The Curbsiders Internal Medicine Podcast #507 Swinging the Pendulum on Menopause Care With Dr Rachel Rubin
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Dec 8, 2025 
Dr. Rachel S. Rubin, a board-certified urologist and sexual medicine expert, transforms menopause care with her innovative insights. She discusses the evolution of guidelines post-WHI, addressing misconceptions surrounding hormone therapy. Rachel emphasizes the importance of individualized treatment options and the need to balance clinician fears with patient education. She also explores practical applications for vaginal and systemic therapies, including testosterone use in women, and shares a stepwise approach for managing menopause symptoms effectively.
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Care Is Moving From Fear To Shared Decision Making
- Menopause care is shifting from fear-driven avoidance to shared decision-making based on newer evidence.
- Social media and patient voices accelerated demand and guideline evolution, says Rachel Rubin.
Treat Hormones As Different Tools Not One Class
- Differentiate hormones by type and route: estrogen vs progesterone, vaginal vs systemic, oral vs transdermal.
- Use transdermal estrogen to avoid first-pass liver clotting risks and vaginal hormones for local GSM symptoms.
Choose Transdermal Estrogen And Micronized Progesterone
- Prefer transdermal estrogen for many patients to minimize thrombotic risk because it avoids first-pass hepatic effects.
- Use micronized progesterone for uterine protection when needed, rather than medroxyprogesterone acetate.