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.
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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
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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.
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