The Ultimate Guide to Women’s Sexual Health, Hormone Replacement Therapy (HRT) & Menopause - The Mel Robbins Podcast Recap

Podcast: The Mel Robbins Podcast

Published: 2026-03-23

Guests: Dr. Rachel Rubin

What Happened

Dr. Rachel Rubin, a board-certified urologist and sexual health expert, joins Mel Robbins to discuss women's sexual health. Dr. Rubin clarifies that urologists, not just gynecologists, are key to understanding and treating sexual medicine for both men and women. She notes a significant educational gap, such as the omission of the clitoris as required knowledge for gynecologists.

Hormone fluctuations are central to many women's health issues. During pregnancy, estrogen levels can reach 3,000 and drop to zero postpartum, mirroring menopause symptoms. Testosterone levels decline starting at age 35, affecting libido and increasing risks of UTIs and painful sex.

Vaginal hormones are a safe, effective treatment for genitourinary syndrome of menopause (GSM), providing relief from symptoms like dryness and UTIs. Dr. Rubin's advocacy led to the FDA removing misleading warning labels from these products, emphasizing their safety. Vaginal hormones can save Medicare billions by preventing UTIs.

Hormone therapy comes in four types: whole body estrogen, progesterone, testosterone, and vaginal hormones. Each serves specific roles, such as estrogen for osteoporosis prevention. Testosterone therapy, though not FDA-approved for women in the U.S., is supported globally for improving libido and mood.

Clitoral adhesions, affecting 23% of women, can hinder sexual function. Dr. Rubin cites a study showing significant improvements in arousal and orgasm after treatment. She stresses the importance of educating women about their bodies for better healthcare decision-making.

Despite their benefits, vaginal hormones are under-prescribed, with only 9% of Medicare patients with GSM receiving them. Dr. Rubin argues for increased access and education, supported by grassroots movements and the Menopause Society.

Key Insights

• Urologists, not just gynecologists, play a crucial role in women's sexual health, covering areas like genitourinary health and hormone therapy.
• Hormone fluctuations, including drops in testosterone starting at age 35, can lead to conditions like low libido, UTIs, and painful sex.
• Vaginal hormones, such as estradiol cream, are effective in treating GSM symptoms and are safe, with no significant systemic side effects.
• Testosterone therapy is supported globally for women, improving libido and mood, but lacks FDA approval in the U.S. despite evidence of its efficacy.