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5 min read"Menopause is a castration event"
Dr. Rachel Rubin, a urologist and sexual medicine specialist, does not mince words about what happens to women's bodies in midlife. "Menopause is a castration event, whether we like it or not," she says. "We are outliving our ovaries." The ovarian function turns off for every woman who lives long enough, typically between ages 45 and 55, and the consequences go far beyond hot flashes. Hormone receptors exist throughout the entire body—in the brain, bones, skin, genitals, and urinary tract—so when estrogen, progesterone, and testosterone production stops, the effects are systemic.
The training gap and the gaslighting problem
Fewer than 7% of doctors training in gynecology, internal medicine, or family practice receive any education about menopause. "If you have nobody in the medical schools who know how to teach it, it's not gonna get taught," Rubin explains. This means women who seek help are often dismissed. Common complaints like brain fog, mood changes, weight gain, and sleep disruption get chalked up to stress, aging, or not trying hard enough. Rubin recalls a primary care doctor in her seventies who came up after a lecture and admitted, "I've been telling people to exercise as my only option for all these years. Your lecture just taught me that maybe there's some other stuff I should be considering."
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What you'll learn
- 1 (00:00) **Episode Introduction & The Core Problem** - Host Norah O'Donnell introduces urologist Dr. Rachel Rubin to discuss perimenopause, menopause, and sexual health, framing the conversation around a lack of medical training and widespread misinformation.
- 2 (04:58) **Menopause as a "Castration Event"** - Dr. Rubin defends her provocative framing, explaining the biological reality of losing estrogen, progesterone, and testosterone, and how this affects every system in the body.
- 3 (08:39) **The Risks of Not Treating Menopause** - The conversation shifts to the long-term health consequences of untreated menopause, challenging the idea that hormone therapy is the main risk.
- 4 (12:24) **The Case for Vaginal Estrogen** - Dr. Rubin makes a strong, data-backed argument that every woman should be offered vaginal estrogen, regardless of whether she takes systemic hormones.
- 5 (19:15) **The "Disappearing" Labia & Lack of Research** - Dr. Rubin discusses a viral fact: the labia minora can resorb during menopause, a phenomenon that has never been adequately studied.
- 6 (20:53) **Dr. Rubin’s Journey & Practice Model** - Dr. Rubin shares her personal story of starting her own sexual medicine practice after being told she wouldn't be profitable, highlighting the systemic undervaluing of women's health.
- 7 (27:00) **Testosterone for Women** - Dr. Rubin and Norah O'Donnell dive into the role of testosterone, which is a "human hormone" that women produce in greater quantities than estrogen.
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Show Notes
This week on Healthful, urologist and sexual medicine specialist Dr. Rachel Rubin discusses how female bodies change during perimenopause and menopause - and explains why women may be suffering unnecessarily. Dr. Rubin and Norah discuss how vaginal hormones could save Medicare between $6 and $22 billion a year and even prevent urinary tract infections. Plus, Norah reveals her experience with menopause and hormone replacement therapy.
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