147. Pelvic Floor PT Not Working? Your Hormones Could Be Why

Many women spend months — sometimes years — in pelvic floor physical therapy making only partial progress. They follow through on every exercise, attend every appointment, and still find their symptoms cycling in and out without explanation. What most of them are never told is that their pelvic floor does not operate in isolation. It is profoundly responsive to hormones — and if the hormonal environment is not addressed, even the best physical therapy can only take you so far.

In this episode of Cycle Wisdom, Dr. Monica Minjeur walks through the direct and measurable connection between estrogen, progesterone, and pelvic floor function — and what it means for women dealing with bladder urgency, urinary leaking, pelvic pain, and bowel dysfunction. Through Claire's story, a postpartum patient whose symptoms kept cycling in and out despite dedicated physical therapy, you will see what becomes possible when hormones and pelvic health are treated together.

You will learn:

• How estrogen and progesterone directly affect pelvic floor tissue quality, ligament laxity, bladder function, and pain sensitivity
• Why symptoms that worsen before your period or fluctuate across your cycle are diagnostic information — not random inconveniences
• What a combined hormone and physical therapy approach looks like and why it produces more complete and lasting results

If your pelvic floor symptoms have never fully resolved, your hormones may be the missing piece. Learn more or schedule a free discovery call at radiantclinic.com.

Transcript

Speaker 0:00

Before we get into the episode today, I want to make sure you know about our free discovery calls to work with our clinic. If you are interested in learning how the medical services, charting instruction, or coaching programs we provide would be a good fit for you, go to our website, radiantclinic.com, and click on the link that says Book Free Discovery Call. One of our team members will get back to you and get all your questions answered about our process towards healing your cycles and restoring fertility. If you still have more questions after that, my team can arrange for a time to talk directly with one of our team members and make sure all your questions are answered and that we are the right fit for you. If we're not the right fit, we'll let you know and help to give you some guidance as far as where your next best step should be. We're looking forward to visiting more with you soon and learning how we can walk this journey together. And now, on to the episode

Speaker 2 1:01

Many women spend months in pelvic floor physical therapy making only partial progress but no one ever asks why. What if the reason your symptoms kept coming back wasn't a strength problem at all, but a hormone problem? I'm Dr. Monica Minjeur, the host of Cycle Wisdom, where we help women and couples restore hormonal balance and reclaim their wellbeing through personalized healthcare grounded in clinical excellence. So let's start off today with a story about a patient of mine who we'll call Claire. Now, Claire came to us during her pregnancy and we followed her hormone levels throughout. In the postpartum timeframe though, Claire noticed that she was having troubles with her bladder and her bowel after delivery, and so we sent her to see pelvic floor physical therapy. Claire was dedicated to her physical therapy exercises, going to weekly sessions and continuing with her exercises during the week as recommended. However, her symptoms continued to cycle in and out without any real explanation. She was frustrated and started to feel like her body was betraying her. Her physical therapist was excellent, but they couldn't explain the inconsistency with Claire's symptoms. We started having Claire track some of her symptoms as far as the bladder issues, the bowel swelling, and the GI disturbances that she was having, and she noticed that her symptoms were dramatically worse right before her period began, but were nearly gone during the time of ovulation. She wondered if her hormones had been involved, and so she followed up with us for additional evaluation. Now, her cycle charting revealed a clear pattern that was linked to her cycle phase, and her hormone testing showed that she had low progesterone after ovulation in addition to erratic estrogen levels that were sometimes high and most of the times low. Her pelvic floor wasn't necessarily weak. She had done all of the important work with this, but she had hormonal dysregulation that was adding to her symptoms. Her luteal phase symptoms that she had after ovulation mapped directly to her low progesterone levels. Moving forward, we started to replace progesterone and addressed her cycle health alongside her ongoing physical therapy exercises. And over the course of the next couple of months, her symptoms became much more predictable and then moved into complete resolution once things had been stable for her. So let's back this up a little bit. Many women know that pelvic floor dysfunction is a growing conversation in women's health, and it frequently involves working with exceptionally trained pelvic floor physical therapists, many of whom have had additional expertise and training in things like dealing with women during pregnancy, postpartum, menopause, and all of the other times that we have big hormonal shifts in our life. However, very frequently we find that it doesn't include the discussion of what's going on with your hormones. Many women either self-refer themselves for physical therapy or have a primary care doctor who sends them to physical therapy when they start to have troubles as far as leaking urine, bowel issues, pelvic floor dysfunction that can relate to low back pain or leg pain. And the reality is, although working with physical therapy can be incredibly helpful in the right situation, we have to also include this in conjunction with a discussion about what is going on with your hormones. Both estrogen and progesterone have direct and measurable effects on the pelvic floor tissue, on the laxity or the stretch of your ligaments, on your bladder function, and on the sensitivity to pain. And because of this, many women spend years in physical therapy with incomplete results because the hormonal influence underneath is not being identified. Symptoms that change during the cycle or even over the course of a month or a week aren't always random. They are oftentimes seen as diagnostic information. Even in our patients who are post-menopausal, their hormone levels can still fluctuate, causing ongoing issues, or in some cases, estrogen just remains low all of the time, which can add to the problems. Many women are telling themselves, "Oh, I must not be doing enough exercises," or, "Maybe I'm just not doing this right," or, "I just have really weak pelvic floor muscles." And in many women, this isn't the sole reason that they're having issues. It oftentimes has to do with the tissue quality, the hormone balance, especially making sure that there's enough estrogen presence, and treating anything that is relating to pain, like nerve sensitivity or dryness And I want to reiterate here, physical therapy is not bad. However, sometimes physical therapy is not the only thing that's needed. If you are not making the progress that you would expect to see with physical therapy, that's where we say it's important to address the hormonal environment to get better outcomes. These symptoms are not just a part of getting older, and although we see that hormone-related pelvic floor changes are treatable, it does not mean that they are inevitable. You do not have to live with leaking bladder or recurrent urinary tract infections or problems every time that you decide to get up and move. So how do these hormones actually make a difference in the pelvic floor? Again, as I mentioned earlier, the pelvic floor is incredibly responsive to hormones, especially estrogen and progesterone receptors, and those hormones shift throughout our menstrual cycle as well as across different reproductive life stages. So at times during menopause or postpartum, our hormones are shifting significantly, and we want to use what we're seeing in your symptoms to identify patterns that might be driving that dysfunction. So specifically with estrogen, it helps to maintain collagen and the elasticity, or it's that stretch that we have in the pelvic floor tissue and ligaments. These ligaments help to support your bladder and the lining of the urethra, which is the small tube that goes from your bladder to the exit of your body. If you have low estrogen, we typically are going to see thinner, drier, and more irritable tissue, and this oftentimes is why we can see women have troubles with increasing urinary tract infections, bladder dysfunction, leaking when they cough or laugh or sneeze. And we oftentimes will see this low estrogen most commonly show up in the menopausal timeframe, but it can also happen postpartum when your hormone levels are really low. It can happen during perimenopause when your estrogen decides to take a rollercoaster ride and can be high at some times and low at other times. We also will see this happen if you are under chronic stress or if you have irregularity with your ovulation. In many cases, this low estrogen can cause problems with your pelvic floor in general, no matter where you're at during your reproductive years or beyond. Now, on the flip side of things, progesterone has a relaxing effect on smooth muscle. Now, this can have an impact on bladder urgency or how quickly you feel like you need to run to the bathroom. It also plays a role when it comes to bowel motility after ovulation has happened. If we have low or a rapid drop in progesterone prior to your menstrual cycle, it can significantly amplify pelvic pain and cramping, and this oftentimes explains why many women feel worse in the days leading up to their period, oftentimes trying to blow it off as what we call PMS symptoms. The reality here is that your luteal phase, so that time from ovulation until your next period begins, is a key diagnostic window. So if you're having any issues as far as bladder urgency, we need to evaluate what's going on. Do you have low progesterone? Does it drop off too rapidly? Is your estrogen well-balanced? All of these things can show up not only in your lab approach, but also in your cycle. So if you are somebody who is having cycles still, charting your symptoms across your cycle can start to reveal patterns. Like if you might have low progesterone, we can see that show up through a shortened luteal phase. Maybe you've got excessive estrogen dominance where you're seeing mucus that's happening throughout your entire cycle. Or perhaps you're somebody who's just not ovulating regularly, as we see in cases with PCOS or PMOS, or other situations where your body just doesn't ovulate and so we don't see that spike of estrogen or that luteal phase at all Symptoms that are primarily problematic in your luteal phase or at the time right as your period is starting oftentimes will point to a progesterone problem. Whereas symptoms that are happening throughout your entire cycle, oftentimes we're gonna think more about things like low estrogen or possibly chronic inflammation, endometritis, other things that could be playing a role throughout your cycle. So again, this is why it's so important to pay attention to when you're having symptoms that are present, and looking at the timing of that in correlation to what's going on with your cycle. Now, we always would still have our patients working with their pelvic floor physical therapist throughout this time because, again, we want to optimize the hormonal environment while we are working on strengthening tissues, dealing with any tight muscles or laxity of muscles, and focusing on how can we best improve the hormonal situation. Again, targeting that hormone evaluation and treatment based on where you're at in your cycle will oftentimes set you up for the best success for complete and lasting recovery. Our goal here is to address both tissue dysfunction or muscle dysfunction, what's going on with the pelvic floor physical therapist, and the hormonal system that's driving the behavior of that tissue or the muscles in the first place. So let's go through a couple of commonly asked questions. One of the most common things that we talk about in our practice is women are concerned about, what is gonna happen if my symptoms are already problematic in my 30s and then I have to go through menopause later? Why do I still have symptoms? What does that look like? So muscle strength itself doesn't tell the whole story, and we want to make sure that we're also balancing the hormones throughout this timeframe. So making sure to optimize your progesterone and your estrogen levels during the perimenopausal transition and into menopause can be incredibly life-changing. We especially notice this shift when women are menopausal and their estrogen levels drop incredibly low. The bladder lining, the urethral sphincter, or kind of that muscle that closes the urethra, and the surrounding tissue are all incredibly responsive to estrogen. So we oftentimes will utilize localized estrogen cream or sometimes even systemic estrogen through topical estrogen or a patch in order to help prevent recurrent urinary tract infections and improve symptoms of urinary urgency and frequency. Because of treating with estrogen replacement in a bioidentical way and in a dosage that makes sense for you individually, we can significantly change the trajectory of what's going on with your bladder. Another question we often get asked is, "My symptoms are worse before my period. Is that hormonal?" And we say, typically, that is going to be a progesterone case. So the premenstrual drop in progesterone levels will increase the sensitivity of those smooth muscles, and we oftentimes will see a significant ramp-up of pain. And this is one of the most clear and obvious symptom connections that we see in practice, and luckily, it's one of the easiest to treat. Oftentimes, if we identify that low progesterone is the issue, we focus on either replacing progesterone at the time that your cycle would normally be secreting it, and also looking at the long-term impacts of how can we help your body to produce more progesterone in the long run. And finally, do I have to choose between continuing with physical therapy or hormonal care? And this is really one of those cases where we say both together oftentimes will give us the best outcomes. So for our patients that come to see us that have bladder dysfunction, yes, we're going to address the hormonal dysfunction, but we also are going to refer them to a skilled pelvic floor physical therapist, and vice versa. Our pelvic floor physical therapists that oftentimes share clients with us will send patients our way if they're struggling to achieve the outcomes that they want. So they'll say, "Hey, we've done everything we can from a muscle and tissue standpoint, but we also know that we need to focus on both sides of this." Imagine if the next time that your pelvic floor symptoms flared, the first question you asked wasn't, "Am I doing my exercises? Am I doing enough?" But instead asking, "Where am I at in my cycle? Is there something else hormonal that might be going on?" The link between hormones and pelvic health should be a part of every conversation so that women don't spend years in partial recovery when the missing piece was identifiable and treatable all along. Imagine if pelvic floor physical therapy care and hormone care worked together, giving women a complete picture of what their body needs in order to improve pelvic health for the long run

Speaker 3 15:01

If you're ready to work with our elite team of healthcare professionals, go to our website, radiantclinic.com, to schedule a free discovery call and learn more about our package-based pricing for comprehensive care. We are currently able to see people for in-person appointments in our Cedar Rapids, Iowa clinic or can arrange for a telehealth visit if you live in many different states across the US. Check out our website for current states that we can serve medical clients, and let us know if your state is not listed to see if we can still cover you there, as we are constantly expanding our reach. Please note that our fertility educators are able to take care of clients no matter where they live. Thank you so much for listening to this episode. Please share this podcast with someone in your life who would benefit from our services. Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom