Episode 63: A Whole-Body Approach to Perimenopause with Dr. Julie Sarton and Dr. Alexa Charbonneau

Dr. Mary interviews pelvic floor physical therapists Dr. Julie Sarton and Dr. Alexa Charbonneau from Sarton Pelvic Healing about common perimenopause/menopause issues they treat, including urinary leakage (stress and urge), dyspareunia (pain with sex), nocturia (peeing at night), constipation, and broader musculoskeletal problems like SI joint pain and frozen shoulder. We discuss how symptoms can reappear or become “unmasked” in midlife and emphasize that while hormones matter, one-size-fits-all HRT messaging misses crucial factors such as nervous system regulation, lymphatic and gut function, fascia changes (including estrogen receptors in fascia), old injuries, breathing mechanics, and visceral/organ mobility. The conversation highlights nuanced decision-making for cancer survivors and people with conditions like endometriosis, genetic detox differences, and mast cell activation (MCAS), stressing quality of life and individualized, team-based care.

What you will learn in this episode: 

• Perimenopause can start as early as 35 and last a decade
• Many symptoms they've normalized (leakage, joint pain, painful sex, brain fog, peeing at night) are treatable, not inevitable
• HRT is not one-size-fits-all — especially for those with endometriosis, cancer history, or genetic variants like MTHFR or APOE4
• How the pelvic floor is connected to the feet, jaw, neck, diaphragm, tailbone, and even cranial bones
• How there are estrogen receptors exist in fascia which may be why old injuries resurface in perimenopause
• Constipation can recirculate estrogen, making hormonal symptoms worse
• The lymphatic system is deeply underaddressed and may have real implications for breast health
• Nervous system regulation is foundational for lasting healing

00:00 Episode Overview

02:00 Meet the Guests

05:36 Common Menopause Symptoms

08:12 Dr. Julie’s Personal Journey

12:43 Beyond One Size Fits All

15:56 Nuanced Hormone Decisions

17:48 Detox Constipation MTHFR

19:08 Cancer Care and Quality

20:30 Mast Cell and Gut Clues

23:06 Lymph Histamine Overlap

24:01 Estrogen Swings Explained

24:37 Pelvic PT Full Body Care

25:53 How Fascia Line Connect the Head to Feet

27:48 Estrogen Receptors In Fascia

29:35 Detective Work Success Stories

30:33 Diaphragm And Visceral Work

32:25 Constipation And Tailbone Keys

34:28 Glymphatics Lymph And Drainage

37:09 Nervous System Lifestyle Reset

39:13 Menopause Recalibration Closing

42:13 Where To Find Pelvic Healing

43:25 Podcast Outro And Support

You can learn more about Dr. Julie and Dr. Alexa’s practice: Sarton Pelvic Healing in Irvine and Southern California here:

https://www.pelvichealing.com

You can follow their instagram below:

https://www.instagram.com/pelvichealing/

Want support for perimenopause that goes beyond hormones?

Whether you (or your clients) are taking HRT but still having symptoms, not ready for it, or can’t tolerate it...there’s more we can do.

I’ll be sharing practical tools from a movement and rehab perspective, focusing on the nervous system, fascia, lymph, viscera, and musculoskeletal system.

If you want updates on workshops, resources, and strategies to support this phase of life more fully, would love you to join my email list.

Subscribe to my email list here

I’ll see you in 2 weeks!

PS:

If you are interested in being a guest on the show, please fill out the form here.

Transcript

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Welcome back to TMI Talk with Dr. Mary. I'm your host, Dr. Mary. Today we're gonna be talking about how physical therapists can make a much bigger impact on the transition through perimenopause and into menopause. And today I brought on Dr. Julie Sartin and Dr. Alexa Charbonneau. I'll dive a little bit more into their bios, but first I wanna give you an idea of what we're gonna learn in this episode. First, that perimenopause can start as early as 35 and last up to 10 years. Many symptoms that we've normalized and call it just aging, such as urinary leakage, joint pain, painful sex, brain fog, peeing at night, are actually treatable and not inevitable. How menopause hormone therapy, also previously known as HRT, is not a one-size-fits-all approach, especially for those with endometriosis, cancer history, or genetic variants like MTHFR. We also talk about how the pelvic floor is connected all the way from head to toe, so our jaw and neck are connected to our feet and our diaphragm and our tailbone and even our cranial bones, and it's connected through something called fascia, which is a 3D continuous connective tissue that connects everything in our bodies. We also talk about how there's estrogen receptors on fascia and how this can explain maybe why old injuries start to resurface during perimenopause. We also talk about how constipation can recirculate estrogen, making hormonal symptoms even worse. We discuss the lymphatic system and talk about how it's deeply underutilized in perimenopause and can have real implications for improving breast health and overall health, and how the nervous system regulation is the foundation of healing. And I really believe that this is one of the most undervalued systems to help support during perimenopause from a Western-based approach, and it's something that I integrate, and they integrate often with their clients to help achieve maximum results. So a little bit about our guests. So Dr. Julie Sarten is a leading pelvic floor expert and founder of Sarten Pelvic Healing. Since twenty eleven, she has welcomed many patients from across the nation and internationally, driven by her vision of creating a clinic where patients can receive comprehensive care under one roof. Today, Sarten Pelvic Healing is the only pelvic floor physical therapy practice in Southern California with a multiplinis-- not multi-- d- excuse me, multidisciplinary team that includes pelvic floor physical therapist, a neurogastroenterologist, an osteopath, a lactation consultant, an acupuncturist, a guided imagery therapist, and a Red Cord certified specialist, as well as a master Pilates instructor. She previously founded and directed pelvic f- the pelvic floor physical therapy program at UC Irvine School of Medicine, where she collaborated with urogynecologists and OBGYNs and created one of the first pelvic health fellowships, training many of today's leaders in the field With over 30 years of experience, she was among the first advanced board certified pelvic floor PTs in the US, and has successfully treated thousands of complex cases. Her e- her expertise is reflected in publications such as the Journal of Sexual Medicine and Clinical Obstetrics and Gynecology, national lectures ranging from American College of Gynecology to Canyon Ranch, and media appearances on the Discovery Health Channel. Passionate about advancing the profession, she has taught at the Chapman University's Doctor of Physical Therapy program, and has co-founded the Pelvic Floor Sexual Medicine Conference and the Pelvic Education Alliance. Dr. Julie holds degrees from Northern Arizona University and and Creighton University, and lives in Orange County with her husband, Kyle, who's an orthopedic physical therapist, and their two college-age children. Dr. Alexa Charbonneau grew up in South Orange County and loved it enough to stay throughout her education. She then moved to San Diego to receive her undergraduate degree from San Diego State University, graduating summa cum laude with a Bachelor's of Science in Kinesiology. She soon moved to Orange County to receive her Doctorate of Physical Therapy from Chapman University. During her time pursuing her doctorate degree, Alexa spent time treating patients in different settings such as orthopedics, pediatrics, acute care/ICU. While in school, she attended the annual National PT Conference and was eager to grow her knowledge in pain science and the physiology of pain as it relates to the pelvic floor. After a clinical rotation emphasizing the importance of pelvic health and visceral mobilizations, and an elective class at Chapman University, Alexa knew she wanted to pursue pelvic health. Through her experience treating patients in an orthopedic setting, she has learned that the pelvic floor is the often the missing piece of the puzzle in treating many common orthopedic conditions, which I could not agree more with. And it was just an incredible conversation to have with them. Their clinic's practice is similar to ours in addressing the whole person, which is vastly underutilized in our medical system. So without further ado, I'm excited to jump into this episode with you

Audio Only - All Participants 5:23

Welcome Julie and Alexa. I'm so excited you guys are here. We're so excited. Thank you. We're excited to be here. Um, yeah. So what we'll do is we're just gonna go ahead and jump right in and dive into some of the questions. So from y'all's clinical experience, what are the most common things you're treating in women that with per in perimenopause and menopause? So I think this is something that's been really, um, developing a lot in the last couple of years. We've noticed a lot more referrals in patients coming in specifically for menopause related symptoms, um, either from their providers or they're getting educated themselves on things that can be improved because of it. Um, so I'd say in general there's kind of, there's quite a long list and I know Julie will. Stand upon what I'm gonna say of things that can be treated in, in PT for perimenopause and menopause. Um, but some of the most common things we see are urinary leakage. Um, it can be either, it's like incontinence with sneezing, laughing, coughing. It can be like an urg incontinence where they try to make it to the bathroom and they can't. Um, it can be, you know, any type of leakage that I think a lot of women think is only. Happening postpartum or with pregnancy. But then it comes back with menopause, which will go into kind of the, the hormonal piece to that. Um, we also see a lot of dyspareunia, which is pain with sex. Um, also very hormonally driven, which, yeah, Julie will go talk about that too. Um, we see nocturia a lot, which is waking up in the middle of the night to use the restroom, um, to urinate. And it's. Very disrupting to sleep, which then causes other issues with the muscles, um, just because there's no recovery time. Um, outside of that, a lots of, um, just general musculoskeletal type of syndromes that are going on with menopause, which Julie will talk about her story too with that. Um, but I'd say a lot of the symptoms that we see almost in that postpartum window. Pretty much anything there is coming back again in menopause time and perimenopause as well. Yeah. I've seen basically things start to become unmasked. They're like, oh, I was fine. Maybe after even, maybe they felt fine after postpartum and then they go into perimenopause and they're like, what? What happened? And I feel my experience with treating, uh, clients during this phase of life, they feel really validated to know that, oh, so I'm not, I'm not crazy. There are. Some hormonal changes and them being in even aware, unaware that it can happen as early as 35 and sometimes earlier, depending on, um, other predispositions that they might have. Yes, absolutely. I think that brings up such a good point too. 'cause it can last for about 10 years, so. Mm-hmm. You know, part of my story too is that, um, you know, I'm 56, turn about to turn 57, and so, um. I have experienced, I'm like poster child. I've experienced every single thing. That's why I was raising my hand that Alexa just rattled off right from the musculoskeletal presentation of menopause, you know, from chronic SI joint pain to bilateral frozen shoulders that literally took three years. From my mm-hmm. That were really challenging. Um, and this was just in the last, honestly, four years that kind of led right into breast cancer. But, um, to, yeah, do, to just going around, you know, seeing every provider where you're like, oh, I'm not getting help. I'm not getting help. And to finally connecting dots of like. Oh yeah, I am 53. I don't have estrogen, which lubricates the joints, right? Like and mm-hmm. Frozen shoulder is like, in Korea, they call it the, the 50-year-old shoulder problem. Right? Like, it's just so common. But, um, so to like urinary symptoms that started, you know, when I was. At least 12 years younger of just, oh yeah. Now simple things. Jumping on the trampoline to recently origin incontinence where I'm like, oh, I can't believe this is happening to me. We're running literally to the bathroom on a trip. Didn't make it to the bathroom. Literally had an accident, peed my hand, saturated them in the lobby as I'm trying to get in a hotel to the bathroom, and I'm like. I am a patient, okay, I need vaginal estrogen, right? But it's more than that. And we're gonna talk about that today, right? We wanna come in from a lens of pelvic floor physical therapists or pelvic therapists, um, and add the musculoskeletal and just really a whole body systems approach to it. But, um, pain with sex, you know, orgasm. We we're gonna talk about all those, but I had pain with sex early in my life due to endometriosis. I had public pain. I was able to get all that down with pelvic PT and other interventions to compliment it, but it all resurfaced with menopause. So, and the approach to that, you know, we will talk about with, you know, your next question too on like, how does pelvic PT really do, you know, come into play and help with that. But, um. All these things are so again, like we love to say common, but they're not normal and they're also not just hormonal. So I think that's another thing we'll talk about and touch. You wanted to touch on like what are we missing? Like, so this is a piece that we're missing and I love menopause is having a moment right now. I love that. But I think one of the things we also wanna highlight is that there is, um, it's a unique challenging journey. I've had a journey as a public floor therapist that has been. Very challenging and I have a lot of knowledge just like you guys, right? Like, and it makes me think about all the women out there who don't have that medical edge and they're navigating it and bouncing around the medical system and being told various things. So I'm so glad you, thank you for having us on to highlight these things and we can share, you know, more with your listeners today too, about just basic concepts and some starting points to look at to get help. No, I mean, I'm right there with you. I don't know if you, and if you did chemotherapy or not, but chemo set me into early perimenopause and I didn't know, that was not even on my radar like at all. And it wasn't really until the last year that I was like, oh my God, all of these symptoms have been perimenopause this whole time. And it set me into early, it set me into like. Perimenopause for a short time, so like right after chemo. Um, and then getting two periods a month consistently for like a few, like six, eight months. And they were like, you're just waited out. Go on birth control. That's what I was told. Oh, great. Yeah. Okay. So they're not gonna influence your vulgar tissues. Right. To which you need both estrogen and testosterone, and you're blocking that from happening, and so now you can have more pain with sets. Yep. And so it was like not knowing and then going into it and realizing, same thing, Julie. It's like I. I ha I know, I, I know a lot of people I know, I know where the resource, a lot of resources and I, I just felt so lost. So, um, I would say let's go ahead and, you know, w. Let's go into what, you know, what, how you guys realize that physical therapy can play a much bigger ball. Because right now the menopause movement, I think there's good and there's like pros and cons to it, right? Like right now, everything at on social media are one size fits all. Approaches that are like take HRT. This is it glorious? Right? I don't believe it's the saving grace for a lot of people. I personally have history of endometriosis. I can't tolerate some of it. I know. I think we're twinning over here. Yeah. I'm like, are we the same person? Um, and so that's where I'm like, whoa. Okay. Well. All, there's all these resources as physical therapists from helping with constipation. The lymphatic system di like helping with digestion, educating on the body, the nervous system. So let's dive into that because yes, I think we should play a much bigger role, uh, like a much, much bigger role. Agree, yes. Preach, preach, preach. Because yes, this is our philosophy too, right? Mm-hmm. So no system works alone. Every system feeds off the next one. Mm-hmm. So if we are not taking a full, uh, body approach, we are missing so much as providers, as pelvic PTs. And so, yes, I, I do wanna talk about, um, do you wanna start with like a few of the things and then I'll interject Yeah. With a little bit of. Mm-hmm. I think, I think just like you said, Mary, there's a lot of the patients coming in are like all excited about, they found the information on Instagram, like, oh, I need to be on estrogen. But one, they never talk about progesterone or testosterone. And also they, I think they just. They're, they don't understand how estrogen is literally everywhere. They think it's just in their pelvic floor. And so a lot of times they're making those connections in PT with us. Like they come in for one specific symptom, like leakage, and then we start to talk about other things. And like they have the frozen shoulder history or they have the ankle instability. Like there's all these pieces of it that are actually connected to the hormonal pieces. Um, and I think a lot of pelvic PTs, even in general, like to focus. Just on the pelvis. And so like Julie said, we'd have like more of a full systems approach of, okay, if you're not having bowel movements, if you're not getting lymphatic drainage, if you're not regulating your nervous system, it doesn't matter that you can have the estrogen, but you're, it's not, you need all those things to be working in as a team. Um, and a lot of the patients are just mind blown by that. They just. Because it's not something that's connected like on social media even. It's a one size fits all approach. Yes. And a lot of these people have very specific symptoms that they may have even gone to other, you know, orthopedic PTs for, for example. And they try to treat an isolated area, but really it's part of a bigger dysfunction. And I think it's so hard. 'cause I have physician friends that even tell me they're OB GYNs and they're like, yeah, don't send me patients that need hormones. And I'm like, well, why not? They don't understand hormones. Mm-hmm. And so because they're not being educated and there isn't, you hit the nail on the head. It is not one size fits all. It is nuanced. And so many of us are super sensitive, you know, and what we call zebras, right? Or outliers. But I think there's more of us. That are like that then really are recognized. Mm-hmm. So like you and I both have an endometriosis history. Well, I am on HRT, I am on an estrogen systemic patch, even though I have a history of endo and when it gets too high, my menstrual cramp pain comes back. Right. So it's this dance that I have to do. Part of why I chose to go on that is because, again, it's nuanced with my history. I also. I'm an A POE for gene carrier. I lost my mom to Alzheimer's. It was a 10 year history, um, that led right into chronic stress all through perimenopause, into menopause. Um, I'm at a higher risk for that because of that, and. Um, and the research shows that the brain has estrogen receptors in it. Mm-hmm. I need to protect my brain at all costs, so I am choosing to do that, but I have to do a dance with a doctor who a, is willing to put me on that despite my, not just endo, but now breast cancer history. Mm-hmm. Right. And I'm being monitored very closely, but I mean, I am picking, you know, between these two challenging different diagnosis, so. To find a doctor that was willing to walk that journey with me was incredibly hard and willing to hear me hold space for me and actually do the things that resonate with me and honor my choices. Mm-hmm. Right? Like if I need to end up having my cancer ever does, God forbid, return, you know, uh, going to next steps. I'm trying to do a great prevention protocol, so that never happens, but I'm willing to do that. So, um. Or, you know, and my doctor was willing to do that. So there's where it's very nuanced. Um, and so yeah, to just say everyone needs, you know, v vaginal, estrogen, and a patch at this amount is so wrong. It's so wrong. Mm-hmm. And even when, you know, like for me too, it's this balance when my estrogen just climbs a little too high or have a history of constipation, just like you were saying, like if we're not detoxing right. Estrogen can get recirculated back into the system. All those metabolites that we're supposed to be peeing and pooping out or sweating out. So if we don't have good detox, I don't. I have an M-T-H-F-R, also genetic gene carrier. So my methylation for people who don't understand that, it's just your ability to detox. So I have an impairment. Just like 40% of the population who doesn't have that. So I have to be all over, like my ability to poop, right? And detox and in the sauna and exercising and doing the things. But if, if I don't do that and I get backed up, I even notice, I'm like, oh my gosh, my mast cell issues, right? My histamine issues are higher. Right. And I'm like, and I'm itching in the middle of the night and my anxiety climbs, and then my pelvic floor tension climbs because that governs your autonomic nervous system, governs your pelvic floor. So it gets very convoluted. And so I do think though, as we like clinicians, like all of us, the three of us here, and as we talk and have these conversations and share and educate the patients, then it doesn't have to be. So, uh, crazy making for them. Yes. Right. And us. Well, totally. And I, I wanna add on to what you're saying is I think what's frustrating in my experience being a cancer survivor as well, mine was Hodgkin's lymphoma, is that the cancer Western cancer world is very, very scared about any risk of you getting cancer again. So they're very risk adverse. And what this does. Is, um, there's a lot of shame around not choosing Western based approaches. Yeah. But also at the same time, very risk adverse for something like maybe estrogen. Right. And so in that we're not looking at quality of life. Like I don't wanna live an extra 30 years if I'm gonna feel like shit. I'm sorry. I'm just not. And I am, I'm really frustrated with, with that. 'cause people are like, well, I have to take Tamoxifen. And I'm like. If you look at the pros, look at the data, you decide if you feel horrible and you are taking it for 10 years, I want you to sit down and be like, your quality of life matters. Yes. And. And that's something to consider. And, and like you said, you're balancing it with the, the Alzheimer's, right? You've got this balance that you've gotta look at and you know, it's our own individual choice. And it's unfortunate that you had to fight to find a doctor, add on all of the stress that you're already navigating as a cancer survivor. It's a whole other, other level of it, and I'm recovering from a mast cell flare myself, so you hear me like clearing my throat. So it's, it's funny, I, um, had a, a big mast cell flare in September and, and I like, I had a cold that wouldn't go away and I was like, this is so weird. Stopped another medicine I was taking for, um, on and off for a while and it flared up all of this mast cell. 'cause in western medicine we don't really acknowledge mast cell activation. Um, I went to a functional medicine doctor who's also a friend. We did a stool test. Turns out I had salmonella in my gut for four years or three years. Oh my gosh. So I'm thankful that she had helped me. 'cause now we're working on reducing the biofilm because there's apparently that can produce film around the gut, which then can cause the mast cells to flare and reduce in nutrients to be absorbed. Now if I just went to somebody and told them my symptoms, they would've probably just put me on. Estrogen and progesterone. But it's, that's not the issue right now. Right, exactly. I am so thankful for her because there's a direct correlation with my gut now. Yes. And I was, I asked her, 'cause she treats perimenopause a lot and she's like, yeah, this is the issue with the one size fits all approaches. 'cause like, yeah, you're an early perimenopause, but this isn't a menopause. This, this is, let's get this under control first. Right? Mm-hmm. And then if you need hormones, we can talk. And I'm like. Oh my gosh, my mind is blown. But mast cell takes forever. This is a long time. It, it, it, I know. It is a hard thing. And I think that brings another point up, right? Is that usually as pelvic floor therapists, like we are treating multiple avenues. And I think for our patients listening to understand that you are gonna get 10 or 20% as you go after like. The mast cell component, and then you're gonna get another 10 or 20% as you layer in like the hormonal and then the vascular component and the musculoskeletal. But collectively, when that all comes together, the magic starts to happen. Mm-hmm. And we, we see a difference. We see improvement changes. Right. So, um. It's like the orchestra playing, right? It's, it's, well, I think it's also important, like, you know, you were talking before is educating patients on Yeah. What is, you know, what are some of the things they're experiencing with mast cell? Like for me it's like sinus coughing, bloating, itch. People think it's a histamine. So like, I'm not itching and I'm like, we, you don't have to be itching. Look up any histamine response and it can be pretty much any organ. Yeah, right. Um, and if we're not sweating, you know, you're not. Helping for the people listening. You know, you have your lymphatic system, which are vessels in the body and there's, they're multi-tiered, it's like our drainage system and there's fluid around that. Mm-hmm. And when we sweat, that's what removes that extra fluid to help assist the lymph system. And that will clear out our histamine. I'm like, how much? We're not talking about like, right. You know, if you look at the histamine response and slow, um, lymph, it's just very similar symptoms as low estrogen. Yes. Mm-hmm. Yes. Brain fog, fatigue, irritability. Yes. Same, same, same. So I'm like, if, if PTs, we can zoom out Yes. And be like, Hey, this person's having a gut issue. You know, they're not pooping, they're estrogen's recirculating. And I, I don't even think people recognize the fact that. These perimenopausal symptoms like hot flashes are that fluctuation of estrogen. And, and that can be because estrogen's spiking and crashing. And that can be because you're not pooping and the estrogen's getting recirculating. So I'm so happy you guys are, you all are doing this because I just, we just need to keep you talking about it. At more, I think we're the like, you know, we like rehab practitioners in general are some of the only people that look at the full body, and I don't even think as PT C look at the full body as a profession. We don't but as much, yes, I know. I love to see this as standard of care, you know, with in the pelvic floor world where, and instead of, and I, and I get that there's a big umbrella and everyone wants to specialize. Even within the specialty, like, oh, I'm gonna do postpartum. Right. Or in pregnancy, or pelvic pain, which is my love. But like we need to level, continue to level up because mm-hmm. We have such a unique advantage by being in the model that we do practice of, both of our practices are cash models, so we spend an hour with the patient. Mm-hmm. They're never gonna get that at the, you know, in the medical model with the physician. Mm-hmm. Never. Unless you're going full concierge. But, um, so it is, I feel like our duty and Obliga obligation too, like we have them to, you know, captive audience to educate as well on these things. And, um, my favorite tagline is like, I wanna make you the CEO of your body. And so that's it. You, you're not relying on and you're questioning what you hear. You don't take what the doctor says is gospel. Mm-hmm. Um, because half of them are saying the wrong stuff. It's true. I mean, and there's some amazing doctors out there, but yeah, you just totally, I mean, it's like that in any prof, any profession, you know? Right. And, and I think. Just so much too. I have a patient right now who's post menopause and having hip pain and, and not realizing, you know, another thing I like to look at is the, the fascial planes. Yes. Um, you know, the spi, the spiral lines. Yep. Yeah. Lot of videos. Yep. So for people listening, you know, somebody's coming in with chronic hip pain, which you'll see a lot of in perimenopause. Oh yeah. What's going on at their shoulder and what's going on in that, in their foot. Because it's like, you look up the spiral lines of that deep fascia, it can explain a hell of a lot, and people's minds are always blown. I, I love that you go, you all do this a lot on your socials. I know. Can you talk a lot about the feet connection too? One of our favorite, yeah. I love the one that Alexa did. She literally taped the spiral fascia line with Yeah. My body with kt Kinesio tape all the way through. And, uh, because it's so true and people don't edu, you know, don't understand. Even what fascia is, let alone that there's fascial trains and lines for the connect your head to your toe and Yeah, well the patient, it's also like such a moment of education for them. 'cause they're coming in for their leakage and then you start treating their foot and they're like, what are you doing? I'm not here for my feet. I'm like, well if we, we need to, this is all part of one's, again, the whole, the full body approach, like I think. A lot of them have come from other clinics that didn't have the time or the expertise to even think that, like to even go there. So it's just such a like, oh, I thought I had to do my other PT script for my foot. But it actually turns out that it's causing the leakage from the, like the dysfunction in their foot is actually causing the leakage. So it's always cool to have those, you know, aha moments, I think. Oh yeah. It sounds like you all experienced the same type of, usually we're like the third or fourth pt. A lot of times people see Yes. And I'm like, nobody looked at your foot when you were returning to run Uhhuh. Ever what? Yes. Yeah. And so yeah, those connections. And for people listening too, that we're now finding that deep fascia has estrogen receptors, right? And so when that's removed, the fascia gets more rigid. So that's why people will, my experience, maybe this is what you all, you theorize this as well, is I think that's when the old injuries start kind of being like, why all of a sudden am I having the sit pain? I'm like, it's not. There's something that happened. It's not just your right hip. It's, yeah. Yes. Now your fascia moves differently. Yes. And you're seeing it. Correct. Mm-hmm. Yes. It's not hydrated and Yeah. Yeah. It wasn't like, yeah. I think a lot of the patients too, like, I don't know what I did yesterday to set this off, but No, it's like, this is from like your whole lifetime of, you know, I try to explain it to them kinda like psychotherapy. Like it's not just the, the argument you got in yesterday, it's like what started off when you were a child and all the ways that your fascia has changed from your life. Experiences. And I think the me, the, the hormonal piece of that and all the new research on that, like the estrogen, estrogen receptors in the fascia is really kind of mind blowing. It's really mind blowing. And I love that you're saying that Alexa. If you think about it, you know, when I explain that to people, tell me all of your injuries. And they're like, I go as as young as you can remember. 'cause I know you had an ankle sprain. Yep. You know. And they're like, I don't remember having ankles straight. I'm like, I'm just gonna look at your ankles, because you probably did, you know, probably. Yeah. And you probably at some time fell on your tailbone. Yes. Right. At some point. Right? Yeah. It's in your life, whether you're two or 10 or 20 or whatever. Yes. So I, I agree. There's so much, and that's what makes it fun. That would makes like after 30 years of practice for me, I'm like, oh, I'll never get tired of it. No, no. Because when you get to be the detective and connect those dots. And when you have somebody who comes in to see you with full blown urinary retention, who is sent in because they need to prove that pelvic PT is gonna fail. So their insurance will pay for neuromodulation inner stem to help them, which is like a pacemaker for the bladder. So she could start emptying her bladder and not have to self cath every day and have overflow incontinence. And when you know, I connected like, oh, you have a history of. Severe neck pain, jaw pain, and I treated that before even touching her pelvic floor. And she got up to go pee and came back and said That was the best pee I've ever had since I had my injury, which essentially was after childbirth and we didn't touch her pelvis. Right. Like those are the connections as PTs and pelvic OTs or what, and even as patients where you're like, oh, this system is so brilliant that we have, so how fun is it that we get to keep learning? It is so fun. It is so fun. And like you were just saying, you know, I had a patient, um, recently who was having chronic tailbone pain. It wasn't till. Like the fifth or succession that we actually did an internal treatment because I focus so much on her diaphragm and it was freeing up her diaphragm that reduced, she didn't have any tailbone pain. Mm-hmm. You know, the diaphragm's like the center of all of the faci components and are people really, and and how many people do you have that come in are actually breathing from their diaphragm? Right. Almost none. Yeah. Right. And the other one I wanna tap into the ileocecal valve, You get that stuff moving and you'll make some poop real fast. I feel like that's so underrated too. Do you all work on that area as well? Yeah. Mm-hmm. Yes. We have some PTs too who are vis viscerally trained, and that's a huge like to yeah, piece level four. So like we all, most of us. I have gone to at least level one, but then I brought in, I wanted a master. So we also have like somebody who's done through the Uhl Institute, like level four neuro meningeal and something called vis, um, visceral manipulation for your listeners that don't know that where you're working specifically with the fascia round organs and helping to restore, right, the normal mobility motility of those organs. So it's not just, that's another thing, you know, it's not just muscles and it's not just. Fascia. It's not just bones, it's organs. Mm-hmm. Yeah. And connections and nerves and the dura and, you know, connecting from the head down into the pelvis. And so yeah, it's, it's, it's all the things. And then liver, you know, we need liver to help detox estrogen. And if your liver, when you're moving the liver. You can only get so far, and then if your gallbladder's filled up, I, I just don't think people realize that all of this, how this all can affect it. And for people listening, the ileocecal valve is where you chew your food once you chew your food. And you all can add into this as well if you'd like, but that stem tells the stomach, Hey, food's coming. That stimulates acid, then it goes out of the stomach into the small intestine and then in to get to the large intestine, there's a little valve on the right lower area of your abdominal cavity or your abdominal area. And when that, that's where I find, and I'd love to hear what you all think, um, that's where I find most people that are constipated are backed up. Um. Majority of the time, or it's a, a rectocele issue where they're the poop's there, but it's not coming out, um, because of the rectum, prolapsing into the vagina. So I'd love to hear what you all are seeing. Mm. Um, similar plus that that hypertonic non relaxing puborectalis is so critical. Mm-hmm. And then position, speaking of tailbone, right? Position of coccyx, I think is also so critical too, because almost everyone has had a fall like we were just talking about at some point in their life. So that tailbone, the way it comes down, it should be in this nice rainbow shape. So if you're HyperFlex rotated or side bent, that shifts, what happens as. You know, the pelvic floor attaches onto that tailbone. Mm-hmm. And so here's the rectum and the tailbone, I'm sorry. Here is the sacrum and the tailbone and the rectum sits right here. And then that tailbone will push right into the anal canal. Mm-hmm. So then people, I think the, um, if they're seeking pelvic PT and they don't have that assessed whether they have tailbone pain or not, like we're also missing a piece. Mm-hmm. Like in pelvic floor therapy, like we put that on our radar for. Everybody, we don't care if they don't have symptoms there. Like we gotta see what is happening. So constipation for sure, but honestly like for almost any diagnosis, because it's such a keystone structure, so much attaches there. I love that. I love hearing what everybody's keystone pieces. 'cause it's just, that's incredible. I think that's important, you know? And um, the other thing that's interesting and. I am looking into it myself as taking the training on the glymphatic system. Mm. I, I'll have to send you the info here, but they're, please do. I may join you on that. I'll send you the info because I'm taking at the end of this month and basically, you know, with the fascia and the brain, they're saying it might be able to help with A DHD, brain fog, Alzheimer's. That's awesome. Um, Parkinson's, like if you think about if the neck, if the brain is not draining. Mm-hmm. Yes. Right. How much of this also is affecting our function in perimenopause as well? Wow. A hundred percent. I, I, I, I know that's probably a good reason why I ended up with, uh, breast cancer was it came on the heels of my, uh, frozen shoulder. I was so locked down for a year and a half on my right side. I couldn't move. At all, like despite every intervention, I ended up flying to Canada to have radiofrequency ablation actually, uh, that wasn't even offered here in the US to unlock the shoulder, but with the lymphatics not able to drain through this region, I think the breast was the, unfortunately the victim then. And so, um. Yeah, I think that is huge. Back to, I think it's huge. I mean, I even have my, the whole system, I have my patients, I'm like everybody, I want everybody like doing like, you know, rubbing above the collarbone and then the axilla area and getting that breast, like moving the lymph from the breast into that area. 'cause we're sit around, our boobs are in these bras and it's just stagnant. Like move them and, but yeah, I think there's, there's so much more research to be had on, um, on the lymphatic system as well. Yes. And even it's just assessing it. I mean, we, how often do you actually like look at your patients, like behind their knees and their feet and like a lot of patients just say, oh yeah, I have this swelling. That's just how it is. Yes. And like there's, and the groin, there's something you can do about it and Yeah, same. And it's. Yeah, it's so simple. Yeah. Yeah. Uhhuh, it's so simple. I know I am your twin because I like, I always have swelling through here too. I'm like, so even since I was a PT student, I'd do all my rotations and I'd run around. I'd be like, can you feel this? Is this normal? Like, well, if you think about it, look at all of the cranial bones and osteopaths, why are we not as PTs? So I'm like, let's bring this into the mix too, because if we can affect how different areas drain, why not at least try vent? Yep. And then back into, oh my gosh, to rebalance the brain for the nervous system because it always comes back. Yeah. That's where we start. It is. And we tell our patients, like my favorite saying is, your nervous system will beat our hands. I don't care how skilled we are if we don't get your nervous system into this happier place, right? We can't get some of these things back online permanently. It won't, it won't work. And, and you know when, when I hear fascia, people talking all about fascia, I'm like, yeah, but you're not, you can work on fascia all damn day. But if you're, if you're running around with your head cut off, yes. And maybe you have a mast cell flare and you don't know why, and that's causing anxiety. Like there's, there's so much with like our lifestyle of just not slowing down. But then how much is neuroinflammation from like a mast cell activation? Then there's um, then there's the physical symptoms and it's like you can't, if you don't address the nerve system and, and that person, their lifestyle and they're waking up the second they're waking up, they're on their phone. The second they're running from second to second. I'm just like, the first thing I want you to just slow down your movements, just start there and respect that 30 minutes before bed and 30 minutes in the am and I'm like, that's just like my bare minimum. I'm like, if you can do that. Yes. Huge, huge. It is huge. Yeah. And I think when people come to physical therapy, they, they don't expect that type of like, uh, home exercise program. They're expecting no. A stretch. And they're like, what do you mean? Like, yeah, right. This is my homework. Yeah. I kind of feel like I, I love that you all do this too, 'cause I sometimes I feel like we're on an island and people are like, are you doing witchcraft? I'm like, no, no. No, this is important. More important than stretching, in my opinion, like a thousand percent. A thousand percent. Well, this has been such a lovely discussion. Is there anything else you wanna close on and, and that you could think of that we didn't chat about? I wanna respect your time and make sure you're, mm. That's, I think, I guess my biggest thing is, or at least for people listening, is that. Not to underestimate the power of physical therapy in general and like what we can offer as for resources, especially if, as Julie was saying, we get a lot of patients coming in who are just kind of lost and they don't have proper medical management. And obviously we're not MDs, so we're not gonna be able to prescribe them medication or do some of the things that MDs can do. But I think the people think of physical therapy as like, go in, do your strengthening, do your stretching, get your massage and leave. And I think now in 2026, um, there, there's so much more that we do, especially in pelvic health. And, um, we can be a resource even from a virtual setting, like a telehealth to just get people kind of on track. And it really, it's amazing how much it can. Improve everything. Absolutely. And if women can just remember that menopause doesn't have to be kind of like this midlife, oh my gosh, half of my life is over and now I ha I'm just destined to live like this for the rest of their life. It's almost, I like to view it as this beautiful time for recalibration for the body. Mm-hmm. Too. And so find a therapist that. Has the experience with menopause. 'cause not every pelvic therapist is going to mm-hmm. Um, and has the training because they're gonna also be linked up with the right doctors usually too, because it is a team approach. Mm-hmm. Patient, right? Therapists, MD sex therapy, sometimes psychotherapy. Right. Um, so. Dietician, all the things, right? So the whole team. But, um, but yeah, just know that there's so much help out there and that you're not alone to navigate this. And these, once I think you get the education and some of the tools that are needed, like you can be powerful beyond measure. That's what our, our guided imagery therapist loves to share that with patients like, you know, you're powerful beyond measure, which I have been enjoying this phase of my life. Um. Because, yeah, all the things that have come out of like, even the, the challenges and, you know, some of the traumas and as I've learned, um, I, I get to go share that with. The rest of the world. So it's a fun, I love that fun place to be. So it doesn't have to just be all the things we started with. Like, oh, pee in your pants. Like, well, that's what got it under control. That's what, yeah. I think that's what a lot of people see on social media and the younger generations are getting scared and I'm like, wait, Eastern Medicine calls this a rebirth. That was what my whole TED Talk was on, is how this is a rebirth. Yes, estrogen and progesterone were supporting us like bumpers at a bowling alley. And as those decline, we have to be more specific with our direction in our life, and the body shows us now, and we just don't think of it that way in our culture. True. You're It's so true. It is so true. I love the rebirth that has been, it's been the story of, yeah, my last five years. So yeah, I feel that. I feel that. So how can people find you all? I can also put your information in the comments as well, but if somebody's listening in, just wants to hear. Yeah, go for it. Um, yeah, we have quite a bit of social media presence, so our Instagram is at Pelvic Healing. We also have a YouTube channel that we're posting some longer videos with, um, some treatment things to try at home, and more educational videos. Um, we have our website also just got, we just redid our whole, um, brand and our website has all lots of resources on it as well. And also links to all of our social media pages, which is also pelvic healing.com. Yeah. Perfect. If any of your listeners are out here in California, we're in Southern California, orange County. Um, and we do have patients that will travel in to see us from all over now, which is really fun. Um, so we offer intensives as well. And, uh, just here to, to help, like we said, right? Mm-hmm. With the movement. And we're so excited that you're out there, and I love that you're doing this podcast. I can't wait to hear your TED talk. Oh, thank you so much. All right. We'll chat soon. Okay. Bye bye.

Speaker 2 43:17

Thank you so much for listening to my podcast. It would be a huge help if you could subscribe and rate the podcast. It helps us reach more people and make a bigger impact. I would also love it if you could join my email list, which is LinkedIn, the caption for podcast updates, upcoming offers and events. You can also find me on TikTok, YouTube and Instagram at Dr. Mary pt. Thanks again.