The Ultimate Guide to Women’s Sexual Health, Hormone Replacement Therapy (HRT) & Menopause
Mel Robbins (host), Dr. Rachel Rubin (guest), Mel Robbins (host)
In this episode of The Mel Robbins Podcast, featuring Mel Robbins and Dr. Rachel Rubin, The Ultimate Guide to Women’s Sexual Health, Hormone Replacement Therapy (HRT) & Menopause explores women’s sexual health decoded: GSM, vaginal estrogen, HRT, testosterone advocacy 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.
Women’s sexual health decoded: GSM, vaginal estrogen, HRT, testosterone advocacy
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.
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.
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.
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.
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.
key_topics':['Why women’s sexual health is under-taught and under-diagnosed','Dismissive advice and medical gaslighting around pain and libido','GSM/GSL: pH shifts, thinning tissue, microbiome changes, misdiagnosed “UTIs”','Recurrent UTIs as a hormone-linked condition; prevention beyond antibiotics','Vaginal estrogen: safety, dosing, delivery options (cream/tablet/ring), cost','FDA boxed-warning history and recent removal for vaginal estrogen products','Four-buckets framework: systemic estrogen, systemic progesterone, testosterone, vaginal hormones','Testosterone in women: evidence, access limits, expected benefits/side effects','Clitoral adhesions prevalence, symptoms, and simple office-based treatment','Pelvic floor tightness and vestibule pain as leading causes of painful sex','How to advocate in short doctor visits; building a “pit crew” of care'],
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Key Takeaways
Recurrent UTIs are often a hormone-and-microbiome problem, not just a “sex problem.”
Dr. ...
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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.
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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.
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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.
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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.
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Testosterone is a “human hormone,” and low levels can affect libido and ‘feeling like yourself,’ even before menopause.
She notes testosterone can decline in women starting in their 30s; while no FDA-approved female product exists in the U. ...
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A large share of women may have clitoral adhesions, which are rarely examined but often treatable.
Rubin cites clinic data suggesting ~23% prevalence and describes a simple in-office (or OR for children) separation procedure that can reduce pain and improve arousal/orgasm for many patients.
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Two leading drivers of painful sex are hormonal tissue changes and pelvic floor muscle tightness.
She frames sex as a “high-contact sport,” where low-hormone tissue becomes fragile and painful, then triggers protective muscle guarding—often requiring both hormonal treatment and pelvic floor physical therapy/rehab.
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Better outcomes start with anatomy literacy and targeted self-advocacy.
She encourages using a mirror to learn vulvar structures (clitoris/hood, vestibule) and approaching clinicians with, “Are you the right person to help me with this? ...
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Notable 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
Questions Answered in This Episode
If GSM can affect women on birth control or breastfeeding, what symptom patterns help distinguish hormone-driven GSM/GSL from a true bacterial UTI that needs antibiotics?
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.
Get the full analysis with uListen AI
What exact twice-weekly dosing schedule and application technique does Dr. Rubin recommend for estradiol cream vs. the 10-mcg tablet, and how long until benefits peak?
Dr. ...
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For someone already on systemic HRT, what specific signs indicate they still need vaginal estrogen/DHEA, and how should clinicians monitor response (e.g., pH strips, symptom logs)?
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.
Get the full analysis with uListen AI
What are the best-supported safety data for vaginal estrogen in women with active or prior breast cancer, and how should “shared decision-making” be documented?
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.
Get the full analysis with uListen AI
How did the Women’s Health Initiative messaging lead to FDA boxed warnings on all hormone products, and what evidence most strongly undermines those generalized warnings—especially for local therapy?
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.
Get the full analysis with uListen AI
Transcript Preview
Our medical expert today is gonna teach you what every woman should know about menopause, HRT, vaginal health, pelvic floor issues, and the very common hormonal changes that happen to women throughout their lifetime. I truly hope you share this with every woman you know. It will not only change her life, what she learns in this episode might just save it.
People who are on birth control pills, people who are breastfeeding, people who are on hormone therapies and breast cancers, perimenopause and menopause can increase your risk of UTIs drastically. Using vaginal hormones prevent urinary tract infections by more than half.
Wait, you can get UTIs from hormone changes?
Yes.
Oh my Go- I've never heard this before.
The biggest PSA that we need is to get this in the ears of every human on Earth, because women are dying. You and your family members are at risk of dying or being in the hospital, and it can be treated for every aged person, for every person with every medical problem, and can cost you as little as $7 a month.
What? Hold on a second.
All I'm doing here is taking a problem that we have always known about with science that we have always had, and saying every woman on Earth needs to know about this.
Dr. Rachel Rubin is a board-certified urologist and one of the nation's foremost experts in sexual health.
23% of all women who come into the clinic have what's called clitoral adhesions.
What is that?
Okay. So I had a woman in my office just this week, and what caused her urinary pain? Birth control pills and spironolactone for her acne.
My mouth is on the floor right now. I have two daughters in their 20s. Dr. Rubin, if you could speak directly to the person that's listening, if they take one action, what would that one thing that's the most important thing to do be?
I think...
Dr. Rachel Rubin, welcome to The Mel Robbins Podcast.
Oh my gosh, I'm so happy to be here. This is a dream come true.
Well, it's a dream come true for me too, and by the time you're done listening, I know you're gonna say to yourself, "Wow, Dr. Rubin is a dream and a treasure. I'm so happy that I chose to spend time listening to this." How might our life be different, or the lives of the women that we love be different if we take to heart everything that you're about to teach us today about hormones, women's sexual health, just the whole range of topics we're gonna cover, much of which you will have never heard in your life before?
Whether you are going through puberty, whether you are going through childbirth, perimenopause, menopause, this is important for your quality of life, your general health, your sexual health, and listening to us today is going to give you the strength and the confidence to learn more and to advocate for yourself so that you live your best damn life.
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