Overview of Finally, Menopause Relief: How Did We Not Know This? with Dr. Rachel Rubin
In this episode of We Can Do Hard Things, Glennon Doyle, Abby Wambach, and Amanda Doyle talk with board-certified urologist and sexual medicine specialist Dr. Rachel Rubin about perimenopause, menopause, and the widespread medical misunderstanding around women’s hormonal health. The conversation reframes menopause as a whole-body biological transition—not just hot flashes—and makes a strong case for better education, better advocacy, and more access to evidence-based treatments like vaginal estrogen, progesterone, and testosterone.
Main Takeaways
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Perimenopause can begin much earlier than people expect.
- The transition can last up to 10 years.
- Symptoms may start in the mid-30s to 40s, even if periods are still happening.
- Menopause is defined as 12 months without a period; after that, someone is considered post-menopausal, but hormonal effects can continue for life.
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This is a whole-body hormone issue, not just a reproductive issue.
- Hormone receptors exist throughout the body, so symptoms can show up in sleep, mood, joints, bladder health, libido, skin, memory, and more.
- Dr. Rubin emphasizes the feeling of “NFLM” = “not feeling like myself” as a major clue.
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Women are often dismissed because symptoms are misattributed to stress or aging.
- The panel discusses how life stress can overlap with hormone changes, making it easy for symptoms to be minimized.
- Dr. Rubin argues that this overlap is exactly why clinicians need to understand the biology better.
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The medical system is poorly trained in menopause care.
- She says most doctors receive little to no education about perimenopause and menopause.
- A single lab result is rarely enough; symptoms and timing matter more than one blood test.
Common Symptoms Dr. Rubin Says to Watch For
Beyond hot flashes, symptoms may include:
- Sleep disruption
- Brain fog / word-finding issues
- Irritability or mood swings
- Anxiety or feeling emotionally “off”
- Heart palpitations
- Migraines
- Itchy ears
- Burning mouth
- Worsening allergies
- Joint pain, frozen shoulder, plantar fasciitis
- Vaginal dryness, pain with sex, reduced arousal
- Lower libido
- Urinary urgency or recurrent UTIs
- Bone density loss
Important pattern:
Symptoms can worsen around the menstrual cycle during perimenopause because hormones fluctuate unpredictably rather than simply declining in a straight line.
What’s Actually Happening Biologically
Dr. Rubin gives a simple explanation of the hormone cycle:
- Estrogen, progesterone, and testosterone are present in different amounts across the cycle.
- In perimenopause, ovarian hormone output becomes unstable and can swing wildly.
- In menopause, hormone levels flatten at a very low baseline, which can actually feel more stable than perimenopause.
She stresses that:
- Perimenopause = chaos from fluctuating hormones
- Menopause = a more stable but low-hormone state
- This is why some people feel worse in perimenopause than in menopause
Hormone Therapy and Treatment Options
1. Vaginal hormones
Dr. Rubin is especially passionate about local vaginal estrogen or vaginal DHEA because they:
- Prevent recurrent UTIs
- Improve vaginal dryness and pain with sex
- Help arousal and orgasm
- Support urinary health
She notes these treatments are:
- Safe for many people, including some with cancer histories
- Useful at many ages, including during breastfeeding
- Often underprescribed despite strong evidence
2. Whole-body estrogen
Can help with:
- Hot flashes
- Night sweats
- Bone protection
- Sleep
- Brain fog
- Joint pain
- Sexual symptoms for some people
3. Progesterone
Used mainly to protect the uterus when estrogen is given systemically.
- Micronized progesterone is described as a safer, well-studied option.
- It may also help sleep and mood for some people.
4. Testosterone
A major focus of the episode.
- Women naturally make testosterone, and levels begin dropping in the 30s.
- Dr. Rubin says testosterone can meaningfully improve libido and overall wellbeing for some women.
- She criticizes the lack of FDA-approved testosterone options for women in the U.S.
The Hormone Misinformation Problem
One of the biggest themes is the damage done by the early-2000s hormone panic:
- A major study was miscommunicated to the public as “hormones are dangerous.”
- The actual data, Dr. Rubin says, showed benefits such as:
- fewer fractures
- less diabetes
- lower all-cause mortality
- lower colon cancer risk
- in some groups, lower breast cancer risk
- That fear led to decades of overcaution, poor prescribing, and warning labels that were not well supported by the evidence.
She argues the problem is not a lack of data—it’s a marketing and education failure.
Advocacy, Red Flags, and What to Do Next
Green flags in a clinician
Look for someone who:
- Takes your symptoms seriously
- Knows menopause is an evolving field
- Is willing to learn with you
- Offers multiple options instead of one default prescription
- Understands that one blood test does not tell the whole story
Red flags
Be cautious if a clinician:
- Says “your labs are normal” and ends the conversation
- Dismisses symptoms as “just stress”
- Thinks menopause is irrelevant if you still have periods
- Only offers birth control as the solution
- Is not up to date on current guidelines
Practical advice
- Ask whether your doctor follows current menopause research.
- Bring symptom notes or a journal.
- Consider building a “pit crew” of providers: primary care, hormone specialist, pelvic floor PT, mental health support, and more.
- If your doctor is compassionate but underinformed, bring them guidelines or Dr. Rubin’s resources.
Bigger Cultural Message
The episode goes beyond medicine and into systemic bias:
- Women are often treated as though they only matter in the context of reproduction.
- Menopause care has been historically underfunded, under-researched, and under-taught.
- Dr. Rubin argues this is not just about comfort—it’s about quality of life, safety, work, relationships, and dignity.
Notable Insights
- “NFLM” — Dr. Rubin’s shorthand for “not feeling like myself.”
- “You’re not too young” — a repeated reminder that symptoms can start long before people expect menopause.
- “If you have a uterus, progesterone protects it.”
- “Vaginal hormones are for everyone.”
- “This is a marketing problem, not a data problem.”
Action Items Mentioned
- Track symptoms, especially sleep, mood, libido, joint pain, and urinary issues.
- Ask whether your symptoms could be connected to perimenopause or menopause.
- Seek clinicians who are informed and collaborative.
- Consider treatment options beyond birth control pills.
- Use reliable educational resources and share them with your doctor if needed.
- Visit Dr. Rubin’s website and newsletter for more guidance and handouts.
Closing Message
The episode’s core message is simple: women should not have to suffer, self-diagnose, or beg to be believed. Perimenopause and menopause are common, treatable, and deeply under-addressed stages of life. Dr. Rachel Rubin’s message is both validating and urgent: learn your body, find your people, and advocate hard—because better care is possible.