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12. Perimenopause: Kegels, Squats & Pelvic Floor with Dr. Karen Connor, PT
51 Plays15 days ago
In this episode of Perimenopause: Head to Toe, Dr. Rachel Pope sits down with Dr. Karen Connor, a seasoned physical therapist with over 20 years of experience, to discuss how perimenopause and menopause affect the pelvic floor. Dr. Connor shares her extensive expertise in pelvic health, shedding light on the changes women experience during this stage of life and how pelvic floor physical therapy can help manage and prevent complications.
Key Highlights:
- What is the Pelvic Floor? Dr. Connor explains the role of the pelvic floor muscles, their importance in overall health, and how they provide support for vital organs.
- How Perimenopause Affects the Pelvic Floor: Learn how hormonal changes during perimenopause and menopause lead to tissue thinning, reduced elasticity, and muscle weakening, all of which can affect pelvic floor health.
- Pelvic Floor Exercise: Dr. Connor emphasizes the importance of pelvic floor exercises like Kegels, and why combining these with other physical therapy techniques is crucial for comprehensive pelvic health.
- Heavy Lifting and Pelvic Floor Health: Dr. Connor shares her insights on lifting heavy weights and how it can impact the pelvic floor, offering practical advice on how to protect it.
- Managing Pelvic Pain and Prolapse: From pain with penetration to prolapse, Dr. Connor discusses how pelvic floor therapy can help women manage these conditions, even if they're already experiencing symptoms.
- The Importance of Working with a Pelvic Floor Physical Therapist: Dr. Connor highlights the benefits of seeing a pelvic floor physical therapist for tailored care and exercises that address the unique needs of each individual.
For Women in Perimenopause and Beyond:
Dr. Connor stresses that no matter where you are in your health journey, pelvic floor physical therapy can help manage symptoms and prevent future complications. Whether dealing with prolapse, incontinence, or pelvic pain, proper treatment can significantly improve quality of life.
About Dr. Karen Connor:
Dr. Connor is a highly experienced physical therapist, educator, and pelvic health advocate. She co-authored the book Sex in Your 60s and has served in various leadership roles within the American Physical Therapy Association. Dr. Connor currently runs a private practice, Cleveland Pelvic Wellness, alongside Dr. Jessica Jenkins, where they provide specialized pelvic floor therapy to women in Northeast Ohio.
Resources Mentioned in the Episode:
- Cleveland Pelvic Wellness Website: clevelandpelvicwellness.com
- Sex in Your 60s (Book co-authored by Dr. Karen Connor)
- The Menopause Retreat - November 14th
Recommended
Transcript
Introduction to Dr. Karen Connor
00:00:00
Speaker
Welcome, everybody. Today, i have a very special guest, Dr. Karen Connor. She has been a physical therapist for more than 20 years. She holds a master's degree from Cleveland State University and a doctorate from Alabama State University. She's a lifelong learner and teacher. She's a part-time professor at Cleveland State University.
00:00:17
Speaker
She's regularly invited to present at large multidisciplinary symposiums and groups like UH Hospitals, Female Sexual Health Symposiums, oo woo and the Menopause Society. ah Dr. Connor co-authored the book Sex in Your 60s, and she has served as the Ohio representative and volunteer coordinator for the section women's health of the American Physical Therapy Association. She has served as vice chair of the Northeast District of the Ohio Physical Therapy Organization as well. And in her spare time, Dr. Connor likes to hike, read, laugh, and hang out with friends and family. She is an avid beginning
Understanding the Pelvic Floor
00:00:52
Speaker
watercolorist. I didn't know that about you. I can tell you a little addition to this bio is that Dr. Karen Connor has taught all the pelvic floor physical therapists that I know and respect. but She is the source. So thanks so much, Dr. Connor, for being on today as we talk about how perimenopause and menopause affects the pelvic floor. Thank you so much for having me. And you know I am a big fan of yours.
00:01:16
Speaker
If you want to see a woman who is changing the world, make sure you research Dr. Poe. You're very sweet. Thank you. My first thought of interviewing when I was thinking through this organ system and thinking through perimenopause and menopause affects us from head to toe. And i want to interview everyone. I want to...
00:01:33
Speaker
interview neurologists and podiatrists and everybody who can who can talk to or speak about how these changes through women's midlife start to affect these organs.
00:01:45
Speaker
And the pelvic floor is an area that you and I both and take care of a lot for women. And so kind of wanted to start off just and just to backtrack. For anybody who is listening and is like, what the heck is she talking about pelvic floor?
00:01:59
Speaker
Can you explain that term?
Impact of Menopause on Pelvic Floor Health
00:02:01
Speaker
I can. So the pelvic floor is a group of muscles that are inside our bodies. The good news is we don't have to think about them most of the time because it would be exhausting if we did.
00:02:11
Speaker
So for the listeners out there, if you put your hands sort of just below your belly button, you're going to feel a bone called pubic symphysis. And if you put another hand behind you where your tailbone is, I think we all know where that is, the pelvic floor connects front to back.
00:02:26
Speaker
It provides sort of a hammock structure to give support to the organs. It is a group of muscles that all work together. They coordinate to provide stability, sphincteric control, sexual health, a little bit of everything.
00:02:41
Speaker
I'm a little biased, but I do think they are the coolest muscles in the body. They are so important. And I don't know if I got this from you. I know I didn't make this up, but you know I like to tell people how important the pelvic floor is. If you think of like a skeleton and the bony pelvis, like the pelvis of a woman, there's nothing in the middle.
00:03:00
Speaker
That's holding up all of those organs above it. Your pelvic floor is doing that. For all people, I think it is really underestimated in terms of the impact it has just on our overall strength and balance.
00:03:14
Speaker
So when people talk about the core, a lot of times people just think, oh, it's the abdominal muscles and it's the back muscles. But really, if we're going to talk about the core, we need to include the diaphragm and the pelvic floor.
00:03:25
Speaker
because that sort of abdominal canister works together. And ah compromise in any part of that canister from breathing to abdominal work to pelvic floor can cause issues and can cause things like urinary incontinence, pain, pressure, a whole host of other things.
Exercise and Pelvic Floor Strength
00:03:42
Speaker
Oh, that makes sense. So what are the changes that happen to the pelvic floor during perimenopause and menopause? What do you see in your patients? So I tell my patients, I call menopause the great reckoning.
00:03:53
Speaker
It is when all of our bad habits catch up to us. Because I think as women in particular, and women who have had children, we become sort of last on the priority list of how we take care of ourselves.
00:04:05
Speaker
So you have a baby, obviously the focus is I've got to feed the baby, take care of the baby, put roof over the baby's head and help them navigate to adulthood. And somewhere along the way, we lose the focus on ourselves.
00:04:18
Speaker
So menopause is often the time when children are leaving the nest and some other health issues start to arise. So because we lose estrogen, which is again, just a natural part of the process, our tissues start to thin and become less springy.
00:04:32
Speaker
they become a little drier and a little bit more fragile. So the support that we were getting from the pelvic floor strictly from like collagen and estrogen diminishes significantly. If you were already a little weak in your pelvic floor and had kind of skated by because you had good collagen and estrogen,
00:04:48
Speaker
you are going to lose that. So this is why pelvic floor control becomes really important because we're all gonna deal with that thinning, but it's the muscle tone and control we have going into menopause that can make a big difference.
00:05:01
Speaker
And you see the thinning of muscle, you know, you see it happening as people age in general, like I think back to even grandparents, you know, of course, as my own parents are aging, you see their muscles thinning. We don't really see the pelvic floor muscles, obviously, but I guess it's the same process that's happening. Part of that is age. Part of that is menopause, I suppose.
00:05:23
Speaker
Yes, to both. Because sarcopenia It's something that happens in both men and women where we start to lose sort of that bulkiness of the fibers and actually lose muscle fibers. That kind of brings me to my next question. So what can somebody do to prevent those changes?
00:05:36
Speaker
So the good news that there is absolutely things you could do in terms of the pelvic floor. So one of my pet peeves is when people have come in and they're maybe experiencing like, let's say some leakage.
00:05:48
Speaker
And they look at me with absolute disgust in their eyes and they're like, I've done kegels for 20 years and I don't see how you're going to help me. Real and true conversation. So then that's when I explained the pelvic floor is part of a system. And that system includes the hips, the back, the abs, the Really, I've been doing some really interesting reading on the foot and the pelvic floor.
00:06:08
Speaker
So connections, like you were saying, the whole body and its muscle. So if they've only been building one group of muscle, they probably aren't getting the results that they want. I describe it that if you flex your arm like you're lifting something up, so bend your elbow.
00:06:22
Speaker
That's your bicep. And the bicep is part of the shoulder. But if that's the only exercises you did for your shoulder, you wouldn't get the benefits you'd want. So the best thing you can do for muscle and retaining muscle fiber is exercise.
00:06:34
Speaker
I know I'm everybody's least favorite clinician when I bring this. So you do have to find exercise that works. Lifting heavy is great for women. It is great for muscle mass. It's great for bone health. It's great for cardiovascular health.
00:06:47
Speaker
So lifting is one of the first things I try to get people to do within reason. That will help retain sarcomeres and build muscle fibers that are remaining. All right. That brings up a question. I've been dying to ask somebody like you, and this is the perfect opportunity. I hope you don't mind. I'm swinging this one on you. So I love Dr. Mary Claire Haver and what she's doing for women perimenopause and menopause because people are coming into my office with her book and they're like, tell me more. How do I get my life?
00:07:16
Speaker
you know, on track. And I love that. I love that huge change, that cultural shift that she's helped to be behind. One thing I wonder with all the heavy lifting and especially women who are lifting heavy for the first time, sorry, just to clarify if if people haven't read her book or follow her stuff, she does talk about lifting and resistance training and strength building. And I know it's not just her, but probably Dr. Wanda Wright. There's lots of others who talk about lifting heavy um and it's not just about like toning your muscle, but it's building your muscle. And the first thing that I think about is,
00:07:46
Speaker
Oh God, your pelvic floor. Because I've seen even young women who are weightlifters or in really you know strenuous sports and do a lot of heavy lifting have prolapse.
00:08:02
Speaker
And I've seen, you know we see that happen through menopause and beyond, maybe it's age, maybe it's estrogen, but we see prolapse as a result of heavy lifting. People who are primary caretakers and have to lift their dependent, their child or their adult you know adult child or their partner or whomever, and we see prolapse happening in their pelvic floor.
00:08:21
Speaker
So what would you tell someone who is planning to start lifting heavy for their strength and their bones and
The Role of Pelvic Floor Physical Therapists
00:08:27
Speaker
their muscles? How do they protect their pelvic floor? So I first say start small.
00:08:32
Speaker
i should we should I should paraphrase and say the goal is to eventually lift heavy. Nobody should be walking into a gym, grabbing a heavy set of dumbbells and just start working out. In terms of, let's say you don't have any help, you don't have any advice.
00:08:44
Speaker
What I tell people, the the signs to look for are pressure in the pelvic floor. You feel like something is going to fall out. Pain in the pelvic floor, like you're getting stabbed in the vagina or incontinence.
00:08:55
Speaker
Incontinence is a failure of the full system. Any three of those tell you your pelvic floor cannot support what you're doing. The best advice I can give is, of course, I'm going to say start with a PT because that's my job, especially a pelvic PT, to assess the strength and make sure you have a good strategy. And that in particular, because this is lost in a lot of women postpartum,
00:09:16
Speaker
the talking between transverse abdominus and the pelvic floor. So if those two aren't talking, again, you're gonna be lacking full support. And that is something we can absolutely look at. And then we were talking a little bit before we started recording about the importance of those deep, deep stabilizer muscles.
00:09:31
Speaker
ah call them the non-sexy muscles because they're not going to give us the J-Lo booty or the six pack, but they are what is going to give us a pain-free and mobile life. And those have to be functioning well to make up. What are those?
00:09:44
Speaker
Oh, that would be transverse abdominis, shout out, the pelvic floor, the deep muscles of the pelvic floor, obturator internus, externus, piriformis. The gameli for stabilization, those are the deep ones. And we don't talk about them. We all just want the J-Lo butt and the flat abs.
00:10:01
Speaker
But if you don't have the strength to go along with it, you're just, the long-term gains are not going to be what you want them to. be If you don't have the deep, I mean, this is clinical anecdote. This is, I haven't done the research on it, but people that aren't firing those deep muscles don't typically seem to build the muscle mass that they want.
00:10:19
Speaker
So I'll see people come in and they feel like their rear end is really flat. And when I go to look at it, glute maximus, which is the big glute muscle we all know about, can be strong. But as I get into deeper testing, glute meat is weak, piriformis is weak.
00:10:34
Speaker
So it's like almost like the muscle can't really bulk up until it has the full support system. That's interesting. So, okay, what should people do? Like, are you saying like there are exercises that a pelvic floor physical therapist would recommend?
00:10:47
Speaker
Or is there like a kind of exercise people should be doing? Oh, that's such a good question. It's more than kegels, but you have to have an awareness of your pelvic floor moving. Are you feeling alone through perimenopause or menopause?
00:11:00
Speaker
Are you wondering if anybody else has the experiences that you have? Do you want more than just a few minutes with a healthcare care professional with expertise in menopause care? Come to our next menopause retreat. If you're based in Northeast Ohio, we have retreats on a quarterly basis.
00:11:16
Speaker
You can come in person or virtually. or ask your employer to pay for it for you. We're happy to do corporate retreats as well. Everyone deserves community and care during perimenopause and menopause. So again, I'm going to say if you have never exercised before, you really should see a PT first because you want to know if you have any injuries or limitations.
00:11:39
Speaker
And is that just any physical therapist or a pelvic floor? I would say any orthopedic therapist. And or find somebody you can sometimes there are really great personal trainers out there that do a fantastic job of understanding the body.
00:11:54
Speaker
But conversely, I've also seen trainers that push their patients way too hard at first and then there's injuries. So having somebody, you know, could be word of mouth. It could be talking to them, seeing if they understand in particular women's health.
00:12:07
Speaker
It can be really helpful. And then I believe there are people who love to exercise. Right. I am happy for them, but most of us have a lot going on in our day and we need really targeted exercises to get the most bang for our buck.
00:12:22
Speaker
So I like things that incorporate a lot of different body movements. So a squat is one of the best, a squat with dumbbells. You can either kind of hold them over your shoulders or do a suitcase carry, which is by your side and a body weight squat.
00:12:36
Speaker
Again, watching for pressure, pain, or incontinence. Any of those three, you pick too heavy of a weight. or you're not firing your pelvic floor. So when you go into the squat, it's impossible to tighten. The pelvic floor is eccentrically lengthening.
00:12:51
Speaker
And as you come up and you really activate the glutes and pull in the pelvic floor and the TA extra is when you will get the work. So a squat with dumbbells in different positions is one of my favorite ways to start.
00:13:04
Speaker
If you have knee pain, hip pain, ankle pain, again, this is where you want to go see somebody who knows what's going on. No exercise should cause you pain. And most of the time it's a technique issue rather than just arthritis.
00:13:17
Speaker
Right. So I like squats. Getting on and off the floor is a good one. Oh, from laying flat? From if you're playing on the floor with your kids, a lot of people can't get off the floor. So even just practicing, so let's say today you're like, oh, she mentioned getting off the floor. i can't do that.
00:13:34
Speaker
So you start on a lower chair and you start to build the strength in the legs to kind of be able to push yourself up. Not being able to get out of a chair without arms is actually ah is considered a fall risk.
00:13:45
Speaker
So having the strength, it's something we can all practice today of not using your armrests to help push you up. Really make your butt and your legs do the work. So there really is a lot of preventive work that can be done.
00:13:57
Speaker
Almost like we need to make the space for it in order to... But that's why I think picking two to three exercises a day and really committing to them is much better than asking ourselves to 30 minutes of hard stuff every day. Yeah.
00:14:13
Speaker
I want... But I can do some spots and then practice getting myself up off the floor after I'm
00:14:20
Speaker
See, two easy things you can do. The other easy one, and again, this is not always connected to the lifting, but it's balance exercises. Pelvic floor function and balance go together.
00:14:31
Speaker
There is some really interesting early research that was done on the woman named Janet Hulme. She's a PT in Missoula, Montana. And she went into a nursing home and taught them this basic exercise called roll for control.
00:14:43
Speaker
that you can do sitting in a chair and we can post a link to it in the comments or people so people know what I'm talking about. She went in thinking she was going to try to help with incontinence. This was her goal.
00:14:54
Speaker
Well, not only did she help with incontinence, people started to fall less. Balance got better. And again, from a developmental perspective, usually around the time kids are really up and mobile and able to do a variety of positions is when you start to think about potty training, partially because the pelvic floor is stronger.
00:15:12
Speaker
Interesting. but just wow. Blowing my mind. Which is why I am against the whole like trying to teach an infant to potty treat. Yeah.
00:15:23
Speaker
No, just yeah let them be because you they need to build their poor little muscles. Yeah, that makes sense. That is so cool. The reverse end of the lifespan is with sarcopenia and muscles thinning. Plus our nerve fibers change. We become a little less sensitive to things.
00:15:36
Speaker
Again, it increases our fall risk as well as increasing continence. So they go together. So interesting. Okay. So for people who might be listening and say, well, I already have some muscle weakness, muscle wasting, or I already have prolapse, or I already have some of these things that we've talked about.
00:15:55
Speaker
Is it too late for them? What do they do? and have they but They need a pelvic floor physical therapist, not just an orthopedic physical therapist, right? And maybe you can differentiate. Yes, happily. So I say i am an orthopedic therapist who specializes in the pelvic floor because I recognize that pelvic floor is part of a larger orthopedic system.
00:16:16
Speaker
However, most orthopedic PTs don't like to think about the pelvic floor. Some will incorporate it, which I'm grateful for, will kind of have you try to activate the pelvic floor. So an orthopedic therapist is going to be the person to go to for neck pain, back pain, hip pain.
00:16:33
Speaker
We are taught, we are graduating in Ohio as direct access practitioners. So you could, in theory, sprain your ankle. And instead of waiting three days, getting in with the doctor, then getting imaging, go see a PT because we're taught to screen for things like And Ohio has a really good practice act.
00:16:49
Speaker
But an orthopedic PT should be able to teach you how to exercise safely, kind of teach you a progression to go along. If you mention the pelvic floor and they turn slightly white or bright red,
00:17:01
Speaker
maybe consider another pelvic floor or another physical therapist. But an orthopedic is gonna be more outside. Pelvic floor therapists are also gonna think about the inside. Okay. And there's additional training that they've had, right?
00:17:14
Speaker
There are. We graduate PT school with minimal. We know it's there. We've heard about it, but I think much like in med school, until you specialize, it's sort of this black void. There's the belly button and then the hip starts and stuff happens in between, but we just kind of close our eyes.
00:17:30
Speaker
So most of us have gone to advanced training. They're offered through our professional organization, which is the APTA and other institutes like the Herman and Wallace Institute, which is where I did most of my training. And there's levels, there's like kind of one through four, and then there's ancillary classes.
00:17:46
Speaker
in things like oncology, myofascial release, um trauma, aging, menopause. So there's a whole bunch of classes we can take to do that. So yeah, the extra training. And it it gives you a comfort level and an appreciation of working with the pelvic floor.
00:18:00
Speaker
There are students and now, I'm happy to say, I'm most familiar with Cleveland State who do clinicals in pelvic health. So that really counts a lot towards their education they are able to practice some of the techniques we learn and maybe get a little bit of a head start.
00:18:13
Speaker
That's cool.
Managing Menopause-Related Pain
00:18:14
Speaker
And I have to say, i mean, i love working with you because I feel like you'll have patients that you're like, you know what, Rachel, I think she kind of needs some vaginal estrogen. And you see, like you see the interplay of what's happening from the surface level and deeper.
00:18:32
Speaker
Well, let me also put that back as a compliment to you that you are a doctor who is always open to collaboration. And I feel like urogynes and gynecologists, urogynes in particular, and are really like, they love to hear from me. And that makes my heart so happy. And I so respect the medical knowledge and to be a part of a team and having a really team that likes to talk to each other is just so necessary.
00:18:56
Speaker
And you were part of the reason I started to really focus on vaginal estrogen too. Our sex med group has taught me a lot. no, that's really cool. So if somebody is already having some of these issues,
00:19:07
Speaker
seek help from a pelvic floor physical therapist and see, you know, what you can do to sort of work back some of the issues and then prevent them from getting worse. Is that what you would say? Because I'm sorry, I cut i cut you off a little bit earlier.
00:19:18
Speaker
Are you kidding? I probably went on like 20 different tangents. So that's my brain. So yes, in terms of pelvic organ prolapse, urgency, frequency, incontinence, both anal incontinence and urinary incontinence,
00:19:30
Speaker
you can absolutely get better with PT to some extent. A prolapse is when there is a muscle that's sort of stretching the tissue that supports it, right? And a prolapse can get to the point where the bladder is outside the body or the uterus is slightly outside the body.
00:19:45
Speaker
In cases like that, you're most likely going to need surgical intervention because the architecture has changed has been compromised enough where it needs surgery. But it doesn't mean pelvic floor PT won't help you because we can still get you stronger and the better and stronger you go into a surgery, the better the outcome is.
00:20:03
Speaker
Yeah, definitely. If you have a mild prolapse, absolutely. It'll never be what we were when we were 16 or 15. but maybe for my 12, I don't know, but it can get better and it can absolutely, yes, barring any other things, prevent it from getting worse.
00:20:16
Speaker
Yeah. And in terms of, I guess, muscles, I wonder, you know, I have these patients I'm kind of thinking about who are going through menopause and their pain starts Maybe. It's kind of like the chicken or the egg.
00:20:30
Speaker
But it seems like their pain starts at the entrance of the vagina where there's been a lack of estrogen, lack of testosterone, and then narrowing. And they start to have pain. And then they're having pain with penetration so much that they're anticipating pain. So then their pelvic floor muscles start to sort of brace themselves for the pain and become tense. And then they get trigger points and they get... you All of these things where it kind of cycles upon each other. And I feel like for those patients, they're not usually thinking about the pelvic floor. And even sometimes for healthcare care providers, we're not thinking about the pelvic floor yet because the focus is on the entrance of the vagina or the vestibule. But what would you recommend for those patients? Like where do you do you work on it all at once?
00:21:14
Speaker
Or how do you address the pelvic floor aspect of that pain with penetrative sex? So, yes, that is that is a challenge for a lot of women. And then once you bring pain into the cycle, desire goes down, libido goes down because who wants to do something that hurts?
00:21:29
Speaker
so If a woman has seen me and has not seen a medical provider like you, because you know I refer you a lot of people, and I see a lack of estrogen, it's the first thing that I'm going to do. Because I just describe it like we could probably get there without the estrogen, but it's much harder and it's a much more uphill battle.
00:21:45
Speaker
Makes sense. Then, as much as stretching the tissues, we need to retrain the brain. Because the brain has been programmed on a primal level that penetration hurts. We have to reteach the brain that no, it doesn't hurt. It doesn't have to hurt.
00:21:57
Speaker
So dilators are one of the many ways that I really like to do that. You can get dilators that are smaller than your pointer finger and you work with just starting to maybe approach the entrance and maybe just laying it on there.
00:22:10
Speaker
Or if that's too much and you feel yourself tense up, you lie it on your thigh. Again, do some deep breathing, some sort of cognitive retraining to realize like I'm in control and I can do this. Then once you can insert the dilator,
00:22:23
Speaker
you do it to tolerance. So if that small dilator is enough, then that's where you stop for a while. You allow your brain and your tissues to learn to relax around that. As it gets easier, you can go up a size in the dilator.
00:22:36
Speaker
There are also dilators that you can sort of pump up for a very small amount of change and stretch. But I would say the big thing is estrogen dilators and brain retraining. Because again,
00:22:48
Speaker
we're primed to protect ourselves. Like that's, that's our job as a human is protect our reproductive organs and protect ourselves. And if it hurts, we're going clamp up. So dilators, I really recommend dilators.
00:22:59
Speaker
Makes sense. think everybody needs lube and they don't necessarily realize it, but I have had so many patients through the years when I give them like samples of lubricant who come back to me and they're like, thank you.
00:23:10
Speaker
You changed my life. And I'm like, I know. No, I said, you can thank the person who invented it. But yes, even people who swear on a stack of whatever they hold dear that they lubricate.
00:23:22
Speaker
Oh no. Oh, it takes it to a whole new level. It takes it to a whole new level. Yeah. I don't think people get it until they've tried it. So and if you're listening to this and you haven't tried it. And if you are perimenopausal menopausal, think about a silicone lubricant rather than water-based.
00:23:37
Speaker
yeah So silicone is your friend. It's medical grade. Body does fine with it. I could not agree more. Okay. One more question for you. As I try to always mention perimenopause too, because I think menopause is getting more attention and people...
00:23:52
Speaker
can kind of wrap their heads around, okay, it's been a year without period and menopause. But perimenopause is really confusing and can last for longer. And the thing that I see more and more often is when it's the week before a person's period and they start to have pelvic pain.
00:24:10
Speaker
Or they start to have burning at the entrance of the vagina. Or they have incontinence. i have I have seen patients who have incontinence only for that one week before their period. And I wondered if you see this as well. I think it's perimenopause. And I can't say 100% whether it's the estrogen or the progesterone or both, but they decrease.
00:24:31
Speaker
But my theory is that it's a preview for menopause. And this is only going to get worse. right So why not treat it? Yes. That's the thing. I think that is fascinating. And I hope you write a paper on that.
00:24:44
Speaker
The other thing I would be curious to start asking those patients if they have joint pain the week before their periods, because that's something I think is highly neglected in women. We're often told it's just arthritis. It's just this. But joint pain is one of the symptoms of perimenopause.
00:24:59
Speaker
Yes. Definitely. And I mean, I say estrogen is behind all the fluid in our body, whether it's like moisture in the vagina, or like moisture in your eyes or, or fluid around your joints. It's because of estrogen or the lack thereof.
00:25:13
Speaker
So if you're starting to get joint pain, and it's, you know, I tell people, make sure it rule out the other medical causes, make sure it's not something else going on, see a rheumatologist or see an orthopod or whoever or your primary care person.
00:25:25
Speaker
But yeah, if you're around 10 years behind the average age of menopause of 51. So if you're in your 40s plus, and this is starting to happen out of nowhere, consider perimenopause.
00:25:38
Speaker
And I think that's a tough, because we have, I think we're working on it. It's getting better, but there's still a stigma about menopause because there's a stigma about aging in our society. So when you mentioned perimenopause to somebody who's like 38, 39, 40,
00:25:52
Speaker
They look at you like you just kicked a puppy. When really we just need to process that this is a natural part. I mean, we can call it Jen Gunter liked the climacteric, which I thought was a really good one.
00:26:03
Speaker
But acknowledging that this is just a body process, that there's no stigma or shame. And the sooner we intervene, the better the outcomes will. be And 38, 39 is not too young. Absolutely.
00:26:14
Speaker
see your pelvic floor physical therapist. Find the person in your neighborhood. Make good friends with them. Make good friends. Make good friends with doctors like you our sexual medicine team who get it.
00:26:24
Speaker
Who I remember having the first conversation with my former primary care doctor when I was 39 40 and saying, and saying I think I'm starting to go through menopause because I have some of the risk factors, right? I'm overweight. I've never had children and my periods were getting weird.
00:26:40
Speaker
And he just looked at me and said, oh, you're too young. It must be stress. It was not stress. But years of that, and again, as women, I think that's what we are sort of taught to internalize. The stress of perimenopause.
00:26:52
Speaker
It was the stress in my opponents. It's either stress or weight. No, it is often more than that. So make sure you have a doctor who will listen to you. and take you seriously because you know your body better than anybody else on the planet. Exactly.
Conclusion and Contact Information
00:27:05
Speaker
Well, thank you so much for your time. your expertise is very much appreciated. and I am so happy to see you in your own practice. I want to remind listeners, to anybody who's in Northeast Ohio, Dr. Connor has her own private practice with Dr. Jessica Jenkins.
00:27:22
Speaker
The two of them have to find sources for the East and West side of Cleveland to provide pelvic floor physical therapy. And you can find more information on their website, clevelandpublicwellness.com, and we'll put the website in our notes.
00:27:36
Speaker
But thank you so much for your expertise and for talking us through this topic today. Oh, thank you so much. Thank you for letting me talk about one of my most favorite topics in the world.