Peter Attia MD348 ‒ Women’s sexual health, menopause, and hormone replacement therapy (HRT)
Episode Details
EPISODE INFO
- Released
- May 12, 2025
- Duration
- 2h 24m
- Channel
- Peter Attia MD
- Watch on YouTube
- ▶ Open ↗
EPISODE DESCRIPTION
Rachel Rubin is a board-certified urologist & one of the nation's foremost experts in sexual health. She shares her deep expertise on the topic of women’s sexual health, exploring why this area remains so neglected in traditional medicine & highlighting the critical differences in how men & women experience hormonal decline with age. Rachel explains the physiology of the menstrual cycle, the complex hormonal shifts of perimenopause, & the health risks associated with menopause, including osteoporosis, cardiovascular disease, dementia, & recurrent urinary tract infections. She discusses the controversy surrounding hormone replacement therapy (HRT) & provides guidance on the safe & personalized use of estrogen, progesterone, & testosterone in women. With particular emphasis on local vaginal hormone therapy—a safe, effective, & underused treatment—Rachel offers insights that have the potential to transform quality of life for countless women. View show notes here: https://bit.ly/4ddMsv6 Become a member to receive exclusive content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ 0:00:00-Intro 0:01:56-Rachel’s training for sexual medicine & women’s health 0:04:55-Hormonal changes during ovulation, perimenopause, & menopause 0:14:34-Why women have such varied responses to the sharp drop in progesterone during the luteal phase & after menopause 0:17:55-Health risks for postmenopausal women 0:20:37-History of hormone replacement therapy (HRT) 0:30:59-Medical system’s failure to train doctors in HRT after the WHI study & its lasting impact on menopause care 0:36:52-Underappreciated role of testosterone in women’s sexual health 0:49:45-Bias against HRT—how institutional resistance is preventing meaningful progress in women’s health 0:57:24-How the medical system’s neglect of menopause care has opened the door for unregulated & potentially harmful hormone clinics 1:01:43-The HRT playbook for women part 1: progesterone 1:10:20-The HRT playbook for women part 2: estradiol 1:19:35-Oral formulated estrogen for systemic administration: risks & benefits 1:23:52-Topical & vaginal estrogen delivery options: benefits & limitations, & how to personalize treatment for each patient 1:31:52-How to navigate hormone lab testing without getting misled 1:39:48-Wide-ranging symptoms of menopause—joint pain, brain fog, mood issues 1:46:33-Evolution of medical terminology & the underrecognized importance of local estrogen therapy for urinary & vaginal health in menopausal women 1:50:15-Benefits of vaginal estrogen (or DHEA) for preventing UTIs & improving sexual health 2:00:30-Use of DHEA & testosterone in treating hormone-sensitive genital tissues 2:07:13-Is it too late to start HRT after menopause? 2:09:24-Should women stop hormone therapy after 10 years? 2:11:19-How to manage hormone therapy in women with BRCA mutations, DCIS, or a history of breast cancer 2:17:39-How women can identify good menopause care providers -------- About: The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity, & all that goes into that from physical to cognitive to emotional health. With over 90 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, & much more. Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan & simultaneously improving their healthspan. Learn more: https://peterattiamd.com Connect with Peter on: Facebook: http://bit.ly/PeterAttiaMDFB Twitter: http://bit.ly/PeterAttiaMDTW Instagram: http://bit.ly/PeterAttiaMDIG Subscribe to The Drive: Apple Podcast: http://bit.ly/TheDriveApplePodcasts Overcast: http://bit.ly/TheDriveOvercast Spotify: http://bit.ly/TheDriveSpotify Google Podcasts: http://bit.ly/TheDriveGoogle Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. I take conflicts of interest very seriously. For all of my disclosures and the companies I invest in or advise, please visit my website where I keep an up-to-date and active list of such companies. For a full list of our registered and unregistered trademarks, trade names, and service marks, please review our Terms of Use: https://peterattiamd.com/terms-of-use/
SPEAKERS
Peter Attia
hostPhysician and host of The Drive podcast focused on medicine, longevity, and health optimization.
Rachel Rubin
guestUrologist and sexual medicine clinician specializing in women’s sexual health, menopause care, and hormone therapy.
EPISODE SUMMARY
In this episode of Peter Attia MD, featuring Peter Attia and Rachel Rubin, 348 ‒ Women’s sexual health, menopause, and hormone replacement therapy (HRT) explores rachel Rubin on Menopause, Hormone Therapy, Testosterone, and Medicine's Failures Rubin describes perimenopause as erratic hormone swings and menopause as an empty tank, with effects reaching bone, brain, joints, bladder, and genital tissue.
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