The 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

MRMel RobbinshostRRDr. Rachel Rubinguest

Mar 23, 2026·2h 8m·Watch on YouTube ↗

📖 CHAPTERS

1. 1
   3:35 – 5:45

   Who Dr. Rachel Rubin is & why women’s sexual health gets overlooked

   Mel introduces Dr. Rachel Rubin, a urologist and sexual medicine expert, and they clarify what urology/sexual medicine covers for women. Dr. Rubin explains how training gaps and siloed care ("gynecology = women") cause sexual and urinary symptoms to be missed or dismissed.

2. 2
   5:45 – 8:17

   Harmful myths & dismissive advice women are told about pain, libido, and aging

   Dr. Rubin lists common, damaging advice women receive when they report painful sex or low desire. She reframes many symptoms as treatable medical issues with biological drivers—not something to "push through" or accept as aging.

3. 3
   8:17 – 14:36

   Hormones across the lifespan: puberty, pregnancy/postpartum, breastfeeding, perimenopause & menopause

   They map hormone patterns to life stages, emphasizing how dramatic shifts influence the brain, mood, vulvovaginal tissue, and urinary tract. Dr. Rubin highlights postpartum and breastfeeding as a temporary low-estrogen state that can mimic menopause symptoms.

4. 4
   14:36 – 21:16

   Recurrent UTIs: the missing hormonal root cause (and why antibiotics aren’t the full solution)

   Dr. Rubin explains that recurrent UTIs are often driven by hormonal changes that disrupt the vaginal/bladder microbiome and tissue resilience. Antibiotics treat infection, but prevention requires addressing underlying drivers—including hormones.

5. 5
   21:16 – 30:11

   GSM explained simply: pH, thinning tissue, burning, painful sex, and “UTI-like” symptoms

   They define Genitourinary Syndrome of Menopause (GSM) as hormone-related changes affecting vulva, vagina, bladder, and urethra. Dr. Rubin describes how rising pH, thinning tissue, and irritation lead to dryness, pain, urgency/frequency, and symptoms often mistaken for infection.

6. 6
   30:11 – 33:19

   Why systemic HRT often isn’t enough & the case for adding local vaginal therapy

   Mel shares she’s on systemic estrogen/progesterone; Dr. Rubin explains many patients still need local vaginal treatment for GSM symptoms. Vaginal therapy is positioned as foundational, like “sunscreen,” taking a couple months for maximal benefit.

7. 7
   33:19 – 41:00

   Vaginal estrogen options & practical use: cream vs tablet vs ring (dose, ease, cost)

   Dr. Rubin walks through common delivery methods and how to choose based on preference, dexterity, and lifestyle. They discuss simple dosing (often twice weekly) and emphasize affordability and real-world adherence.

8. 8
   41:00 – 47:38

   The ICU story & the FDA label change: how black-box warnings blocked lifesaving care

   Dr. Rubin shares her mother’s ICU experience to show how fear-based labeling and clinician unfamiliarity prevented timely care—even in a hospital setting. She then explains the advocacy effort that led to removing incorrect boxed warnings from vaginal hormone products.

9. 9
   47:38 – 55:39

   Who should consider vaginal estrogen or vaginal DHEA (including breast cancer and lactation)

   They outline broad candidacy for local vaginal hormones via shared decision-making, stressing quality of life and infection prevention. Dr. Rubin introduces Genitourinary Syndrome of Lactation (GSL) and notes vaginal hormones can be appropriate during breastfeeding.

10. 10
    55:39 – 1:01:21

    Birth control, spironolactone, and “testosterone blockade” as hidden drivers of pain and UTIs

    Dr. Rubin describes how some hormonal contraceptives and anti-androgen acne treatments can lower testosterone and affect genital tissue and microbiome. They discuss why certain IUDs may be less disruptive and why clinicians should evaluate recurrent UTIs through a hormonal lens.

11. 11
    1:01:21 – 1:17:40

    How hormones influence UTIs: receptors, microbiome shifts, and sex-related pH changes

    They connect anatomy and physiology: bladder/vagina are receptor-rich tissues sensitive to estrogen/testosterone levels. Dr. Rubin explains how higher pH and dysbiosis increase infection risk and why irritation can feel like a UTI even when cultures are negative.

12. 12
    1:17:40 – 1:23:21

    Reframing HRT after the 2002 scare & introducing the “4 buckets” hormone framework

    Dr. Rubin recounts how the Women’s Health Initiative messaging and media coverage created decades of fear and training gaps. She then offers a practical framework: systemic estrogen, systemic progesterone, systemic testosterone, and localized vaginal hormones as separate tools.

13. 13
    1:23:21 – 1:36:36

    Testosterone for women: benefits, prescribing realities, and DHEA vs estrogen vs systemic testosterone

    They discuss testosterone as a human hormone and review why the U.S. lacks an FDA-approved product for women despite international approvals and global consensus statements. Dr. Rubin explains practical dosing using male formulations and what improvements patients commonly report.

14. 14
    1:36:36

    Clitoral adhesions, vulvar vestibule pain, pelvic floor tightness: the anatomy most women were never taught

    Dr. Rubin explains clitoral anatomy, clitoral adhesions (reported in a notable portion of patients), and how simple procedures can improve pain and function. She also defines the vulvar vestibule and pelvic floor dysfunction as leading, treatable causes of painful sex.

15. 15

    Self-advocacy at the doctor: how to use a 10-minute visit and build a ‘pit crew’

    They close with practical advice for patients and clinicians: prepare, use respectful framing, and seek providers willing to learn or refer. Dr. Rubin shares education resources, documentaries, and encourages ongoing learning and community-driven change.