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You leave the hospital with a healthy baby, a folder of paperwork, and zero mention of the fact that your estrogen just went from about 3,000 to almost nothing.
That is where this conversation starts. In 2022, I sat down with Dr. Rachel Rubin, urologist and sexual medicine specialist, back in season one, long before she became the person everyone quotes about hormones. I've known her since she walked into the PT department at Georgetown as a resident and asked if she could shadow somebody and learn about Pelvic Floor Physical Therapy. This is her before the rest of the world caught up.
We're rewinding it now because almost everything she predicted in this episode has since happened.
🔹 The estrogen arc, in actual numbers: baby, teenager, cycling, pregnant, postpartum
🔹 Why breastfeeding puts you in a menopause-like state, and what that does to tissue
🔹 Why the bladder and urethra are full of hormone receptors nobody talks about
🔹 What to say when you're told to use more lubricant and wait until you're done nursing
🔹 Birth control, IUDs and local hormones: what actually interacts with what
🔹 The 2000s study that scared a generation off hormones, and how badly it was reported
🔹 The postpartum visit she wishes every woman got, mirror included
Since we recorded, the FDA moved on the estrogen warning label and the AUA published its first guideline on genitourinary syndrome of menopause. Rachel was already saying all of it into my microphone. Come hear where it started.
A correction on my intro: I say "FDA approval" for local vaginal estrogen in the open, and I want the record straight. Vaginal estrogen was already approved. What changed, in November 2025, is that the FDA moved to remove the black box warning from estrogen products, the warning that scared a generation of women and their doctors off it. The approval was never the problem. The label was.
This episode is education, not medical advice. If you want a clinician who actually knows this material, The Menopause Society keeps a practitioner finder at menopause.org.
Time Stamps
1:00 introduction
4:01 hormone health and changes
11:10 advocating for yourself
17:30 hormones and the urinary tract
21:30 HRT misconceptions
27:45 testing and perimenopause
29:30 advice for moms
CONNECT WITH CARRIE
IG: https://www.instagram.com/carriepagliano/
Website: https://carriepagliano.com
CONNECT WITH RACHEL
IG: https://www.instagram.com/drrachelrubin/
Website: https://www.rachelrubinmd.com/
The Active Mom Podcast — a real mom's guide to pregnancy, postpartum, perimenopause & beyond, for active moms and the professionals who help them get there.
Quick-hit conversations with moms, providers, and researchers... because you don't have a lot of free time (you're probably listening at 1.5x right now).
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