theory 👉 https://melrob.co/let-them-theory 👈 The #1 Best Selling Book of 2025 🔥 Discover how much power you truly have. It all begins with two simple words. Let Them. — This episode is a MUST listen. Mel calls it one of the most important conversations she has ever had on The Mel Robbins Podcast. Most women don’t know this, and this information could save the life of a woman you love. If you are thinking you’re “fine,” while quietly suffering through symptoms that are treatable, you probably don’t know this life-saving medical fact either. Today, Mel is joined by Dr. Rachel Rubin, MD, a leading urologist and sexual health expert, to talk about hormones, menopause, libido, pelvic health, UTIs, and what’s happening in your body. In fact, since recording this episode, the majority of women on the team have spoken to their doctors about what Dr. Rubin shared. You’re about to hear what she wishes every woman knew sooner: Almost every issue that you're dealing with “down there” is likely related to changing hormones. If you’ve ever dealt with a UTI, leaking, urgency, dryness, painful sex, or that feeling that something is “off” down there, and you’ve been told it’s normal, it’s aging, or it’s just something you have to live with, this episode could change your life and have you asking, Why have I not heard this before? Do not learn this too late. By the time most women get the right information, they have already lost years to pain, discomfort, anxiety, and unnecessary treatments. No matter how old you are, all women need to understand this information. This is the conversation that will make you understand your body differently, and realize you have been tolerating things you do not have to tolerate. If you’re a woman in your 20s, 30s, 40s, 50s, 60s and beyond, this is information you deserve to have now. Your health should not be a mystery. You should not have to suffer. This conversation will give you the truth about your health and may even save your life or the lives of a woman you love. For every single study and resource Dr. Rubin mentions, click here for the podcast episode show notes: https://www.melrobbins.com/episode/episode-380/ Follow The Mel Robbins Podcast on Instagram: https://www.instagram.com/themelrobbinspodcast I’m just your friend. I am not a licensed therapist, and this podcast is NOT intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional. Got it? Good. I’ll see you in the next episode. In this episode: 0:00 Meet the Guest 3:35 Why Women’s Sexual Health Falls Through The Cracks 5:45 The Most Common (And Harmful) Advice Women Hear About Pain 6:23 The Symptoms Women Are Told To “Just Live With”: Dryness, Painful Sex, UTIs, Night Peeing, Anxiety, Mood Shifts 8:17 Hormones Across The Female Lifespan: Puberty, Ovulation, Pregnancy, Postpartum, Breastfeeding, Perimenopause, Menopause 14:36 Recurrent UTIs In Women 16:17 Genitourinary Syndrome of Menopause (GSM Explained) 19:20 Vaginal Estrogen Box Warnings 21:16 GSM, Explained Simply: pH, Thinning Tissue, Burning, “UTI-Like” Symptoms, And Why GSM Gets Misdiagnosed 30:11 Why Systemic HRT Often Isn’t Enough 33:19 Vaginal Estrogen Delivery Options: Cream, Tablet, Ring—Benefits, Dosing, Cost, And How To Choose 41:00 Dr. Rubin’s Mother’s ICU Story 47:38 Who Should Consider Vaginal Estrogen Or Vaginal DHEA 49:54 Genitourinary Syndrome Of Lactation (GSL): Why Breastfeeding Can Mimic Menopause 55:39 Spironolactone And Birth Control 57:15 The Benefits Of Vaginal Estrogen Beyond UTIs And Why Dr. Rubin Calls It “Women’s Viagra” 1:01:21 How Hormones Trigger UTIs 1:05:39 The Story Behind The FDA’s Blackbox Warning on HRT 1:17:40 The 4 Buckets Framework For Hormone Care 1:19:10 Testosterone In Women’s Health 1:23:21 Vaginal DHEA Vs. Vaginal Estrogen Vs. Systemic Testosterone 01:36:36 Clitoral Adhesions: The Condition Affecting 1 In 4 Women 1:55:29 The 2 Most Common Causes of Painful Sex 1:58:30 How To Advocate For Yourself At The Doctors — Follow Mel: Instagram: https://www.instagram.com/melrobbins/ TikTok: http://tiktok.com/@melrobbins Facebook: https://www.facebook.com/melrobbins LinkedIn: https://www.linkedin.com/in/melrobbins Website: http://melrobbins.com​ — Sign up for Mel’s newsletter: https://melrob.co/sign-up-newsletter A note from Mel to you, twice a week, sharing simple, practical ways to build the life you want. — Subscribe to Mel’s channel here: https://www.youtube.com/melrobbins​?sub_confirmation=1 — Listen to The Mel Robbins Podcast 🎧 New episodes drop every Monday & Thursday! https://melrob.co/spotify https://melrob.co/applepodcasts https://melrob.co/amazonmusic — Looking for Mel’s books on Amazon? Find them here: The Let Them Theory: https://amzn.to/3IQ21Oe The Let Them Theory Audiobook: https://amzn.to/413SObp The High 5 Habit: https://amzn.to/3fMvfPQ The 5 Second Rule: https://amzn.to/4l54fah

Mel RobbinshostDr. Rachel Rubinguest
Mar 23, 20262h 8mWatch on YouTube ↗

At a glance

WHAT IT’S REALLY ABOUT

Women’s sexual health decoded: GSM, vaginal estrogen, HRT, testosterone advocacy

  1. Women’s sexual and urinary health complaints are frequently dismissed because many clinicians are not trained in sexual medicine anatomy, diagnosis, or modern hormone therapies beyond reproduction-focused gynecology.
  2. Dr. Rubin explains Genitourinary Syndrome of Menopause (GSM)—and similar low-estrogen states from breastfeeding, birth control, or cancer endocrine therapy—as a root cause of dryness, painful sex, urgency/frequency, leakage, and recurrent UTIs.
  3. Microdosed vaginal hormones (especially vaginal estrogen; sometimes vaginal DHEA) can restore pH/microbiome and tissue integrity, cutting recurrent UTI risk by more than half while also improving comfort and sexual function.
  4. Systemic HRT often does not adequately treat local vulvovaginal/bladder symptoms, so many patients need “local therapy” even if they already use an estrogen patch and progesterone.
  5. The episode details how fear from the 2002 Women’s Health Initiative media coverage and FDA boxed warnings suppressed care for decades, and highlights recent guideline/label changes plus a framework (“four buckets”) for individualized hormone decision-making.

IDEAS WORTH REMEMBERING

5 ideas

Recurrent UTIs are often a hormone-and-microbiome problem, not just a “sex problem.”

Dr. Rubin links hormonal shifts (birth control, breastfeeding, perimenopause/menopause, breast-cancer endocrine therapy) to rising vaginal/bladder pH and dysbiosis that predispose to infections and UTI-like symptoms.

Microdosed vaginal estrogen is a cornerstone preventive therapy for many women with urinary and vaginal symptoms.

She states vaginal hormones can reduce recurrent UTIs by more than half by restoring tissue health and microbiome, and may improve urgency, frequency, irritation, and painful sex.

Systemic HRT frequently doesn’t resolve local genitourinary symptoms—local therapy may still be needed.

Even women using estrogen patches and progesterone may require vaginal estrogen/DHEA because low-dose local treatment targets the vulva/vagina/urethra directly where symptoms arise.

Vaginal estrogen is presented as low-risk and low-cost compared with repeated antibiotics.

The episode emphasizes minimal systemic absorption (levels remain near menopausal baseline) and highlights accessible options like generic estradiol cream (described as roughly $7/month) alongside tablets and a 3‑month ring.

Breastfeeding can mimic menopause (GSL), and vaginal hormones can be appropriate then too.

Rubin describes Genitourinary Syndrome of Lactation as a low-estrogen state with GSM-like symptoms and argues vaginal hormones are underoffered despite being safe and not affecting milk supply.

WORDS WORTH SAVING

5 quotes

“Using vaginal hormones prevent urinary tract infections by more than half.”

— Dr. Rachel Rubin

“The two dirtiest words in the English language are vagina and estrogen.”

— Dr. Rachel Rubin

“Your boxed label tried to kill my mother.”

— Dr. Rachel Rubin

“Menopause is a castration event, where your hormones just turn off like a light bulb.”

— Dr. Rachel Rubin

“Sex should not be painful, and you deserve a diagnosis.”

— Dr. Rachel Rubin

Why women’s sexual health is under-taught and under-diagnosedDismissive advice and medical gaslighting around pain and libidoGSM/GSL: pH shifts, thinning tissue, microbiome changes, misdiagnosed “UTIs”Recurrent UTIs as a hormone-linked condition; prevention beyond antibioticsVaginal estrogen: safety, dosing, delivery options (cream/tablet/ring), costFDA boxed-warning history and recent removal for vaginal estrogen productsFour-buckets framework: systemic estrogen, systemic progesterone, testosterone, vaginal hormonesTestosterone in women: evidence, access limits, expected benefits/side effectsClitoral adhesions prevalence, symptoms, and simple office-based treatmentPelvic floor tightness and vestibule pain as leading causes of painful sexHow to advocate in short doctor visits; building a “pit crew” of care

High quality AI-generated summary created from speaker-labeled transcript.

Get more out of YouTube videos.

High quality summaries for YouTube videos. Accurate transcripts to search & find moments. Powered by ChatGPT & Claude AI.

Add to Chrome