Quick Summary: In this episode, Cheryl talks with Dr. Sara Black, a pelvic health physical therapist and founder of @ziaphysiotherapy, about pelvic floor symptoms in perimenopause and beyond. You’ll learn why leakage, dryness, urgency, and constipation aren’t just “part of aging,” how pelvic floor therapy and hormone support can work together, and how rapid weight loss on GLP-1s can affect your pelvic floor.
Intro:
Leakage when you sneeze. Dryness. Planning every car ride around bathroom stops. So many of us quietly put up with pelvic floor symptoms in midlife, and too often we’re told “that’s just how it is.” It isn’t.
In this episode, I welcome Dr. Sara Black, a former Division I swimmer turned doctor of physical therapy who specializes in pelvic health. Sara has also worked as a certified personal trainer and licensed massage therapist, and she brings a performance lens to her clinic, Zia Physiotherapy, in Northern Virginia. We talk about what pelvic floor therapy actually looks like, why topical estrogen and vaginal moisturizers matter, how GLP-1s can affect your pelvic floor, and one simple habit you can start today.
What You’ll Learn:
✔ Your Symptoms Are Treatable: Why leakage, urgency, heaviness and pain aren’t permanent, and why Sara calls pelvic floor symptoms some of the most treatable
✔ What Pelvic Floor Therapy Really Looks Like: How a good pelvic health PT starts with your story, what the assessment involves, and what sessions include
✔ Hormones, Moisturizers and GLP-1s: How topical estrogen and hyaluronic acid moisturizers support your tissue, and why rapid weight loss can strain your pelvic floor
Links & Resources:
Zia Physiotherapy: ziaphysio.com
Email Sara’s clinic: hello@ziaphysio.com
Zia Physiotherapy on Instagram: @ziaphysiotherapy
Cheryl’s FREE Self-Care Menu: cherylpfischer.com/selfcaremenu
Lucid podcast promotion, $25 off your first month: cherylpfischer.com/lucid
Sponsor Mind Your Midlife: cherylpfischer.com/mymsponsorinfo
Frequently Asked Questions:
What are the signs of pelvic floor dysfunction in midlife?
Sara says it can show up as urinary leakage, urgency and frequency, constipation, straining and bloating, pelvic pain, a feeling of heaviness (prolapse), and sexual dysfunction. She adds that it can also be connected to low back, hip, and tailbone pain.
Do I just have to live with leakage after menopause?
No. Sara says many women are told their symptoms are permanent, but pelvic floor symptoms are very treatable. She says it’s never too late to start, and many women find relief within one or two sessions through education and lifestyle changes.
What happens at a pelvic floor physical therapy appointment?
Sara says a good pelvic health PT starts with your story: your goals, exercise, sleep, stress and pregnancy history. When appropriate, there’s an internal assessment, and sessions may include hands-on treatment, breathing and pressure strategies, movement retraining and lifestyle changes. She says you should leave knowing why your symptoms are happening.
Should women over 40 use vaginal estrogen?
In Sara’s opinion, every woman over 40 should use a low-dose topical estrogen cream because declining estrogen affects tissue elasticity, pH, and blood flow. She recommends working with a trusted provider who can weigh your risks and benefits.
Do vaginal moisturizers help with dryness?
Sara says that if you’re not ready for the hormonal route, a vaginal moisturizer is the bare minimum, and to look for hyaluronic acid as the main ingredient. As she puts it, we care for our faces, so why not our vaginal and vulvar tissue too?
Can GLP-1 medications affect the pelvic floor?
Sara says weight reduction can help with leakage, prolapse and sexual function, but rapid weight loss may also mean muscle loss, and the pelvic floor is skeletal muscle. She also notes constipation and straining as an under-discussed side effect, and recommends having a pelvic health provider check your baseline.
Episode Chapters:
00:00:00 - Why Pelvic Health Matters
00:01:00 - Sponsor Lucid For Podcast Growth
00:01:45 - Common Midlife Pelvic Floor Symptoms
00:06:08 - Hormones And Tissue Changes
00:09:23 - What Pelvic Floor PT Looks Like
00:17:15 - Topical Estrogen And Safer Relief
00:20:06 - Moisturizers And What To Look For
00:22:44 - GLP-1s Weight Loss And Pelvic Impact
00:28:58 - Start With A Bladder Diary
00:32:24 - Build Your Team And Advocate
00:36:07 - Self Care Menu And Closing
Music: Cartwheels by Good News Tunes, licensed by Premium Beats. YouTube ID: NOYTHM5TOK62B7JY
This episode is for educational purposes only and is not medical advice. Please talk with your own healthcare provider about your symptoms and treatment options.
Take a little bit better care of yourself in midlife.
