The Ultimate Guide to Women’s Sexual Health, Hormone Replacement Therapy (HRT) & Menopause

March 23, 2026

AI Summary

5 min read

Dr. Rachel Rubin, a urologist specializing in sexual medicine, joins Mel Robbins to explain how hormonal shifts affect women's genital, urinary, and sexual health across life stages. She emphasizes that symptoms like dryness, pain with sex, low libido, frequent UTIs, urgency, leakage, and mood changes have biological roots often dismissed by doctors untrained in these areas.

Hormonal Fluctuations and Common Symptoms

Hormones—estrogen, progesterone, and testosterone—fluctuate predictably but disruptively. Puberty brings wild swings; regular cycles feature low estrogen early, peaking at ovulation (with testosterone boosting libido), then progesterone before dropping. Pregnancy spikes estrogen to 3,000 before crashing to zero postpartum, mimicking brief menopause; breastfeeding often prolongs this low-hormone state, causing hot flashes, brain fog, dryness, and UTIs.

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What you'll learn

1 (00:09) **Episode Intro** - Mel introduces the episode as vital for women's health, covering hormones, menopause, UTIs, and sexual health.
2 (03:29) **Dr. Rubin Introduction** - Background on Dr. Rubin as urologist specializing in sexual medicine, training doctors globally.
3 (06:36) **Urology vs. Gynecology for Women's Health** - Explains urologists handle bladders/urethras/vulvas for all genders; gynecology focuses on reproduction, ignores sexual health.
4 (09:31) **Normalize Common Symptoms** - Lists signs like dryness, pain, low libido, UTIs, frequency, urgency, mood changes not to ignore as "normal aging."
5 (11:27) **Hormones by Life Stage** - Overview: Ovaries produce estrogen/progesterone/testosterone; fluctuations from puberty to menopause.
6 (17:48) **UTIs Linked to Hormones** - Hormone shifts (birth control, breastfeeding, menopause) cause GSM, altering microbiomes and raising UTI risk.
7 (28:09) **GSM Explained** - Genito-urinary syndrome of menopause (any age): Tissue thins/dries like pre-puberty without hormones.

+ Full timestamped outline available in the app

Show Notes

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.

In this episode, you’ll learn:

-Why recurring UTIs, urgency, frequency, and leakage are often hormonal, not “just sex” or “just aging”, and they can be fixed

-What GSM (genitourinary syndrome) is, and how it impacts women in perimenopause, menopause, during breastfeeding, and even while using birth control

-The safe, evidence-backed treatment that can prevent UTIs by more than half, and why almost no one tells women about it

-Why many women need testosterone as a natural way to increase libido, mood, energy, orgasm, and the feeling of “I’m back”

-That 1 in 4 women have a treatable condition that prevents orgasm, and why doctors don’t know how to check it, diagnose it, or treat it

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 episode show notes. This episode is one, in particular, where the show-notes are a must-read.

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