Dr. Rachel Rubin

And because menopause medicine is a tiny little field in a tiny little corner, they looked at me like I was an insane person. I said, what do you mean? Your mother's very sick right now. I said, I know my mother's very sick right now. And this is one thing I can control. I sort of did a do you know who I am? Because I'm on the guidelines committee for GSM for the American Urologic Association.

And because menopause medicine is a tiny little field in a tiny little corner, they looked at me like I was an insane person. I said, what do you mean? Your mother's very sick right now. I said, I know my mother's very sick right now. And this is one thing I can control. I sort of did a do you know who I am? Because I'm on the guidelines committee for GSM for the American Urologic Association.

So for the transplant team, I had to write up a whole S-bar of like, here's why it's important. Here's the research. Here's all the literature. Here's the citations. And they said, but it'll increase her risk of blood clots. I said, no, it won't. Vaginal hormones don't increase your risk of blood clots. It's like hydrocortisone cream compared to a solumedrol. Those are very different things.

So for the transplant team, I had to write up a whole S-bar of like, here's why it's important. Here's the research. Here's all the literature. Here's the citations. And they said, but it'll increase her risk of blood clots. I said, no, it won't. Vaginal hormones don't increase your risk of blood clots. It's like hydrocortisone cream compared to a solumedrol. Those are very different things.

So then they went to the ICU team. I said, no, we can't give this to her to increase her risk of blood clots. Had to convince them. Then the pharmacy, they finally got them to write the prescription. I had to teach them how to write the prescription. Pharmacy wouldn't dispense it. Why? It increases the risk of blood clots. It says so right on the box. So I had to call and yell, right?

So then they went to the ICU team. I said, no, we can't give this to her to increase her risk of blood clots. Had to convince them. Then the pharmacy, they finally got them to write the prescription. I had to teach them how to write the prescription. Pharmacy wouldn't dispense it. Why? It increases the risk of blood clots. It says so right on the box. So I had to call and yell, right?

I'm trying to run a practice in Washington, D.C. My brother and father are trying to advocate with me because they know they also follow me on social media. They know this is important. Finally, the pharmacy dispenses the tube of Estrace. There's no applicator. The nurses don't know how to give it.

I'm trying to run a practice in Washington, D.C. My brother and father are trying to advocate with me because they know they also follow me on social media. They know this is important. Finally, the pharmacy dispenses the tube of Estrace. There's no applicator. The nurses don't know how to give it.

I had to show them and teach them how to give my mother, who is on ECMO and ultimately passed, not from a UTI, thank goodness, but had to show them how to dispense I had to do all this being one of the leading educators on this topic. What does everybody else do? And guess what? The teams changed every week. We had to do this every week and to teach them why this was important and how to do this.

I had to show them and teach them how to give my mother, who is on ECMO and ultimately passed, not from a UTI, thank goodness, but had to show them how to dispense I had to do all this being one of the leading educators on this topic. What does everybody else do? And guess what? The teams changed every week. We had to do this every week and to teach them why this was important and how to do this.

Vaginal hormones should not be gynecology. It should not be a small subset of menopause medicine. We could save Medicare between $6 and $22 billion a year if people understood this, if the box labeling weren't on there. I mean, it is so personal at this point, and yet it is horrible.

Vaginal hormones should not be gynecology. It should not be a small subset of menopause medicine. We could save Medicare between $6 and $22 billion a year if people understood this, if the box labeling weren't on there. I mean, it is so personal at this point, and yet it is horrible.

maybe even not later in life. So we find that systemic hormones are not often enough to help with the genital and urinary symptoms. Most doctors don't know this. Again, what are you afraid of? You're not adding any systemic risk. It doesn't increase. If your estrogen level is 70 on your patch and you add a vaginal estrogen, her estrogen level is going to stay 70.

maybe even not later in life. So we find that systemic hormones are not often enough to help with the genital and urinary symptoms. Most doctors don't know this. Again, what are you afraid of? You're not adding any systemic risk. It doesn't increase. If your estrogen level is 70 on your patch and you add a vaginal estrogen, her estrogen level is going to stay 70.

You're not going to get that systemic absorption, but you are going to reduce your UTI rate significantly.

You're not going to get that systemic absorption, but you are going to reduce your UTI rate significantly.

We just published a study that DHEA does the same thing. It reduces the risk of UTIs by more than half.

We just published a study that DHEA does the same thing. It reduces the risk of UTIs by more than half.

So they've looked at a lot of oral, you probably know this data better than I do, oral DHEA, the data's all over the place because your adrenals are pumping out a lot of DHEA. But when you put DHEA vaginally, the idea is that your vaginal enzymes convert it into both estrogen and androgens.

So they've looked at a lot of oral, you probably know this data better than I do, oral DHEA, the data's all over the place because your adrenals are pumping out a lot of DHEA. But when you put DHEA vaginally, the idea is that your vaginal enzymes convert it into both estrogen and androgens.