Pelvic floor PT!!! I was referred to them after my second pregnancy and bonkers C-section (not a technical term but I’m lobbying for it) and my PT was awesome. I do want to emphasize that it’s not just for vaginal childbirth - a good pelvic PT will look at the entire core, so it’s v relevant for surgical births. And I have had some pelvic floor weakness my whole life it turns out, so it would have been helpful even if I had never been pregnant.
(I cannot even describe how my face contorted at “friable vulva”)
It’s beyond wild to me that Pelvic floor PT is not the gold standard post birth. You just had a 6-10lb baby sit on that, and then be relaxed enough to push them out.
It's kind of funny (or actually sad?) how several of the questions were variations on the theme of how do I not get belly fat in menopause. I think what complicates that for many of us is having a dieting history. I'm convinced that increases weight gain in menopause, compared to women who never dieted (do those exist? Usually they are my thin friends) who maybe gain a little weight but not that much. It's impossible for me to parse how much "extra" weight gain is from my 16 year history of ever-intensifying restriction (no weight cycles) vs how much was part of surgical menopause in my 40s. MHT did not mitigate any weight gain that I am aware of, but one doctor did mention that the amount of estrogen you get from MHT is way less than you'd produce naturally prior to menopause. So that could also be a reason MHT does not prevent belly fat. They are not topping you up to youthful levels (nor would that likely be good for us, I suspect).
When I look at all my older family members, most gained weight and became round little fat people. My great-grandmother's belly was huge while the rest of her was skinny. Having lived through the depression, I doubt she ever dieted, and she was English and loved some candy in her life. No one ever talked about being fatter in old age as a bad thing when I was young (perhaps they were just sparing the children) although I'm sure they didn't like it. Incidentally my grandmother was a chronic dieter and ended up being the largest of her sisters in menopause. So if we are gaining weight in peri/menopause, look back on your dieting or weight cycling history first. That's probably a bigger cause of extreme weight gain in these years. And I still don't think more dieting is the answer!
That's fascinating. It would be so interesting to see some actual research on how dieting and weight cycling impacts weight gain at different life stages... though obviously impossible to get that funded, since the diet industry wouldn't like it! I do think it's telling that so many of the questions are focused on belly fat, though I didn't read these exactly as "how do I not gain it" but more as "I'm trying really hard to be okay with the fact that this seems inevitable...is it?" So much tangled together here, sigh.
Yeah sorry, my clients are the ones who want to stop it or get rid of it. Acceptance doesn't feel like an option at that stage, although I think perhaps they eventually end up with a grudging acceptance. Unless they get the glp1s (which still don't make them happy!)
i'm not sure of the best way to phrase this, but i think for me another issue is that if we've been able to work on body acceptance in our 30s, these changes that hit in our 40s and 50s challenge just where we are in that work. it feels a bit like: i am finally doing well in *this* body and now i have to learn it again with a *new* one?--ugh can't i just be done?! do i have to buy all the clothes again?! i just got folks to stop with the diet talk around me, but here it comes again because it isn't about a diet "it is about strength in aging" (but also it is about a diet) and i'm tired of having these conversations
yup. just tired lol
anyway, looking forward to part 2 and other conversations along these lines :)
Another evangelist for pelvic floor PT!! I am very glad that we are making more and better products for incontinence, but please, please, please: make pelvic floor PT your first stop.
I’ve never been pregnant, and I was having some general pelvic floor issues (a little incontinence when I coughed sitting in a certain position, some pain with penetration). I did pelvic floor PT, and I cannot express the difference it’s made in my whole body. Random tailbone pain? Gone, bc it turns out the tension in my pelvic floor was pulling on it. Much less posterior chain tension generally, including a huge amount of improvement in my plantar fasciitis, hamstring tension, etc.
I also ride horses, and the improvement in my riding was almost immediate—I could rotate my femur, I was able to get out of hip flexors and use more correct muscles, and I can now get better, more consistent contact and help my horse use her top line correctly.
If you are a person with back pain or tension issues in your body, I cannot recommend pelvic floor PT enough.
Also, it turns out that habitually sucking in your stomach can also drive pelvic floor tension, so… is it the weight, or is it trying to suck it in constantly that’s triggering those incontinence issues? I didn’t realize how much I was sucking it in until I did PT, and it was very physically uncomfortable to stop.
I’m very happy to answer questions about my experience, and I also think we should have a pelvic floor therapist on Burnt Toast sometime!
Thank you do much for sharing. I loved reading about your experience! It sounds life changing for you. I am curious about a few details. How often did you go and how many sessions? How did you find your therapist?
My gyno referred me, and they have pelvic floor PT folks in their office. My insurance covered 12 visits, I think, which I did once a week bc my schedule allowed it.
I know some folks at regular PT places also do pelvic floor work, but I think a lot more gyno offices and specialized places are opening up. I had a friend in another state who went a few years before I did, and the PT practice she went to said they did everything “from nipples to knees” lol
Also worth noting: I have a lot gyno-care anxiety, and I did a lot of EMDR and work with my therapist to be able to handle it, and I was really surprised by how little direct internal work it involved.
Great convo, thank you!! Can't wait to share this one.
You got my writer brain whirring on 'belly fat'. My initial idea was 'core cushion' to steal a fitness word, but wonder if keeping the word 'fat' helps the continued effort to de-stigmatize. Isn't the word 'belly' infantilizing? Putting 'belly' in the thesaurus is a wild anti-fatness ride, but 'abdomen' gives more neutral results.
YES the word "belly" is infantilizing. And condescending. And shame inducing (if, like me, you had people touching your stomach - uninvited!- from a very early age with a grimace). If I have to exist in a world that has the phrase friable vulva, I would rather exchange "belly fat" for "abdominal fat."
Oooofff...hug to you and punch in the face to anyone who touches your stomach un-invited, what monstrous behavior. 'Abdominal' does feel more simply anatomical.
Oh goodness, I was crying by the end of this episode! Dr. Mara, you are such a shining light in healthcare. I have had a lot of poor physician interactions lately and to hear your kind, intelligent, and caring words was much needed. I love the conversation about how it is rarely one thing causing something in our bodies. That is so refreshing to hear! And such a good reminder for all of us. The complex issue of trusting our body is another topic that has come up a lot for me lately. Thank you both for a really great conversation. I look forward to more!
Yes yes yes! I'm a total evangelist. I was getting UTIs, and now I rarely get them. Also, sex is more comfortable. But the UTIs were really doing me in.
All my fiends are entering some variation of menopause. I now have a packet for bio-identical hormones so they can take it to their doctors to talk about it because so many are pushed away about it. So many doctors, are either stuck in the past of “all hormones lead to cancer”, or some unwilling to consider the new data and some blatantly feel like a condescending fuck you, because you’re not dying. Anti-depressants won’t fix sleep issues, brain fog, UTIs.
The conversation on the language around belly fat got me thinking of the phrase "letting myself go" and it suddenly occurred to me how ridiculous it is that that has somehow been cast as a negative! I think I've been working on figuring out how to let myself go for my whole life, and am finally making some breakthroughs - maybe I can use my big belly as a reminder of how much more joy I now have space for, and access to.
Pelvic floor PT!!! I was referred to them after my second pregnancy and bonkers C-section (not a technical term but I’m lobbying for it) and my PT was awesome. I do want to emphasize that it’s not just for vaginal childbirth - a good pelvic PT will look at the entire core, so it’s v relevant for surgical births. And I have had some pelvic floor weakness my whole life it turns out, so it would have been helpful even if I had never been pregnant.
(I cannot even describe how my face contorted at “friable vulva”)
lolol
It’s beyond wild to me that Pelvic floor PT is not the gold standard post birth. You just had a 6-10lb baby sit on that, and then be relaxed enough to push them out.
Absolutely. I do hope it’s moving that direction, but of course US healthcare standards never cease to underwhelm.
It's kind of funny (or actually sad?) how several of the questions were variations on the theme of how do I not get belly fat in menopause. I think what complicates that for many of us is having a dieting history. I'm convinced that increases weight gain in menopause, compared to women who never dieted (do those exist? Usually they are my thin friends) who maybe gain a little weight but not that much. It's impossible for me to parse how much "extra" weight gain is from my 16 year history of ever-intensifying restriction (no weight cycles) vs how much was part of surgical menopause in my 40s. MHT did not mitigate any weight gain that I am aware of, but one doctor did mention that the amount of estrogen you get from MHT is way less than you'd produce naturally prior to menopause. So that could also be a reason MHT does not prevent belly fat. They are not topping you up to youthful levels (nor would that likely be good for us, I suspect).
When I look at all my older family members, most gained weight and became round little fat people. My great-grandmother's belly was huge while the rest of her was skinny. Having lived through the depression, I doubt she ever dieted, and she was English and loved some candy in her life. No one ever talked about being fatter in old age as a bad thing when I was young (perhaps they were just sparing the children) although I'm sure they didn't like it. Incidentally my grandmother was a chronic dieter and ended up being the largest of her sisters in menopause. So if we are gaining weight in peri/menopause, look back on your dieting or weight cycling history first. That's probably a bigger cause of extreme weight gain in these years. And I still don't think more dieting is the answer!
That's fascinating. It would be so interesting to see some actual research on how dieting and weight cycling impacts weight gain at different life stages... though obviously impossible to get that funded, since the diet industry wouldn't like it! I do think it's telling that so many of the questions are focused on belly fat, though I didn't read these exactly as "how do I not gain it" but more as "I'm trying really hard to be okay with the fact that this seems inevitable...is it?" So much tangled together here, sigh.
Yeah sorry, my clients are the ones who want to stop it or get rid of it. Acceptance doesn't feel like an option at that stage, although I think perhaps they eventually end up with a grudging acceptance. Unless they get the glp1s (which still don't make them happy!)
i'm not sure of the best way to phrase this, but i think for me another issue is that if we've been able to work on body acceptance in our 30s, these changes that hit in our 40s and 50s challenge just where we are in that work. it feels a bit like: i am finally doing well in *this* body and now i have to learn it again with a *new* one?--ugh can't i just be done?! do i have to buy all the clothes again?! i just got folks to stop with the diet talk around me, but here it comes again because it isn't about a diet "it is about strength in aging" (but also it is about a diet) and i'm tired of having these conversations
yup. just tired lol
anyway, looking forward to part 2 and other conversations along these lines :)
Another evangelist for pelvic floor PT!! I am very glad that we are making more and better products for incontinence, but please, please, please: make pelvic floor PT your first stop.
I’ve never been pregnant, and I was having some general pelvic floor issues (a little incontinence when I coughed sitting in a certain position, some pain with penetration). I did pelvic floor PT, and I cannot express the difference it’s made in my whole body. Random tailbone pain? Gone, bc it turns out the tension in my pelvic floor was pulling on it. Much less posterior chain tension generally, including a huge amount of improvement in my plantar fasciitis, hamstring tension, etc.
I also ride horses, and the improvement in my riding was almost immediate—I could rotate my femur, I was able to get out of hip flexors and use more correct muscles, and I can now get better, more consistent contact and help my horse use her top line correctly.
If you are a person with back pain or tension issues in your body, I cannot recommend pelvic floor PT enough.
Also, it turns out that habitually sucking in your stomach can also drive pelvic floor tension, so… is it the weight, or is it trying to suck it in constantly that’s triggering those incontinence issues? I didn’t realize how much I was sucking it in until I did PT, and it was very physically uncomfortable to stop.
I’m very happy to answer questions about my experience, and I also think we should have a pelvic floor therapist on Burnt Toast sometime!
Love this!
Thank you do much for sharing. I loved reading about your experience! It sounds life changing for you. I am curious about a few details. How often did you go and how many sessions? How did you find your therapist?
My gyno referred me, and they have pelvic floor PT folks in their office. My insurance covered 12 visits, I think, which I did once a week bc my schedule allowed it.
I know some folks at regular PT places also do pelvic floor work, but I think a lot more gyno offices and specialized places are opening up. I had a friend in another state who went a few years before I did, and the PT practice she went to said they did everything “from nipples to knees” lol
Also worth noting: I have a lot gyno-care anxiety, and I did a lot of EMDR and work with my therapist to be able to handle it, and I was really surprised by how little direct internal work it involved.
Thank you! This is very helpful.
Great convo, thank you!! Can't wait to share this one.
You got my writer brain whirring on 'belly fat'. My initial idea was 'core cushion' to steal a fitness word, but wonder if keeping the word 'fat' helps the continued effort to de-stigmatize. Isn't the word 'belly' infantilizing? Putting 'belly' in the thesaurus is a wild anti-fatness ride, but 'abdomen' gives more neutral results.
'core fat' 'waist fat' 'stomach fat' 'ab fat' 'torso fat' 'middle fat' 'central fat' ...
YES the word "belly" is infantilizing. And condescending. And shame inducing (if, like me, you had people touching your stomach - uninvited!- from a very early age with a grimace). If I have to exist in a world that has the phrase friable vulva, I would rather exchange "belly fat" for "abdominal fat."
💯
Oooofff...hug to you and punch in the face to anyone who touches your stomach un-invited, what monstrous behavior. 'Abdominal' does feel more simply anatomical.
🔥
Already looking forward to part two!
Oh goodness, I was crying by the end of this episode! Dr. Mara, you are such a shining light in healthcare. I have had a lot of poor physician interactions lately and to hear your kind, intelligent, and caring words was much needed. I love the conversation about how it is rarely one thing causing something in our bodies. That is so refreshing to hear! And such a good reminder for all of us. The complex issue of trusting our body is another topic that has come up a lot for me lately. Thank you both for a really great conversation. I look forward to more!
Thank you 😍😍😍
Vaginal estrogen is a game changer. Thanks to both of you for this.
yes!
Yes yes yes! I'm a total evangelist. I was getting UTIs, and now I rarely get them. Also, sex is more comfortable. But the UTIs were really doing me in.
All my fiends are entering some variation of menopause. I now have a packet for bio-identical hormones so they can take it to their doctors to talk about it because so many are pushed away about it. So many doctors, are either stuck in the past of “all hormones lead to cancer”, or some unwilling to consider the new data and some blatantly feel like a condescending fuck you, because you’re not dying. Anti-depressants won’t fix sleep issues, brain fog, UTIs.
Heck yes Kerrygold forever!!!! I'm about to have some on some banana bread for breakfast.
Thanks Dr. Mara and Virginia. I really appreciate having a grounded in actual facts and research conversation about this.
😍
I was literally writing about the Jeff Hiller interview with Sam Sanders as Virginia was saying it. Highly endorse and can’t wait to read his book!
The conversation on the language around belly fat got me thinking of the phrase "letting myself go" and it suddenly occurred to me how ridiculous it is that that has somehow been cast as a negative! I think I've been working on figuring out how to let myself go for my whole life, and am finally making some breakthroughs - maybe I can use my big belly as a reminder of how much more joy I now have space for, and access to.