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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Simple Low-Cost Tip For Vaginal Cream Use
- Teach patients to apply vaginal cream with a finger to coat the vaginal walls for absorption and pH restoration.
- Prescribe generics via GoodRx or Cost Plus Drugs to lower cost (≈$13–$30 per tube).
Distinguish Local Versus Systemic Vaginal Rings
- Know there are two vaginal rings: local estradiol ring (no progestin needed) and systemic femring (needs uterine protection).
- Watch patients: many report the systemic ring may underdeliver near month end.
Add Vaginal Therapy Even With Systemic Hormones
- Always screen and treat genital and urinary symptoms even if a patient is on systemic hormone therapy.
- Add a vaginal product when local symptoms persist because it carries minimal risk and clear benefit.