Norah O’Donnell: What I learned from my doctor about menopause

For this week’s “Healthful,” I sat down with my very own doctor, Rachel Rubin, to tackle the important topic of menopause: How your body changes, why women may be needlessly suffering, and what you can actually do about it.

Here’s what I learned in our conversation, streaming now on YouTube and available wherever you listen to your podcasts:

Menopause as “a castration event”

“Menopause is a castration event, whether we like it or not, whether it’s natural or not,” Dr. Rubin said. “Whether it’s supposed to happen or not, we are outliving our ovaries.”

Rubin described menopause as essentially the ovarian function turning off: Your ovaries no longer make estrogen, progesterone or testosterone. “You’re not making the hormones that you were during your reproductive years, and that has consequences because you have hormone receptors throughout your entire body,” she explained.

The severity and symptoms are different for everyone, but women commonly experience hot flashes, poor sleep, mood changes, weight gain and memory issues. 

While Rubin said some men see a natural decline of testosterone as they age, they “don’t really get to ‘castrate’ levels.” She explained her castration remarks in the context of a gas tank ***ogy: “Women, their gas tank is zero. Men, they kind of live at like half a tank, and maybe if they get to a quarter of the tank, they can go to their doctor, they get some testosterone, and they go back to half to three-quarters tank and they feel great.”

Vaginal hormones can prevent UTIs — and save billions in Medicare

Urinary tract infections are common during and after menopause, and if untreated, can lead to sepsis, hospitalization and even death. It’s why Rubin said she thinks all menopausal women should be offered ***l hormones, which fix the urinary tract’s microbiome and can prevent UTIs.

Right now, fewer than one in 10 postmenopausal women are using ***l estrogen, even though its use is supported by the American Urological Association, and it’s often covered by insurance.

Rubin said giving women ***l estrogen could save Medicare $6 billion to $22 billion a year, citing costs around urgent care visits, hospitalizations and ICU admissions.

Women actually produce more testosterone than estrogen

You need testosterone to make estrogen in the ovaries — and women make more testosterone than estrogen.

Rubin said there’s global consensus that testosterone helps menopausal and perimenopausal women with low libido, but there’s no FDA-approved testosterone product for women. Although, it can be prescribed off-label. Rubin said her patients who take testosterone tell her it helps with more than libido — that patients come back and say, “I just feel more like me.”

I’ve never talked about this publicly before, but I use testosterone prescribed by Rubin — it comes in a tube that’s normally prescribed to men, but I administer it in much smaller doses. There wasn’t an “aha” moment for me, but I noticed its effects over time, and in concert with other hormones.