108. Pelvic Floor Symptoms Are Treatable, with Dr. Sara Black

Why Pelvic Health Matters

Cheryl Fischer 0:00

Today we need to talk about something that I think sometimes we avoid talking about because it's I don't know, it's just not something you talk about. And that is pelvic health and pelvic floor therapy. And the key here is do we just have to deal with these annoying things like leakage or dryness, or is there actually something we can do to make it better? Let's talk about it. If midlife was only about hot flashes, 3 a.m. wake up, silly injuries, and worrying about everyone from aging parents to adult kids, we'd all be unhappy and isolated. And that's just not true. Whether you're frustrated at work, stressed about retirement, or just looking for the phone that's already in your hand, you're in the right place. Let's change the story around midlife and start loving this chapter. This is the Mind Your Midlife Podcast.

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Cheryl Fischer 1:00

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Common Midlife Pelvic Floor Symptoms

Cheryl Fischer 1:45

we talk all the time about the fact that midlife, there's a lot going on. There's a lot of stress, there's a lot of body changes. And one of the body changes that quite a lot of us deal with is changes in pelvic health. And that means, you know, remember when you had kids and they told you to do those kegels to get your muscles back and you kind of did it for a while and then you never did it again. And now you kind of deal with leakage, or oh no, what if I sneeze? Or dryness, pain, itchiness. I mean, we could go on and on. Sometimes we feel like this is just how it is. And sometimes, and this really gets me, even medical professionals will tell us that's just how it is. You gotta you gotta deal with it, you gotta adjust. That's aging. No. And I have here with me today, Dr. Sara Black, to help us with this message that this is not just how it has to be, and there are things you can do, and it can get better. Sara is a former Division I swimmer. She is very performance-driven and she's taken that lens to pelvic health physical therapy. So she's worked as a certified personal trainer, a licensed massage therapist, and now has her doctorate in physical therapy and specializes in pelvic health. Her clinic, Zia Physiotherapy, is in the Northern Virginia area. And whether you're in this local area or anywhere else in the world, you will want to learn from her, hear some of the things we're talking about, and maybe connect online and follow actually helpful and true and valid information. So welcome, Sara. Thanks for joining me. Thanks so much, Cheryl. Happy to be here. So when you and I talked before, you mentioned that one of the things that whether we're in perimenopause or we're postmenopausal, just this whole sort of I guess late 30s through late 50s period of life, or maybe even later than that. One of the things that we need to be aware of is pelvic flares. And that was the first time I had heard that term. So tell us more about what that is.

Dr. Sara Black 4:09

Yes. So pelvic floor dysfunction can look like a whole bunch of things. And today we're going to talk much more about the perimenopausal and postmenopausal stages of life, but really can affect women at any stage of life. And it really, so pelvic floor dysfunction really shows up as urinary leakage, urgency, frequency, bowel concerns, so constipation, straining, bloating, even, uh pelvic pain is a big one, and something called pelvic organ prolapse, which can be heaviness in the vagina or the vulgar area, sexual dysfunction. It really shows up in a whole bunch of ways. But then it's also connected to things that we wouldn't think would be connected to the pelvic floor. So low back pain, hip pain for women, tailbone pain. And so unfortunately, this stage of life, perimenopausal stage, is where symptoms can flare and have nothing to do with having children or being in that stage of life, which is generally what we associate pelvic floor dysfunction with.

Cheryl Fischer 5:30

Well, yeah, I have two kids, and I was told to do uh keagels and, you know, give it time. You got to get your muscles back, and obviously your body needs to recover. And it makes me nervous when you list out these symptoms. And we'll see if you're listening, we'll see if you agree. And you say kind of very common things like leakage or constipation mixed in with these different things. I'm like, you know, pain. Okay, I guess I would notice pain, but do I have to worry every time I get a little bit constipated? That feels a little nerve-wracking.

Dr. Sara Black 6:06

Right, right.

Hormones And Tissue Changes

Dr. Sara Black 6:08

And they are they are so intertwined and connected. The the most concerning part for perimenopause is just that, okay, now our our hormones are just erratic and they're fluctuating, and uh they can certainly contribute to what's called genito-urinary symptoms of menopause. And that is very specifically vaginal tissue changes, vulgar tissue changes, um, the amount of flexibility and elasticity that we have in our tissues declines, blood flow declines, um, pH changes, and so all of those physiological changes show up as what we mentioned heaviness in the vaginal canal, leakage, other urinary symptoms, and and the bowel concerns.

Cheryl Fischer 7:01

Yeah. So it almost feels like you're saying that the majority of women in in this age group might need help with this. Is that is that what you're saying?

Dr. Sara Black 7:14

Yes. So what the research is showing, what we do know is that roughly one in two women are going to experience some of these symptoms. Maybe one for the most unfortunate, it's all. It just depends on the woman, but it is it's roughly one in two. And then we know in terms of urinary leakage, which is a very common symptom that women experience, that more than half of postmenopausal women are dealing with that. So it's it's out there, it's common. It's it's the majority of women. Um, so it needs to be talked about.

Cheryl Fischer 7:54

Okay, so what you do is I guess pelvic floor therapy. Is that the best way to call it?

Dr. Sara Black 8:00

We integrate pelvic health, orthopedics, and performance. So we really do our best to help women with fearless movement and support them through life and sport and help them get back to all the things that they want to do, that they need to do as moms and as women.

Cheryl Fischer 8:21

Okay. I can see how everything fits together, right? And I just as an aside, I do barre class as one of the ways I exercise. And whenever they say, Oh, you can go ahead and hop here, I always think, yeah, there will be no hopping. I do not jump because I'm afraid of hurting myself. So what you're saying about movement is really a valid thing. There's a lot of different aspects of it for sure.

Dr. Sara Black 8:42

Yes, yeah. And so, you know, where we live, we have a lot of active women and exercise is very important for mental health and uh uh certainly for the physical side of things. But these women with these concerns are opting for black leggings just in case they leak. They are running to the bathroom right before class starts. Um, they're skipping exercises, just as you mentioned, and and totally avoiding things, right? And so it's not a fun place to be. That is that is what we're helping women with. We're again fearless movement. We're helping them get back to what they want to be able to do.

What Pelvic Floor PT Looks Like

Cheryl Fischer 9:23

Yeah. Okay, so tell us then a little bit more about pelvic floor therapy and how it actually helps.

Dr. Sara Black 9:30

I hope we can spend a good bit of time on this because what I love in social media now uh and podcasts and and in the outside world is we're getting a lot more information about pelvic health PT, but not the nitty-gritty, you know, what to really expect. So finding a good pelvic floor physical therapist if you're going through these symptoms is super important. Pelvic health PT should not just be tell me, just tell me what hurts, poke around a little bit, give you a couple of exercises, and then send you home. We really start with your story and not your body. What's bringing you in? What are you having difficulty with? What are you trying to get back to doing? Um, and we really want the context behind that. What does your training and exercise look like? How about sleep? What are your goals? How are you moving? What is your mental stage? Um, what's your pregnancy history? All of those kinds of context clues. Uh, because the symptoms that these women are dealing with are just one piece of the puzzle. So we really try to get down to the bottom of the story. We we try to really understand the why behind what's happening. And and then getting into the objective, um, fun PT stuff, right? Is is sorting out is your system capable of doing what you're asking it to do? And is it working for you the way that you want it to work for you in this in this midlife stage? So that that's the start. Most women know that there is an internal rectal or vaginal assessment if that's appropriate. And if it's appropriate, we do assess it directly that way. We do our best to make something that's potentially intimidating just normal, right? We need to get our hands on these muscles and this tissue. Just like if your shoulder was hurt, we would want to do the same thing with those, those, the joint itself and the muscles and the nerves and the tissues. Um, so same for the pelvic floor. And then we decide together what the game plan will be after that. You should leave your session knowing exactly why your leakage or your bloating or your constipation is happening to you.

Cheryl Fischer 11:59

I appreciate you saying get your hands on those muscles because for me that kind of changed the perspective a little bit. These are muscles. They might happen to be muscles that we don't just show out and about all the time, but they're muscles. I appreciate that perspective.

Dr. Sara Black 12:15

Yeah. And the biggest thing for us is the education behind it. We that's central to and should be central to pelvic health PT. It's we're not just treating patients, we are helping them learn more about their bodies so that they do, again, what we mentioned before, feel confident and capable of the things that they enjoy.

Cheryl Fischer 12:38

And so does therapy then become sort of a mix of exercises and things that you do on your own, as well as maybe repeat visits for some sort of treatment in person as well?

Dr. Sara Black 12:53

Yeah. So so your sessions, the sessions themselves might look like hands-on treatment. They might look like uh breathing and pressure strategies, movement retraining, lifestyle modifications. All of these things affect your pelvic health, and stress is certainly one, right? Um life stressors, this stage of life tends to be another reason for the flair, not just the physical, the physical changes in the tissue that we were talking about before, but um the fact that this is a really stressful time for women, starting in their late 30s and and on through uh through mid-50s. So, yes, there that is generally what sessions look like, at least with us.

Cheryl Fischer 13:40

I I love that you're saying it's a stressful day. Well, maybe I don't do I love that it's a stressful time. No, I love that you're saying that because I say that all the time. There's so much change happening in our lives during this phase. That's one of the reasons I even have this podcast is because there are things we can do to get through it in a way that is healthier and easier. And it, you know, it doesn't have to feel like you're just being bombarded every day by a new problem. But there is a lot, a lot going on. So yeah, stress is certainly a piece of that.

Dr. Sara Black 14:19

Yeah. And I I think a common, a common feeling that women have, at least the women that are um entering our clinic, is that um they're told that this is just something that they have to deal with and these symptoms are permanent. And that's absolutely not the case. Pelvic pelvic floor symptoms are very treatable, some of the most treatable. And so that's kind of where the hormones come into play, too, in conjunction with this pelvic health PT that we're talking about. You know, the hormones repair the tissue, and pelvic floor PT helps to retrain the function of the tissue, is the best.

Cheryl Fischer 14:56

So let me just let me just pause there for a second because I've spoken with a couple of different medical professionals on the podcast before as well. And we've talked about this the situation that still exists. No matter that, there's all this information out there, there's there's information about menopause everywhere, it feels like. There are a lot of medical professionals who say exactly what you just said. Well, those symptoms don't sound too bad. You just got to live with it. This is how it is. Get, you know, adjust. Maybe they say it more nicely than that, maybe they don't. And that I that was my experience when I was interested in asking about hormone replacement therapy because I was told my symptoms weren't bad enough to really do it. And I went somewhere else and I figured it out. So not everybody kind of realizes to do that. And and yeah, I guess I I can think of conversations that I've been in where people have complained about different symptoms that we've been talking about today and kind of been like, oh, I guess I gotta live with it, you know, what am I gonna do? So the fact that you're saying it's treatable is a big, big deal.

Dr. Sara Black 16:07

Mm-hmm. Yep. Yeah, it's it's a critical window. Um, as you mentioned, starting in your late 30s and onward, we should start to look at this as proactive pelvic floor care. Um, and it's not either or, it's not hormone support or pelvic floor PT and assistance that way. It's gotta be both to get the most bang for your buck. And it's never, ever, ever too late to start. There is always something that can be done, and women should not just put up with with these symptoms by any means. The number of women that come in and find relief in one to two sessions is pretty incredible. It's even if it's just a couple of because you can't strengthen in a couple of sessions, right? That's right, that's not uh that's not what you're achieving. Yeah, it's it's lifestyle modifications. It's just knowing what the norm is and knowing that um your concerns are experienced by a lot of women. You're not alone, that in and of itself is is really powerful.

Topical Estrogen And Safer Relief

Cheryl Fischer 17:15

So amazing. That's amazing. Okay, so you started mentioning hormone treatments, and I want to talk about topical estrogen. And I have sort of two things I want to talk about with this. Number one, kind of what is it, how does it help? But number two, there's a lot of people out there saying that they have this non-prescription thing that will help. And I wonder what your thoughts are on all of that. But we can start with what is it, how will it help?

Dr. Sara Black 17:45

Yes. So reintroducing moisture uh to the vaginal canal is is super important. So so we can touch on that. But I believe every woman over the age of 40 should be using a low-dose topical estrogen cream. And that is that's for the simple fact that we are we are losing our estrogen. Our estrogen is decreasing, and there's absolutely nothing that we can do about that. It is going to happen to every vagina and vulva. And that will account for the tissue changes that we talked about before, tissue elasticity, maintaining the wrinkles of the vaginal canal, which is super important, changing the pH in a positive way, blood flow. For all of those physiological changes, it it's it's an absolute game changer, and it's in my opinion, it's necessary for every woman over the age of 40. Wow. That's a strong statement. Yeah.

Cheryl Fischer 18:48

Yeah.

Dr. Sara Black 18:48

And then then we are improving the urgency, the frequency, the leakage because the tissue is happier. Yes.

Cheryl Fischer 18:57

Oh, I see. Okay. Yeah. Yeah. Yeah. And interestingly, this is a pretty inexpensive prescription to get as well, as far as I understand it. So it's simple if we can find someone who will prescribe it.

Dr. Sara Black 19:11

Yeah, that that's the biggest thing. It's finding a trustworthy provider in your area that is going to support you through perimenopause, menopause, and postmenopause. They're going to be with you every step of the way. They will help you weigh the risks versus the benefits. But the topical estrogen is there are not a lot of risks that come along with topical estrogen. It's very safe. It really should be over the counter at this point. Um, but yes, that's that is a great start. And sometimes women need a whole body or a systemic estrogen because their symptoms are somewhat improved, but need a little bit, need a little bit more. And that's that is again where the trusted provider comes in and um can help you weigh, weigh your pros and cons and what to do with that. Yeah.

Cheryl Fischer 20:04

Yeah. Okay. Okay. So

Moisturizers And What To Look For

Cheryl Fischer 20:06

then let's talk about all of these different things that we kind of see advertised on social media that are a lot of times called an alternative to the prescription or something that will really help in some way. Is there something we should look for? Should we kind of avoid them? Like I realize you can't speak product by product, but tell us a little bit about that.

Dr. Sara Black 20:29

Yeah, there are a whole bunch of products out on the market. So if you're you're not quite there in terms of, or if you're not quite ready to go the hormonal route, bare minimum, we should be using a vaginal moisturizer. So there are a whole bunch of products. As I mentioned, there's a whole bunch out there, but looking for the main ingredient being the hyaluronic acid to help the pH of the vaginal tissue. Um, we should all be moisturizing our vaginas and our vulvas. So good ones out there are vulva bomb is a great option, right? Not marketing for anybody in particular, but there's there's a whole bunch of great ones out there. Yeah. Rejuve, yeah, but but no matter the uh brand, just looking for the hyaluronic acid. Okay.

Cheryl Fischer 21:21

That's helpful because you're the first person that has said that about moisturizing. That's the first time I've ever heard that. And I've had conversations about this before. So that's very interesting.

Dr. Sara Black 21:32

Well, just like, I mean, think about how much money we spend on facial moisturizers and everything that we do for our face, we should be doing the exact same thing for our lady parts. Yes. Why not? Yeah.

Cheryl Fischer 21:44

I get it. Yep. And so the prescription version of topical estrogen is just giving us the the strength of the estrogen and the the medical grade. Is that what the difference is?

Dr. Sara Black 22:00

Yep, you're anything that's well, um, if it's prescribed, it will have estrogen in that, and that's that will not be an over-the-counter product. So yeah, you're intro then introducing hormones to bioidentical hormones into the tissue. Um, the the moisturizers are okay, if we're not quite ready to go the hormonal route, maybe you're just occasionally noticing some itchiness, dryness, just not quite right. And at different stages of your cycle, then that's where uh a moisturizer can really come in handy.

Cheryl Fischer 22:35

Yeah, well, it's good to know that that's even okay. Uh, that it's not, you know, introducing more problems than it's worth. Interesting. Right.

GLP-1s Weight Loss And Pelvic Impact

Cheryl Fischer 22:44

Okay, now another thing that came up when we were chatting earlier is GLP ones. And I think the reason that came up is that, I mean, I could list out people that I spend time with and I'm friendly with, and at least half of them are on GLP ones now. And maybe some are that aren't even talking about it because they don't want to talk about it, which is fine. It's very common, right? So, does that now have an impact on pelvic health in some way?

Dr. Sara Black 23:16

So we're not talking about opinions of women being on GLP ones for weight loss or not. It is, um, it is out there and it is very prominent. And so we as providers, uh, myself as a provider, really need to just stay on top of that. It's not for me to say that that's a good decision or a bad decision. Specific to the pelvic floor, it's playing devil's advocate. There are I've seen positive and negative effects to taking GLP1s. The the sometimes what happens is rapid weight loss, right? If it's so every woman is going through different doses um with with their physicians, with their um prescribing physicians there. So we'll talk about rapid weight loss. Weight reduction in general can can be super helpful for stress incontinence, urge incontinence, um, stress being a pressure management issue. Um, you are introducing load to your body, and your the bladder neck and the urethra are not able to kink in time. That's so coughing, sneezing, laughing with stress incontinence. Urge incontinence is something triggers you, and oh my gosh, you have to go now or you're not gonna make it. Um, weight reduction can be super helpful for those symptoms, for prolapse, for it back to the heaviness that we were talking about, um, and even sexual function. So on there is a positive to weight loss for for the pelvic floor. My concern with it is when we have rapid weight loss with these products, and I've seen that as well, um, that is that is going to change the entire mechanical load. So GLP1s are not, they're not targeting fat mass. So when you lose weight, you are in theory losing muscle mass and lean mass as well. And the pelvic floor muscles are skeletal muscle just like every other muscle in the body. And so that's that's where we're running into issues, rapid weight loss, not keeping up with the physical capacity in terms of the pelvic floor, and then ending up with unfortunately uh worsening of symptoms, worsening of leakage, heaviness, just because the the strength, the coordination of the pelvic floor, the again, the capacity of those muscles is not has not quite caught up to the to the changes.

Cheryl Fischer 25:54

So I I I fully agree we're not talking about whether GLP one is a good or a bad thing. Um, everybody's individual. But let me see if I can say back kind of what you're saying, because I think it's valuable for people to hear. It sounds to me like you're saying that weight loss in general, no matter how it's happening, is a good thing. There's less stress on the body in the ways that you described. But rapid weight loss may involve muscle loss, which does affect what we're talking about with pelvic health. And so if that's happening as part of whatever it is that you're doing to lose weight, then even more reason to be finding out about the health of your pelvic floor and looking into therapy because there's a bigger risk. Is that fair? Yes.

Dr. Sara Black 26:47

Yeah, have have someone in your corner to uh be to check on things, right? To to um get a baseline and to continually check for those concerns. So, yes, that's that's exactly right. Exactly as you mentioned it. There is a more under-discussed side effect of GLP1s, which is um now we've got the sh the GI issues, the straining and the constipation. And that absolutely definitely impacts the pelvic pelvic floor in in a negative way. And um, for that side effect alone, pelvic floor PT can be super helpful. It's that's very relevant then. Yeah. So aside from aside from the weight loss, there's just that not so great side effect.

Cheryl Fischer 27:35

Yeah. Yeah, good point. Absolutely. And I'm thinking of the people I know who are taking them, and I know they've kind of mentioned these things in conversationally. So, yes, that makes sense. It sounds to me like this switch that I'm making in my brain. And if you're listening, maybe you're making this switch too, that we're talking about muscles here, and we need to treat this the same as we would other muscles. We're aware that we need to have leg muscles so we can get up out of our chair when we're 80. We're aware that we need our muscles so we can lift something. And this is also a muscle that we need to take care of. It sounds like shifting the mindset in that way is is gonna help. I love it.

Dr. Sara Black 28:14

That's yeah, that's exactly right. It is. And because it's in such an intimate and sensitive part of our body, we uh we don't think of it as the same now, but it is. I mean, it it absolutely is and has the same training principles and and whatnot. It's just a little bit different in how uh the connections, right? There's there's connections to organs, not bone to bone like our other muscles. So it it actually deserves um deeper focus and attention, but it is still skeletal muscle. It is um still definitely going to be impacted by the rapid weight loss of GLP1s.

Cheryl Fischer 28:57

Okay,

Start With A Bladder Diary

Cheryl Fischer 28:58

interesting. Okay, so if somebody's listening then and kind of following what we're saying, nodding along, is there something that they can start doing now? Some new habit or something different they could do that might start to help with this? With being more aware of the pelvic floor in general? Ooh. I'm catching you off guard with that one, I know, but I'm curious.

Dr. Sara Black 29:22

I love it. Yeah. I one of the very first things that we have any woman do that's experiencing bladder symptoms is log it. I would say that would be a great first step. It gives you a lot of good information. When are you going to the bathroom? How strong is your urge? Is there leakage associated with that? What are you doing when the leakage happens? Um, what kind of fluid are you drinking? Is it a whole bunch of caffeine and seltzers throughout the day? Are you chugging water at the end of your day because you you're trying to catch up? Um, the bladder diary tells us a lot. And then knowing the norms behind that. We we should all, you know, there's a lot, um, a lot of ladies that say I have a small bladder, right? But um it's not really a thing. We should all be able to hold our bladder for two to three hours before having to go again. And nighttime at this stage of life, you know, zero to one time a night is what we're aiming for. So just knowing some of the normals and starting to track and and be aware. Awareness is the the first step. So I don't know if it's the answer you were looking for, but I love the bladder diary, and most of our ladies are begrudgingly filling those out in the beginning.

Cheryl Fischer 30:40

So yeah, it's not so fun, right? It doesn't sound like something fun to keep track of. However, I can see the power in that in just knowing and understanding what's going on. Absolutely.

Dr. Sara Black 30:51

Yeah. Yeah, because of what you mentioned before. Life is so busy. We have so many other things going on. We're not paying attention to whether we're going to the bathroom every 30 minutes until you start writing it down. It's like, oh, you know, this really is impacting my life. I can't sit down for a whole dinner or a movie without or a car ride is a really common one without having to stop several times to go to the bathroom. Yeah. So and you're saying that that can be improved.

Cheryl Fischer 31:21

Yes.

Dr. Sara Black 31:21

Yay. Yes, yes, yes. That is, it is so fun to help women. When I first met you, the first thing you heard me say is we help women with pooping, peeing, and sex. And so to be able to help women with those concerns is just so rewarding. And that's what we're over here doing every day.

Cheryl Fischer 31:41

I love it. Well, okay, so tell me where can people find you online, in person, all the things. Yes.

Dr. Sara Black 31:50

So we have a clinic, brand new clinic now in Maryfield, Virginia. We have Instagram where I have my lovely ladies give staying on top of the most up-to-date research and all of the things. So you can find all of that on Instagram at Zia Zia Physiotherapy. Our website is ziaphysio.com, and you can always email us at hello@ziaphysio.com to get in touch with her. Perfect.

Cheryl Fischer 32:19

Perfect. And I'll have all that in the show notes. So to make it really easy. Perfect. Okay,

Build Your Team And Advocate

Cheryl Fischer 32:24

so as we wrap up, here's the thing I always ask at the end, because I know that people listen to podcasts while they're driving and doing the dishes and whatever else they're doing. And so they're not going to remember everything. So if we had to pick one thing that somebody listening should really remember from this episode, what would that be?

Dr. Sara Black 32:45

Yeah, I just I think with so much information out there regarding pelvic health and hormones, it is again, it's so great that that information is out there. But the the most important thing I would say right now is just stick with good information. Good information is key in midlife. Listening to podcasts like Cheryl's, finding quality information related to menopause, finding quality providers who specifically mention that they will help you through perimenopause and menopause. And then advocate for yourself. So the biggest thing is just build your team. If you are in your late 30s and listening to this, build your team now. If you are 45 to 55, it is not too late. Start building your team of trusted providers and advocate for yourself. If your physician is saying no to hormones, ask why. If they're if they are recommending a specific avenue of hormones for you, ask why. And just make sure that they're they're weighing all of the risks versus the benefits for you, and you'll you'll be in a good spot. So that that's my one one important takeaway. Find your team, find the good information.

Cheryl Fischer 34:08

Yeah, and I couldn't agree with that more because there's a lot out there and there's a lot of people trying to come up with gimmicks, and we have to be a little bit careful to navigate around that. So yeah, I I appreciate you saying that. And there are certainly a lot of resources that are good information. So thank you for being one of them. I was saying something when we hit a hundred episodes back in September. I was saying something to my email subscribers about the fact that when I ask about the one thing to remember, it's almost always related to trusting our intuition, trusting ourselves. And I'm gonna extend that to what Sara just said as well, because going on the hunt for good information and getting a team together that's gonna support us and our health through this period of time is trusting our gut and trusting our intuition that we deserve care that is valid and smart and helpful, that we deserve to be able to improve our symptoms, that we deserve to have a team to help us. Maybe it's pelvic floor physical therapy, alongside a menopause certified doctor, alongside exercise, maybe with a professional helping us, maybe not, a team of people helping us to kind of be our best self in this phase of life because you heard her say it, and I'm gonna say it all of these symptoms do not have to stay and they do not have to get worse. And there are things you can do. And to me, that's so empowering. And I really want to leave you with that message a hundred percent for sure. There are things you can do, it can get better.

Self Care Menu And Closing

Cheryl Fischer 36:07

I'm so thankful for that message. Now, speaking of taking care of yourself and having a team, if you don't already have my free self-care menu, make sure you go to CherylPFischer.com/slash self-care menu. Easy link to remember, and I'll put it in the show notes and grab it. Save it on your phone, save it on your computer, print it and stick it on your wall. If you have a few minutes, I'm gonna give you some ideas on how you can sort of power down, rest, refocus, and it does matter. It is a huge important way that we can take care of ourselves, even if we're resting for just a minute, because that's all we have. Now, if your brand or book or business is looking for ways to reach savvy midlife women, there are a couple of sponsorship slots available in the upcoming months on Mind Your Midlife. Go to Gerald PFischer.com slash M Y M sponsor info and take a look. And until next time, keep remembering Midlife is your time to take just a little bit better care of yourself. On the outside, body, physical, pelvical, and on the inside, and that's all about mindset. Just a little bit more care. Take it.