Insurance, Hormones, and the Help You Need

In Menopause/Perimenopause by Stephanie Prendergast

By PHRC Admin


Let us help you untangle something that should be so simple yet is not and continues to be a problem for many; accessibility to healthcare that thousands across the nation need and could benefit from. There exists a notable disparity in the healthcare sector, often overlooked. It’s the inequality faced by individuals going through menopause when it comes to accessing affordable hormone treatments, compared to the ease of accessibility for medications treating conditions such as erectile dysfunction. This discrepancy not only sheds light on the high costs of hormone therapy but also highlights an alarming lack of awareness among medical professionals about its benefits.


The Cost of Hormone Therapy

Menopause is a natural stage of life that many will experience. Despite this, many find themselves grappling with the high costs of hormone treatments, a vital part of managing menopause symptoms. Regrettably, while treatments for conditions like erectile dysfunction are readily accessible and reasonably priced, those going through menopause often struggle to find affordable options for their hormonal needs.


Take this quote by Deborah Copaken for example:


“If I were a middle-aged man suffering from erectile dysfunction, I could walk into my neighborhood pharmacy and buy a 30-day supply of Sildenafil (the generic for Viagra) for $8.67 out of pocket, and, no, that’s not the insurance copay.”


Copaken’s recent article, “How to Hack Insurance So You Can Get the Hormones You Need,” featured in Oprah Daily, really hit the nail on the head when discussing the accessibility of women’s healthcare and healthcare products.

The Role of Knowledge and Awareness


Contributing to this issue is a significant lack of awareness among doctors about the benefits of hormone therapy. This gap in knowledge often leads to a reluctance in prescribing these treatments, leaving many without access to this essential support during menopause. This discrepancy underscores the need for improved education and awareness among healthcare providers about the importance and benefits of hormone therapy.


Finding Affordable Hormone Treatments


However, there are several avenues for obtaining affordable hormone treatments. One such option is working with menopause specialists who have a detailed understanding of the hormonal changes individuals undergo during this phase of life and can provide tailored treatment plans.


Another promising option is online telemedicine start-ups. These platforms offer virtual consultations and treatments at a fraction of the cost, making them a viable alternative for those struggling with the high costs of traditional healthcare.


Furthermore, cost-saving initiatives like Cost Plus Drug offer a beacon of hope. These initiatives aim to make medication more affordable, ensuring that more people can access the hormone treatments they need.


Towards More Transparent and Equitable Healthcare


The challenges faced by those going through menopause highlight the pressing need for more transparency and equity in healthcare. As we move forward, it’s crucial to ensure that everyone has access to affordable treatments and that doctors are well-informed about the benefits of hormone therapy.


In conclusion, while the path to equitable healthcare might be fraught with challenges, the possibilities offered by specialists, telemedicine start-ups, and cost-saving initiatives provide hope. What’s clear is that a shift in perspective is needed – one that acknowledges the importance of healthcare during menopause and strives towards making it accessible and affordable for all.


Special shout out to our friends who were also featured in this article, Dr. Rachel Rubin, Dr. Ashley Winter, and Dr. Kelly Casperson.



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What are pelvic floor muscles?

The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.

What is pudendal neuralgia and how is it treated?

Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.

Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.

What is interstitial cystitis and how is it treated?

Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.

Who is the Pelvic Health and Rehabilitation Team?

The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.

How many years of experience do we have?

Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.

Why PHRC versus anyone else?

PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.

Do we treat men for pelvic floor therapy?

The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.

Do I need pelvic floor therapy forever?

The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.