menopause

Thrive with Age: Menopause Solutions

In Menopause/Perimenopause by Stephanie PrendergastLeave a Comment

“It’s NOT all downhill from here! When you learn how to find balance in your life and in your hormones, it’s really possible to feel vital through perimenopause, menopause and beyond.”

DR. AMY DAY, FOUNDER, THE WOMEN’S VITALITY CENTER IN BERKELEY, CA

Too many women are silently struggling through bothersome symptoms of perimenopause and menopause on their own. Women often feel embarrassed about the changes their body is going through, and studies show the symptoms of menopause, especially the genito-urinary symptoms of menopause (GSM) are significantly under-reported by women to their own OBGYNs. By the time women reach perimenopause, they often have long-standing relationships with their gynecologist. The fact that the majority of women are not comfortable talking to a trusted doctor about these symptoms demonstrates the need to destigmatize the menopause milestone.

The issues are proper treatment run deeper than just embarrassment about the nature of GSM symptoms. Menopause experts report that there is a significant disconnect in the medical community between the latest studies on effective therapies for menopausal women and clinical practice. Therefore, when the small percentage of women do bring up their symptoms they may be dismissed or misguided. The reasons for this are multifactorial, however, here is a quick summary of a few top issues. Numerous studies have come out recently reporting that women are not taken as seriously as men when reporting symptoms to their doctors and show that minority women are treated even less seriously than white women. In 2001, The Women’s Health Initiative released data regarding the dangers of Hormone Replacement Therapy. In 2013, the majority of this information was not only refuted by researchers, but multiple repeated studies showed opposite results than the first studies. The newers data shows that Hormone Replacement Therapy (HRT) actually had protective effects against cancers and heart disease. In 2001, roughly 57% of menopausal women used HRT. Today, the number is less than 7%. As a result, women are suffering unnecessarily. Despite the newer studies, women often still think HRT is dangerous. Doctors may or may not be current with the new data and may or may not be interested in counseling women about menopause. 

The age women go through menopause has not changed despite the fact women are living much longer. Similar to the hormonal changes that occur with menopause, pelvic floor muscle dysfunction can cause painful sex and bothersome urinary symptoms. With or without HRT, women have an opportunity to reduce pain, improve bladder issues, and feel better with pelvic floor physical therapy. Most women do not know what pelvic floor physical therapy is, therefore they also do not know how much it can help their symptoms. 

Philanthropic women’s health advocate Karen Holly was diagnosed with cancer in her 40’s and the result of her (successful!) cancer treatments resulted in early menopause. As an educated, professional woman she was shocked at how difficult it was to find consistent and accurate information, both from providers and her own research. Karen came to see us at the Pelvic Health and Rehabilitation Center as part of her recovery from the treatments. It was this experience that inspired Karen to create a platform to help women get the information they need from the experts. You can read more about Karen and her mission here. 

In May, Karen put together the first panel of experts in the Bay Area and it was a smashing success. 

The second panel is happening Saturday, October 5th in Berkeley, CA. The  panelists are: 

  • Me, representing pelvic floor physical therapy
  • Amy Day, ND representing  naturopathic approaches to menopause
  • Risa Kagan, MD, FACOG, CCD, NCMP and President of the North American Menopause Society, representing medical management 
  • Peter Koshland, pharmacology and hormones
  • Tendai Jordan, representing spiritual  and life coaching approaches 
  • Ragaia Belovarac, representing ayurvedic approaches 

The goal of the panel is to help get evidence-based and accurate information about menopause into the community. We want to arm women with the information they need to thrive through menopause. It is never too early or too late to get educated and make the right decision for you. 

Space is limited! For more information and to register please visit : https://www.eventbrite.com/e/the-womens-health-panel-thrive-as-you-age-tickets-68570952565?aff=ebdssbdestsearch or www.karenkholly.com/upcoming-events. Please share this post with anyone else you think may benefit from this information!

FAQ

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.

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