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Women’s Health

**Disclaimer: If you are squeamish about health info you may not want to read this. Also this has nothing to do with horses. Also, also, I am a doctor but not a gynecologist or physical therapist and all information shared here is from my conversations with those specialists. If you have any personal health concerns please make an appointment with your primary doctor or gynecologist to discuss.**

When I was diagnosed with Butt Alzheimer’s earlier this year, I figured that was about the oddest piece of information I would ever be told about my body. Apparently that was taken as a challenge to which my body responded with “Hold my beer”.

At least that’s how I felt when my gynecologist looked me in the eye and said “you know how most people hold their stress in their neck or lower back? Well, you hold yours in your vagina.”

In a most incredulous way I blurted out “is that a thing?!”

To which he chuckled.

I’ll back up a little bit. The migraine I had at the end of July scared me. The aura was frightening but what really got to me was the timing. It occurred right before all my typical period symptoms began. Each month for the last year a new lovely surprise has joined the foray: back pain, intercourse pain, constipation. It was like a mini Christmas each month where all you get is an ugly sweater and some socks.

Fortunately I already had a Pap smear scheduled with my internist at the end of that same week and I discussed with her my concerns that a migraine may be in my future every month. In fact I told her “if that is the case I may need to file for a divorce from my uterus as I do not have the time to have a migraine every month” She referred me to a gynecologist since I hadn’t seen one since going through all the infertility treatments 7 years prior.

It can be embarrassing to discuss private information with a new doctor but I’m in the industry and know how important a thorough and accurate history of present illness (HPI) is in the diagnosis of an issue. I told this stranger everything even the intimate parts of my concerns. The period symptoms. The pain with intercourse. The fact that I get my period symptoms twice a month though only bleed once every 28-32 days. I was thorough. It’s the way I’ve been taught.

He listened and made a guess that it could be endometriosis and then began the physical exam. About 30 seconds later he told me about my stressed out vagina. The muscles on the floor of my pelvis are locked in rigid contraction. Apparently my glutes aren’t the only part of me that are over doing their job.

Pelvic Floor Dysfunction is much more commonly seen after labor as a relaxation of those same muscles which results in urinary leakage and common complaints of women after having a child. In my case the opposite has happened and everything is tight. His palpation of those muscles left me with internal cramping the rest of the day and he remarked that he was surprised I was even able to have a normal gait with how tight my pelvis is.

The treatment for pelvic floor dysfunction is therapy. This involves a lot of unpleasant sounding things such as internal manipulation, the potential use of dilators and lots of stretching. This sub specialty of physical therapy is newer and my town only has one therapist certified to perform it. They are booked up until October or November, so my pelvic floor will have to remain overly tight until then.

It wasn’t until I sat in the parking lot in my car reading every tiny piece of information I could pull up on my phone about the condition (surprisingly little though maybe not that surprising as women’s health issues haven’t been studied until fairly recently) that it hit me to ask him if riding either caused this or if this is hampering my riding. I’ll ask the therapist when I start this fall.

Apparently releasing those tight pelvic floor muscles will resolve the majority of my symptoms. Symptoms I’ve had for many, many years even decades. Why no other gynecologist recognized this is most likely due to the simple saying “the eyes see what the mind knows” that I was taught in residency. Most doctors don’t know about PFD and so they don’t diagnose it.

My other concerns were also addressed though they aren’t as simple. The twice monthly period symptoms and the migraine, which he confirmed is most likely period related, are due to improperly functioning ovaries. My request to have them removed was denied. So much for reproductive rights in 2019.

He recommended I start an SSRI (selective seraronin reuptake inhibitor aka antidepressant) to help with the symptoms but I declined. I don’t want medication. He then prescribed cardiovascular exercise. My gynecologist told me I have to start running again at least during those times of the monthk. The endorphin release will mimic the SSRI and help. Ok. I can do that.

The migraine is trickier. The only medication known to help period induced migraines is the triptan group but he said those are really strong and may limit my ability to work when I take it. No thanks. I’ll deal with the head pain. He then recommended I get my daith pierced in my ear as that is a known acupuncture spot to help with migraines. I guess I’ll figure out who pierces that and get that done. We will see if it helps.

I’m to keep a period journal of all my symptoms and when they occur and return to him in January or February after I’ve completed the therapy as well. At that time, if I’m still having issues I’m going to demand an ovarectomy at the least or a hysterectomy if need be.

2019 and 37 years of age is turning out to be an interesting one health wise. Thankfully my butt returned to normal function after physical therapy in the winter and I am hopeful therapy will help yet again here. 2020 may start off with me feeling more “normal” than I have in decades.

If you are dealing with less than ideal internal issues, please see your gynecologist. Women’s health is finally in the forefront and being researched and taken seriously. Simple things like not being able to wear a tampon due to cramping and pain aren’t symptoms you have to live with. As more research is performed and as more doctors are learning about pelvic floor conditions in women, you will see a lot more women getting diagnosed and treated and a lot more women enjoying a completely pain free existence.

25 thoughts on “Women’s Health”

  1. I am sorry that you are going through this. I do have a question- why was your request to have your ovaries removed denied? Was it because of health reasons or something else?

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    1. It’s because of my age. They think I’m too young. But they don’t work. Ive had unprotected sex for 15 years and went through infertility treatment. It ain’t happening and now I’m too old to even want it to anymore. I’ll be more demanding in February. I understand the need to fail conservative care before undergoing surgery. It’s a cover your butt situation.

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  2. Thanks for your honesty! Women’s health issues definitely take a back seat and I am guilty of not getting out of my comfort zone enough to be completely honest during an exam

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    1. I’m not shy about it and after talking to him I learned that a lot of what I considered normal isn’t. I’ve been dealing with issues my entire adult life that I haven’t needed to simply because I thought it was what everyone went through. That’s why I figured I would post about it. A lot of what women assume is a part of being a woman doesn’t actually have to be

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  3. I finally found a solution to my ridiculous bleeding and cramping every month and was given a uterine ablation. When my PCP heard what I do to manage my periods, she was horrified and immediately gave me a gynecologist referral. I am going to miss her. She was the best at taking care of my oddities of health.

    Suddenly I don’t need to wear depends during my period out of fear that I’m going to stain all my clothes. The cramps also went away for a while, but now they’re coming back. But honestly, I can deal with cramps because it’s not being accompanied by ridiculous bleeding.

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    1. My actual period is the easy part. I barely bleed and it lasts only a few days. It’s the lead up and now the fact that I go through PMS every two weeks that bothers me. I’m glad your doctor listened to you and you got help. I can’t imagine what you had to deal with every month

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  4. Wow. I didn’t know these problems existed. Now I have a bunch of new things to worry about. I hope you’re able to get the care you need. I cannot stand DRs who think that I will change my mind and they’re protecting me by making me keep my ovaries longer than I want to because they’re sure I will want kids one day. I went through that with a few before I found a good one. Then I moved and now I need to find a new Dr.

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    1. Yup. You have it spot on. For me there is the added fact that I’m broken down there so it doesn’t even matter if I wanted kids or not. I can’t have them. So remove everything and let me move on.

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  5. There is tons of info on pelvic floor dysfunction in women’s strength circles (not general weightlifting. I’m talking hardcore lifting like Olympic weightlifting, powerlifting and CrossFit.) It is a common problem and it comes up a lot due to how hard you have to brace your entire core (pelvic floor muscles are included) when moving x times your bodyweight. If you have pelvic floor issues, you’re going to learn about them real quick if you’re serious about your training. Granted, it is a general female elite athlete problem: it’s not limited to iron sports exclusively.

    Had to comment to let you know you might be able to find more information in that direction. 🙂 If you haven’t found it already, of course.

    NIH did a study on this subject: https://www.ncbi.nlm.nih.gov/pubmed/30730341

    Hormone health is overlooked by the general population and it’s one area that women especially should pay more attention to: hormone imbalances can cause all of those PMS symptoms. They can often be managed with diet modifications. I used to have wicked back pain and cramps during my period that were so bad they would interfere with my sleep at night. Only muscle relaxers helped; ibuprofen barely touched it. The week before my period, I suffered from generalized fatigue, weakness (it really affected my training), headaches, breakouts, and mood swings, only during that one week of the month. The birth control pill helped, but it also had side effects that I wanted to live without. Following my nutritionist’s advice, I came off the BCP and started seed cycling last year and I can’t tell you when the last time was that I experienced any of those PMS symptoms with that severity. Every once in a while something major will happen (like a trip, for example) and I stop seed cycling for a week…and I’ll feel the difference with my next period.

    Laurie Christine King is a former CrossFit elite athlete and now a nutrition coach, and she is currently among the best sources of information on the subject of female hormone health. Here’s a little more info on her along with an interview where she talks about all of these subjects: https://www.stephgaudreau.com/troubleshooting-female-hormones/

    LCK’s website: https://lauriechristineking.com/

    On seed cycling: https://thechalkboardmag.com/how-to-seed-cycle-for-your-period-hormone-health

    This book is also absolutely amazing!

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    1. Thank you for all the links! My main source medical journals and publications have minimal information. Which seeing how the world is 49.6% female, is very sad.

      I’ll look at each link you posted. That seed cycling one is fascinating. It’s an easy thing to try as long as I can find a source for the seeds. Flax and sesame won’t be an issue. I’m all for a holistic approach to my health.

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      1. I get the seeds at places like Whole Foods or Wegmans, or just order on Amazon. Trader Joe’s also tends to have them. Flax is easy to find already ground. With sesame, pumpkin and sunflower seeds, I just grind them in a cheap coffee grinder I got on Amazon for $12 and freeze what I’m not using to keep them fresh. I sometimes sub the sunflower or pumpkin seeds for their nut butters: 88 Acres makes an amazing pumpkin seed butter (it’s a hideous green color but it tastes soooo good) and you can get sunflower butter at larger grocery stores that have more specialized items. 🙂

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  6. Ugh you poor thing, this sounds awful.

    I can relate on a small scale after going through numerous doctors for issues I was experiencing down there, and even gynocologists weren’t providing much help. I ended up having to be referred to a vulval specialist before being diagnosed with provoked vestibulodynia. It took almost 3 years to get that answer, which was incredibly frustrating.

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      1. It just folds into daily life eventually. And unfortunately there’s not much I can do when the doctors tell me there’s nothing wrong. I even had a surgical biopsy and was given no more information or help

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  7. Ugh. That sounds so awful! And boo to not having a Dr who will just let you move forward with what you want for your body. I only have one girlfriend who was able to get her Dr to say yes to that on her first ask, which is remarkably sad. She’s up in PBGH and I know you have family that way, so if your local folks continue to be lame, I am happy to get you the name of the person who did her surgery!

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  8. That sounds like a nightmare, but it’s good to be on the road to recovery and have knowledge about what’s going on!

    It might be interesting to look into physiotherapy as well. I attended a clinic with Andy Thomas, the physiotherapist with the US Equestrian Teams and formerly the British teams. It was pretty amazing what he can do to help address weakness and compensations in riders. Might be something to consider once you’ve done the medical stuff, if it could help with riding and not re-creating the tension! There are also a number of physiotherapists who trained with him who might be near your area. Just a thought! 🙂

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    1. Is physiotherapy like physical therapy? I googled it and it appears to be extremely similar if not the same. The main approach for me is physical therapy but they are booked until November so in a waiting pattern for now

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  9. one of my friends is a physical therapist for women’s health and has told me all about some of the pelvic floor type issues that she treats. it’s way more common than we think, probably bc historically women just kinda didn’t talk about it… the treatment works tho, in a big way — glad you’re getting what you need!!

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  10. Oh. My. God. I cannot believe I just read this. I had THE EXACT SAME THING going on last year and thought I was losing my mind! Not the migraines/bleeding/PMSing part, I’m post-menopausal, but the constipation, pelvic pain, odd cramping/twinging and painful intercourse (actually was mostly post-that, but it sucked nonetheless). I had no idea WTH was wrong but I was miserable and freaking out.

    It took three trips to three different medical professionals but saints be praised, I finally found the right person who knew immediately and exactly what was going on. And yes, you could have knocked me down with a feather when she said it was because I carry my stress in my girl parts! WHAAAAAT??? I’ve certainly heard of women having lax pelvic floor muscles, my own mother has to wear liners for urinary incontinence, but the OPPOSITE? Who the hell knew!

    Settle in because I’m going to tell you (almost) everything I learned and figured out about this, whether you want to hear it or not. 😉 I’m sorry if this is TMI or I’m over-sharing, but I’d hate to see one more woman suffer if I could possibly help.

    1) PFD is not uncommon in female equestrians. In fact, I was terrified that in addition to not being able to have sex (which would severely disappoint my BF) that I wouldn’t be able to ride (don’t ask me which thing would be worse, LOL). I was told to get thee to PT and she’d help figure it out, and not to panic. I assume that it’s common in riders because we use our entire bodies to equitate, may or may not involve the correct muscles and in my case, at least not breathe properly.

    2) If my experience is anything to go by, I assume most regular gynos and PAs/NPs haven’t a clue. I was first seen by a male gyno who is in the same practice as my regular gal, who wasn’t available (I still think she would have known something). Although he was nice, he didn’t even do an internal exam (!); after hearing my symptoms he prescribed an antibiotic and antispasmodic for a suspected UTI. Even though the urine test was negative and I told him it did not feel the same as a UTI – I’ve had a bunch so I KNOW. Oh, and more/different lube for sexy times. That wasn’t wrong, at least.

    3) Antispasmodic at prescription dosage, aka the stuff that turns your pee orange, can have an EXTREMELY unpleasant side effect. File this one away, ladies, under important knowledge. I got massive, incredibly painful and long-lasting – I’m talking 20 minutes or more – nighttime leg cramps. Like, “screaming and crying in pain” leg cramps. I scared my BF half to death and my daughter came running. I could hardly walk in the morning. After a couple nights of that I finally made the connection and quit taking the med. Never again. (I finished the antibiotic even though I was 99% sure it was unnecessary)

    4) When things didn’t improve I was referred to a specialty practice. I got in right away, but it was to the nurse practitioner. She did do an internal, which hurt like hell and caused more cramping, and a catheterization since she still suspected UTI. She threw in a course of yeast infection treatment for good measure. What did I do? Never filled the yeast med script, because I knew damn well it wasn’t THAT. Scheduled an appt. with the “real doc” before I even left. Good thing, too.

    3) You have already discovered that female gyno problem PT people are thin on the ground. I lucked out and there was one only 15 minutes from home, who I liked very much. If anyone needs one… keep going ’til you find the right person. Your average physical therapist cannot help.

    4) At least you were told PT would include internal manipulation. I was not. Accordingly, when I was there for the first time and the therapist matter-of-factly told me to strip down and get under a sheet I was rather… nonplussed. I’d already had two people messing around down there and now she wanted in, too? Yup. Multiple fingers inserted, lots of rummaging. She would press on my belly from the outside at the same time. Just like with the doctors when she hit trigger points, YOWZA. But…

    5) The PT was INVALUABLE. The therapist helped with the mental panic and stress, the relaxation techniques, the constipation, the feeling I was the only weirdo in the whole world who had this issue, the works. She was kind, thoughtful and thorough. No question was too dumb and the exercises made sense and helped a ton.

    6) The single MOST IMPORTANT THING that I learned, and which I will practice for the rest of my life, is how to breathe properly while exercising (riding!) and consciously relaxing. You might even be able to skip PT if you can master this on your own. It sounds very simple but it does take a lot of practice to do it right.
    Here you go…
    In through the nose ONLY, expanding tummy muscles to draw in air. Not your chest. Out through the mouth, pursing lips like blowing up a balloon. **It is impossible to clench your pelvic floor if you are blowing out air like that.**

    I am grateful that my medical odyssey to seek answers ended as quickly as it did, and that I was able to obtain the tools and knowledge to fix it. I am loads better now. No more cramping, no more pelvic pain doing anything, no more incredibly annoying and frustrating non-stop “twinging.” God, I HATED that! I’m still constipated but am working on improving that.

    I hope you are on the road to recovery, too!

    (P.S. You have my email, I think, if you want to discuss further.)

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    1. Thank you for taking the time to write that out. I was floored when he told me the issue was my stressed out vagina. I’m currently in a waiting pattern to get in with the pelvic floor PT. I’m really hoping it works as well for me as it seems to have for you! I will start working on that breathing technique. I am very, very good at holding my breath when I ride.

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