Her Discussions by Dr Faye - Women’s Health Physio: The Health Advice Women Are Getting Wrong

Episode Date: August 17, 2026

We have some news…We've been nominated for ITV Podcast Creator of the Year (!!!) 🏆If you've learnt something from the podcast this year, I'd be so grateful if you could take a minute to vote for us. It genuinely means the world: https://bit.ly/4ynqe451. Select ‘Creator Shortlist’2. Scroll down to ‘Podcast bCreator of the Year - Her Discussions with Dr Faye Bate’THANK YOU 🤍___How many symptoms have women been told are normal when they actually aren't?In today's episode, we're joined by Chloe Stevens, a leading women's health physiotherapist and PhD researcher, to unpack the health myths women have been taught to accept for far too long.What you’ll learn:🍽️ how 300 extra calories/day can help women regain regular periods🩺 why women’s health physio isn’t just for pregnancy & menopause💸 the wellness products a women’s health physio would NEVER buy🚽 why always needing the loo could be a warning sign😣 how pelvic physio can help women with endometriosis painResources & links mentioned:-Chloe’s Instagram - https://www.instagram.com/chloelewisphysio/This episode is sponsored by @CeraVe and their cleanser range, including the CeraVe Foaming Cleanser, formulated with 3 essential ceramides to support the skin barrier.🔔 Join the HERd* broadcast channel here: https://www.instagram.com/channel/AbY4liwxlLnewx4H/?igsh=MWhuaXFweGtucTB3cA==📱 Find us on socials: Instagram & Tiktok - @drfayebate Podcast Instagram & Tiktok: @herdiscussionspod📩 Want to reach out?Email: [e-mail]🛑 Disclaimers:Opinions are my own. This content is for educational / entertainment purposes and not medical or financial advice.

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Learn more at Accenture.com slash Spotify. and normal are not the same things. It is common for women to leak your rear, but it shouldn't be normalised. More than half of the women in the UK say that their pain has been dismissed by a healthcare professional. Today's guest wants to stop that from happening.

There's no such thing as good posture. The problem isn't how we sit. It's how long we sit for. I had no idea about that. Chloe Stevens is a leading women's health physiotherapist who has spent her career making sure women actually understand their bodies. She's also a PhD candidate looking into how resistance training impacts women's health.

I think it's become so trendy online to really push your body. In marathons, in high rocks, this idea that you have to lift heavy is dead in the water because actually all you need to get to is a place where it's... For the women who are proactive in their 20s so that they can live healthier 30s, 40s, 50s, 60s and 70s, then this episode is for you. I would really encourage you to seek advice because it won't get better on its own nine times out of ten. It's not something that should be ignored. And before we get into the conversation, if you could do me a favour that literally takes you two seconds,

hit the subscribe button or leave a five-star review depending on what platform you're listening on. It really helps us to continue to grow the podcast and bring you guests to help you live a happier, healthier life. Thank you. I think a lot of women think that just physiotherapy is you go and you've pulled a mess. or maybe even if you're we and yourself after having a baby. But I'm so excited for this conversation to discuss why it's important for everyone, especially women in their 20s, to know the importance of looking after your body. But first, I would like to start at the beginning,

because it seems like you didn't have a traditional route to where you are now. Maybe let's start with your mum being a midwife. What impacted that have on you and how that led you to where you are today? Okay. So my mom was a midwife throughout my whole childhood. And I think the biggest thing I remember from my mom being a midwife is that there was no sugar coating anything, which is a really good thing, you know. All anatomical terms were used. Very, very good descriptions of how babies occurred were used. But equally, I think it showed me how hard it is to work in the NHS, particularly in emergency care or midwifery, because she wasn't a home a lot. But I was always very inspired. about how hard she worked. But I think growing up, I watched her and I was like, I don't want to go down that route at all. So in fact, when I was at school,

I actually was very good at languages. And so I started a French and Spanish degree. So I started this French and Spanish degree. And, you know, how it is. When you're at uni, I decided that I wanted to lose weight. And this sounds like an X-factor story. But basically, I decided that I wanted to lose weight. So I started running.

And running did not go very well for me. I was very breathless all the time, never got any better at running and didn't really know why. And I did that thing that GPs hate and I went to get my contraceptive pill and I was like halfway out the door. I was like, I think there's something wrong. Maybe like I've got asthma, you know, you know how it is. When your patient tries to talk about three things at once, she sat me back down and she listened to my heart and she was like, oh, you've got a very significant heart murmur. And that just catapulted from there. I was sent up to London, had lots of heart scans.

and what they actually found was I had almost a common atrium. And my heart was about five sizes too big. Hence why I couldn't run. So this kind of led to a whole trajectory of change in my life. So I had two heart surgeries, which corrected the congenital defect. And after that, I was supposed to go back to uni, moved to Spain, France, and I was like, I just don't want to do this. This has completely changed my opinion of working in healthcare.

And so I need to kind of rewind. Basically, my mum was still working in maternity. So she was like, why don't you come and be a maternity care assistant, which is basically like a healthcare assistant but in maternity, right? So I thought, okay, let's try it. So I did that. And I went back to school and did my biology A level because I hadn't got that. So it was just not a conventional route.

But because my mum by this time was quite high up in midriferry, I feel like everyone thought I was there because my mom was the manager. And so I thought, I want to be in healthcare, but I want to go down a different route. And despite her never being very good at sport, little did I know it's because I had a massive heart defect. I loved sport. So I decided to go into physio thinking that I was going to be a sports physio.

But I think having had that experience of working in maternity, I was like, wow, women are incredible. I was 18, 19 years old at the time. Watching women give birth at that age is, one, a very good contraceptive. And two, very inspiring. So I was like, I really want to work in women's health. And little did I know that women's health physio was a thing. And I was so lucky that when I applied for my first job in London,

the first rotation they put me on was women's health physio. And I literally have never looked back. So it was a really long, winding path to get there. But I started women's health physio 12 years ago and I'm obsessed with it. And I've loved every minute of it. And that's really where my career has come and how it's happened. Yeah. It's so funny you said about the descriptive words

because I always used to hate that my mum called it a vagina. And everyone else called it a flower, a noo. Yeah, a noo, whatever. My mum would say it's a vagina, you know? And I hated that, but then now I know the same, like it's so important. Yeah. And it's very, very similarly, my mom was an nurse. Yeah. So

nothing was sugar-coated. Yeah. You're not getting any time of school. You take a paracetamor, you'll be fine. And I think, you know, looking back, that's what my heart stuff. My mum was like, oh, you're fine, just take a parasite. you're growing, you're a teenager, and now my mum, I think, feels a lot of guilt for that. So if I say anything's wrong, because I actually did have something quite wrong, she was like, go to the doctors, just go to the doctors. I think that's kind of stopped because of what happened.

But equally, yeah, you know what it's like having a mum as a nurse midwife. Yeah, you've been very outspoken on social media about products you think are wastes of money. So I'm extremely excited to come on to buy or buy by buy. Yeah. But first, I'd love to talk about what it is, a women's health physio, actually. does and what are the most common issues women come to you with? Perfect. Yeah.

So women's health physio encompasses a woman throughout her lifespan. And I think there's a very big misconception that it's just pregnancy and it's just menopause. And whilst these are risk factors that heighten the risk of pelvic floor conditions, there can be issues throughout a woman's life course. So what I'm seeing a lot of the moment, I would say, is incontinence in younger females. particularly younger females who are very athletic or are training a lot. And I mean, we can go into this later, but like low energy availability is linked to kind of incontinence.

So one of the major things that we see is incontinence, which is leaking from the bladder. There's two types of incontinence that we tend to see most of, and that is urge incontinence, which is like a sudden urge to need to go to the toilet that can't be delayed. We should be able to delay and stress incontinence. So leaking with coughing, sneezing, laughing, these sort of things. We then sometimes see like overactive bladder. Like going to the toilet more frequently than your friends is a question I often ask people.

Are you the one that's always needs to loo? Like this can be a kind of sign that there's something going on with your bladder. So we look after bladder issues. We then look after kind of vaginal issues and they might be things like prolapse. So prolapse is where the vaginal walls start to bulge because there's pressure from one of the other organs either side or above. So the uterus, the bowel, the bladder. So we look after women who have prolapses. Not all prolapses are symptomatic, but that is a thing that we see a lot, particularly postpartum, and particularly in menopause. And then we also look after kind of bowel issues.

So like leaking from the bowel, anal incontinence is quite common. I think people think anal incontinence is just leaking feces, but it's actually an inability to control wind as well. So we kind of have these three categories of things that we look at. after. But equally we play a big role in helping women in pregnancy. So exercise in pregnancy or pain in pregnancy and supporting women with maybe pelvic girdle pain. And then we also help women return to exercise postpartum. Another area that physios do really well in in women's health is endometriosis. And I think that's something that's not very well known is that because physio, I think, as you said, is often kind of thought, oh, you've got a muscle sprain. That's why you go. But actually we have a big

role in helping people understand and manage pain, which is obviously a massive symptom of endometriosis. So really, there's a whole kind of plethora of different things that we help women with throughout the entire life cycle. We're going to have to come on to the tips for endometriosis because I know a lot of our listeners have endometriosis, but I want to come back to the seeing an increase in incontinence in women in their 20s. Do you have any idea why you've seen that increase. Yeah. I think it's become so trendy online to really push your body in marathons, in high rocks. I mean, I feel like marathons aren't even enough anymore, are they? Like, people are doing ultras, back to back, all these things. And whilst I celebrate that,

I don't think women have ever been told how effectively to afuel themselves and to allow themselves to recover. So I'm seeing more and more younger women in clinic who haven't had babies who are not in menopause and they are so shocked that they are leaking. Now, when we look at low energy availability, which is where your energy output is far over your energy input, that can start to change things hormonally in your body. So one of the telltale signs is irregular periods. But off the back of that, what is happening is your estrogen is low. And if you think about the vulva, the vagina, it's a very estrogenic environment. So it likes estrogen. So when you're, that estrogen goes low, what happens is we start to see like thinning of the vaginal tissue. So we see

what we call vaginal atrophy. We can see increased risk of things like thrush or UTIs, but also because of that thinning of the vaginal tissues, women start to leak urine. And that's because they're basically in this very low estrogen state because they're not fueling for those energy demands that they're putting their body through. So so many times I've had women come to me for leaking. But also what we tend to see in these women is they're not recovering from injuries. They might have niggily injuries that they're not recovering from irregular menstrual cycles. And that is that low energy availability state, which can turn into relative energy deficiency in sport if it's chronic. So, as I said, whilst I celebrate this kind of push towards performance-based sports and away

from aesthetics, I think that's great. I think we need more education of women of how to fuel themselves because we're seeing a lot more of these problems in pelvic health as well as a result of low energy availability. It's the deadly combination of there is still aesthetic pressures on women. You can't run away from that. And then the increase in women taking up endurance sport, which is amazing, but you're right. A lot of us have grown up with parents who, mothers, specifically, who would restrict themselves in front of us, you know? The classic almond murm of oh I'll just have an orange for dinner I'll just have a smoothie you know it's not enough and then you're trying to take that into sport and that all that constant pressure to think that you know

small is better thin is better you know and then you're trying to push yourself in these sports and I feel like so many younger women are just hitting all these problems you know fertility bone density but also in my area of work pelvic health and I don't think anyone kind of ascribes low energy availability to pelvic health unless you're a pelvic floor physio. And I've had to have quite frank conversations with these women. It's like, if you aren't prepared to fuel yourself,

then I can't, this is the problem. Like, you need to be able to, you have to kind of step away from this want to stay small and think about fueling yourself for your long term health. I'm not saying you should stop doing your exercise. And in fact, there's a really good study called the refuel trial where

women had irregular menstrual cycles. and they didn't change their training at all. So they didn't change their training intensity, but they brought their calories up by about 300 calories a day. And I think it was around three to six months and most of them got regular menstrual cycles back. So I think it's about having a conversation of, you can do this exercise.

You're not fragile, and I'm not saying you're weak and you shouldn't do this because that's a whole other narrative women have to live with, right? But equally, what we do have to understand is you need the fuel to do that. And that is going to reduce the likelihood heard of some of these issues that occur. We're going to have to come on to also how GLP1s feed into that and of course come back to it and amiturosis.

But first we've got the section of a podcast called Buy or Bye Bye. I'm going to show you a piece of paper with the product on and I would love to know whether you would buy this product, metaphorically, or say bye-bye. Okay, good bye. Perfect. So pelvic floor trainers. Can I nuance? Absolutely.

The whole reason I love the podcast is because it gives. so much more nuance than a quick clip on social media. So we love nuance here. We love. Okay. I think in certain scenarios, pelvic floor trainers can be really helpful. We have different types of pelvic floor trainers. So we have biofeedback, which is a probe that goes into the vagina.

And basically you watch a visual on the screen to see if you're getting that squeeze. So you're getting some feedback because a lot of women don't know if they're doing it correctly. So that gives that feedback to say that they are creating pressure. So that can be helpful. So I think they can be helpful. We have e-stim, which is a probe that can go into the vagina and stimulate the muscles, which equally can be helpful. We have the newer things onto the market, like the pelvic floor chairs.

Have you seen them? No. It's a chair that you sit in and it contracts your pelvic floor. They're in a lot of like aesthetic businesses. And so these can be useful and there's some low-grade evidence to say that they are helpful for stimulating a pelvic floor muscle contraction. but my bug bear with those is that person has not been assessed. So there's been no assessment.

So it might actually be that they have a pelvic floor that doesn't relax and that's where they're having issues. And then you're overstimulating it by sitting on this chair and that can cause problems in of itself. Equally, when you stop using one of these adjuncts, the benefits go. And so I think they can have a benefit definitely, but I don't think they're ever going to replace going to see a pelvic floor physio and having a proper assessment and learning to do the exercise without the adjunct.

And then I think, you know, if we need to add the adjuncts in, fine. So I would say, I think you can buy them, yes, but I would always be supervised by a qualified clinician if you do buy them. For anyone who hasn't been to see a women's health physio, what does visiting a women's health physio involve from walking through the door to leave in? So you'll have a very long subjective history where you'll talk about everything. You'll talk about, you know, your gynecological history, your obstetric history, your medical history. You'll talk about your bladder function.

You'll talk about your sexual function. You'll talk about your bowel function. And there's a long list of questions that we ask to kind of ascertain what is potentially going on. And then you'll also more than likely have a vaginal assessment. So we do do internal examinations. We tend not to use speculums. Some clinicians do, but it tends to be a digital examination to look at kind of the pelvic floor strength and look at different parts of the anatomy and make sure everything is functioning properly.

Then it will come down to kind of individualising exercises for you. I think if you went online, you'd think that all we did was describe people keegals. And we're trying to move away from the term kegles because that is a one stop shot. That's one exercise. And we call it pelvic floor muscle training because there's a wide spectrum of things that you might be given to do. You might not be given strengthening exercises to do

because you might have a strong pelvic floor and you might need to learn how to relax your pelvic floor which we tend to see a lot with like our endopacients, chronic pain patients. They don't have a problem with strength. They have a problem with relaxing. So there might be other tools that we might add in to help you relax your pelvic floor,

which aren't pelvic floor trainers but we use things like dilators, ones, things like this if someone isn't relaxing. So there's so many different avenues of pelvic floor physio. And I think it kind of gets a disservice online. It's like, oh, you just prescribe kegels. And there's so much more to it than that, most definitely. So say if you were going through the NHS, what does that pathway look like? And then what does it look like from a private?

How much would you pay for a session with a pelvic floor physio? And this is a big issue that I'm really passionate about. It's a postcode lottery, first of all, like many things within the NHS. So it really depends where you live and what services are available. If you're postpartum, there was a government initiative a few years ago that was supposed to set up perinatal pelvic health services. And they should have mostly come to fruition now. I still know that there are some areas that haven't set up that service yet. And then a lot of places across the country will have a bladder and bowel service, which is for continents-related issues.

But again, like there's a very long waiting list and it is a postcode lottery. So you're probably going to be waiting a long time. I think, you know, if I think about my own NHS clinics, I think the waiting list is about 18 weeks at the moment, which, you know, compared to other things, isn't that long, but because it can be so helpful with a little bit of resource or a little bit of a... Across Canada in a Volvo. Destination, Vancouver, turn left to leave.

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learn more at VolvoCars.Ca investment in people it's a shame that it takes that long for women to get there privately there's more and more pelvic health physios and I think POGP, which is the pelvic obstetric gynecological physio association. Oh yeah, big one. Yeah, big one. They have a really good resource on their website where they have a directory.

So you can find physios that are registered as pelvic health physios through their directory online. So I definitely have a look on there. And then you're going to be seen much quicker, but obviously at a cost to yourself. Do you know roughly ballpark? Do you know? Roughly ballpark. I think you're probably going to pay for an initial assessment and treatment. you're probably looking at 100 to 150 pound for that first session.

And then follow-ups tend to be shorter, so they tend to be slightly cheaper. Maybe around the, I'd say, 60 to 80 pound mark. But I guess if you're in central London, that might be a bit different. I'm just thinking where I live down in Kent, that's the kind of ballpark figure. Nice. Yeah. Collagen powders. Bye-bye.

Bye-bye. Nice quick. Like, as soon as you take the collagen, the enzymes in your stomach basically get rid of the collagen. so it's not going anywhere. So I think actually that's a complete waste of your money. Foam rollers. People love them. And there's tiny bits of evidence that doing them before an exercise

can increase the range of movement in some exercises. But this idea that a foam roller can break down scar tissue, adhesions, facial tissue is just fundamentally not true. So I think they can be a great way to kind of make you feel a bit more relaxed, potentially relax your nervous system a little, or maybe warm you up for an exercise. But I think they are often kind of very oversold as to what they can do. You know, people say, oh, I'm phone rolling my IT band because I'm getting out the knots.

No, you're not. Like that's a facial tissue. You do not want it to disintegrate or be loose because it's holding everything together. So I think I would say buy it, but know that the reasons behind it are often missold. I think they can have a place and a lot of people like them. in my mind what they're doing is basically calming your nervous system down if you're doing it post-exercise, which can feel quite nice, and potentially increasing the range of movement into before you train. Posture corrector.

Bye-bye. Bye-bye. Yeah. Go to the gym, do some strength training. If you put that on, you're going to sit in a certain way. As soon as you take it off, you're going to go back to the way you were before. And this idea that there is a good posture is just not reported in the evidence at all. there's no such thing as good posture.

You know, this idea that if I sit up like this and pull my shoulders back, I'm in a better posture is not true. Even if I sat bolt up right, I could have back pain. If I slumped like this all day, I could have back pain. The problem isn't how we sit. It's how long we sit for. And so I would say a very physio term is like your best posture is your next posture. So basically move.

I had no idea about that because I literally sit like a short, but also I probably don't stand enough during the day. We've got standing desks in our office and my standing desk never gets used. My fiancé uses his all the time. Oh, really? So maybe that's my side that I just need to every half an hour or whatever. Just get up and use the standing desk. This thing of good or bad posture is just not a reality.

So just move more frequently is what I would say. Nice. For posture creatures, no. Magnesium supplements. I'm not a big advocate of supplements because they're not third party tested. And I think it's such a predatory industry. Equally, you can get magnesium from food, nuts, seeds, legumes. I think it's also in a lot of leafy green veg.

You don't know how much magnesium are in those supplements because they don't have to be third-party tested. I know a lot of people say magnesium helps them with sleep, but I would kind of hazard a guess that if you were to kind of eat a very balanced nutrient-dense diet with all of those things that I just listed, you probably have sufficient magnesium. So bye-bye. Bye-bye.

Yeah. And I've got to add one on personally. It isn't on the list. But lymphatic vibration plates. Bye-bye. Bye-bye. Go for a walk. That is going to be the best way to kind of get everything moving within your body.

You don't need to vibrate on a plate. It reminds me, do you remember like in, I think it was like early 2000s when everyone was using power plates? Yes. Do you remember power plates? Yeah. I just don't get it. Like, I think you'd be far better off to get all of the benefits of going outside in

nature for a walk, that's also going to help with your mental health, you know. We know there's so much benefit to being outside in nature. I don't see any sort of resounding evidence that would ever tempt me to buy a lymphatic drainage plate at all. If you want to get your lymphatic system moving, go move your body. That's the easiest way you don't need to pay for a £100 pound lymphatic drainage massage or a vibration plate. You know, you have the free alternative right there. And then I say this all the time. And this morning, I was using a, um, a gas. A guy. on my face for a lymphatic drainage massage on my face. And my fiance came in and he went,

you know, you could just go for a walk, fate. But I was in a rush. I think the whole reason we have buy or by bye in as a section is it's recognizing that you can spend money on these things. But they are, a lot of the time, they're a much cheaper alternatives. They're going to get you the much bigger benefits. Exactly.

Let's come back to endometriosis and then we'll come on to GRP ones. Yeah. So endometriosis, you mentioned that a lot of women with endometriosis, they struggle to relax their pelvic floor. Are there any other common issues you see amongst those women and common solutions that you offer? Yeah. So I think one of the big things is the kind of very dysregulated pain mechanisms within the body. Because we know that if pain lasts over three months, you know, we call that chronic pain. and if you think about most women with endometriosis,

it's taking eight years to get a diagnosis. This is like chronic pain. And so when we start to move into the areas of chronic pain from a physio perspective, it's a lot of things about understanding pain and also how we can help to manage pain in those women. And so I think with regards to physio, our first thing should be like pain education.

And pain can come from so many different avenues when it comes to endo. So of course we can have this sort of very sensitive nervous system that interprets any signal as pain, which I'll come on to. But then we obviously have the painful periods. We might have nerve pain. We might have things like adhesions and scar tissue which stops some of the free movement of the organs within the pelvic cavity. And then I think also it can be quite challenging to be physically active. So all of these things can really compound. then we can have a lot of pain with sex with endometriosis,

pain with emptying your bowes, if there's endometriosis around the bowel, and pain with emptying your bladder. So there's so many different avenues that pain can occur in endometriosis. So one of the biggest things that physios can help women do is to turn down that pain dial. By no means am I saying that that is going to eradicate pain.

But I think what we want to do is think about mechanisms that can help to help that women manage. So what might we do? Things that we might do is talk about kind of pain education. And as I said, when you've had chronic pain for a long time, the way I explain it to my patients is like, imagine that a shopping centre has been built. And there's only a little A road that goes to that shopping center.

Eventually that A road is going to get clogged up with cars trying to go to the new shopping centre. So what then they do is they build a motorway. So all the cars can get there more quickly. And your body does that. So what will happen is you'll have a painful source. So mainly, or should we say the uterus or the peritoneal cavity in a woman with endometriosis, I know it can be everywhere, but, you know, let's say for the most part.

So initially we'll have pain signals going there that they might be a bit slower. They're getting clogged up on that road. So the body learns that pain. And what it does is it builds that motorway. So now we've got really quick pain mechanisms. And so everything in that area can feel so sensitive to women with endo. Even like sometimes I'll just do like very light, touch around that area and it literally feels like I'm burning them with a lighter or it's like

very sharp intense pain and that's because your body's become so ashoot at learning those pain signals that they're so rapid. So what we want to try to do is try to desensitize those areas and turn that pain down. So we might start with things like breath work. I say that with caution because I think sometimes if I say that to her with endometriosis she probably wants to get a fork and stab me in the eye with it. Yeah. So don't breathe, you know. But what we do know about the nervous system is when you've had chronic pain, it's constantly in that fight or flight state. So it's constantly got that high tone muscle. You know, we can feel like we have elevated heart rate, elevated respiratory rate, higher blood pressure, because your body is constantly interpreting that threat.

So breathwork can help in one way because it basically stimulates the vagus nerve, which can bring us into more of a calmer nervous system state. so like our rest and recharge state. Now, I'm not saying that that will completely get rid of the pain, but it can allow an opportunity to kind of manage it a little bit better. Equally, with breath work, it can be really helpful from a pelvic floor perspective. If I said to you, Faye, pretend you had really bad period pain, what you'd probably do is crunch over, tenter abdominals, do that kind of leaning forward thing, right?

And so what I tend to find in these women is they've got like loads of activity in their muscles around their abdominals, their glutes, their pelvic floor. Everything is really tight because it's guarding and that in of itself, if you walked around with your fists like that all day, you wouldn't be surprised if your fist hurt. But there's so much tension in these muscles for these women. So when we think about the pelvic floor and its relationship to the breathing, if I take a deep breath in, my diaphragm descends down, which increases the pressure down onto my pelvic floor, so my pelvic floor moves down. So breathwork can actually start to get a bit more reciprocal movement of the pelvic floor and the diaphragm together, but here that pelvic floor is really tense. And so breathing can have that

twofold effect. You know, we're calming the nervous system, but we're also getting that pelvic floor moving, which often, as I said, can be quite ridded in a woman who has endometriosis. So that can be helpful. The other things that we can do is particularly if a woman is having bladder issues. So a lot of women will have like increased frequency with endometriosis. They'll go to the toilet a lot more. And that's because their bladder is really sensitive. So we might help them to retrain their bladder. And that can be really helpful. We might if they're having problems with sexual function, which can be a really big one. A lot of women with endo can have like lots of problems with penetrative sex. So we might help them with kind of different adjuncts. Like I said,

we use dilators, which can kind of stretch the vagina. We use wands, which can help to massage intern, internally and so these things can be helpful and then thinking about bowel function as well. A lot of women with endometriosis can have superficial or deep endometriosis on the bowel. So opening your bowels can be really, really painful. So we talk about different kind of mechanics of how to empty your bowels. So there's lots that pelvic health physios can help women with endometriosis for. I've learned the hard way that when it comes to cleansing, gentle is key. I used to think squeaky skin was the way to go.

How wrong I was. Seravet cleansers have been my go-to for a while. You've probably seen me share them before. This is a myth of thinking your skin has to feel squeaky clean or over-explouated to be clean when that is actually disrupting your skin barrier. What you want to look for is a cleansing formula that has added seramides to further protect the barrier, leaving your skin feeling soft and hydrated instead of tight and over-exploaded. Think of it like this. If your skin squeaks, your skin barrier is weak. Seravays, cleansers have three. essential ceramides and they cleanse and lock in skin barrier strength in just one wash. My favorite is the foaming cleanser, which I'll pop a link in the description for. And remember, gentle is good. I completely hear you're on the breathwork thing because I was also one of those people who, when I was stressed. Yeah. And if someone would tell me to take a deep breath, I would want to punch them in the face. Yeah. Going to medical school and learning about the Vegas nerve. Yeah. And how the Vegas nerve is stimulated literally by deep breathing into your semi. And then now you see on the market all these vagus nerve stimulators. Again, a similar thing where you can breathe. You can breathe. You can breathe. But

it took me a long time to find breathing exercises that work for me. Yeah. Hate square breathing. Yeah. Lying down flat, putting my hands on my tummy, breathing in deeply so my hands rise. Mm-hmm. A couple of times until I feel calm. That works really well for me. And I think it's just about finding breath work that works for individuals. Yeah. I completely understand why it can feel like a smack across the face where anyone's hell just to deep breathe. Exactly. So I think you had to be really careful of your wording. Yeah. And clinicians should be good at that.

I mean, we don't get it right all the time. Like, don't get me wrong. I've probably butchered a lot of clinical experiences for women in the years. But I think if you can explain it in that way, and as you said, find something that works for you, like box breathing. A lot of people hate that holding with nothing in their lungs. It can make them feel more anxious.

So it is about that kind of individualization of everything. And I think that's why seeing a clinician is so important because whilst kind of lived experience of other people with endometriosis online is really helpful and we often miss that in a medical setting, I think that that's only worked for that one person, whereas we can give you options of things that might be helpful for you and your endometriosis. Yeah. Coming on to GLP ones, you are doing your PhD in resistance training and menopause, question mark. Yeah, yeah.

We always have fairly controversial conversations about GRP ones. I think that they're an incredible gift of modern. medicine to a lot of people as someone who's struggled with their weight in the past, I think it gives so many individuals a lifeline. What I often find on social media is a completely polarising conversation and we lose some of the nuance. What's your view of where we're going with the GLP ones? I think they're an amazing advancement in medication and if someone had high blood pressure, no one would say to them, or maybe don't take your anti-hypertensives or if someone had high cholesterol, wouldn't there? No one would say, oh, I think you're cheating by taking

statins. So I think we have to accept that they're here to stay and they are changing people's lives for the better. I think that what needs to come with a GLP1 is a scaffold around it to understand like lifestyle and behaviour change. Because whether you're using a GLP1 or you go into an extreme calorie deficit, when we lose weight at a very accelerated rate, we will lose some muscle. So when I say it should be scaffolded by lifestyle advice, we need to be retaining that muscle mass. because, you know, we don't want you to deplete all of your muscle tissue because that can then lead to problems with kind of sarcopenia or potentially you might lose some bone tissue like osteoporosis.

So I think GLP-1s are fantastic, but they need to be scaffolded with lifestyle stuff where we talk about resistance training. We talk about kind of cardiovascular exercise. We talk about kind of understanding nutrition and food. So I think for me, JLP ones are fantastic, but I think they do need that scaffold. And I think from what I know, I don't know about you, but when people are taking them in the NHS,

it tends to come with that scaffold. You can't get them for weight loss unless you are having weight loss counselling around it. And so I think that's a great thing. And obviously it's really helpful with the things of like treatment for diabetes. My concern is when it's kind of leaked into wider markets and I don't think people have the same scaffold around when they're just buying it from different places.

I mean, I really hope that that's not the case, but I'm not really sure about the private sector when it comes the buying of GLP ones and if there is that kind of stringent scaffolding around it. So I think for me, I think they're fantastic. I think they're here to stay. I do not think it's cheating. And I think often people who are saying that it's cheating

and are polarized in the anti-GLP ones do not understand the complexities of overhaul. overweight or being larger bodies or obesity because it's far more complex and nuanced than you just need to eat less and move more. It's it's so tied to kind of so socioeconomics and different factors within health. So I think they're fantastic. I think it does come back to the quite fatphobic rhetoric and the idea that it's just a case of laziness and as someone who is bottled with her weight. It's an awful awful complex process to go through. I know people who are taking it from nail, nail shops.

That's my fear. Yeah. And dipping in and off it, you know, going on it and coming off it, going on it, coming off it. If you're going to start it, I appreciate finding the right dose can be a challenge. But that needs to be with a medical professional. And you need to be doing resistance training as well to protect your bones and your muscles because rapid weight loss can be damaging for those things. We've got a section called Real or Not Real. I'm going to show you a video and I would love to know what your thoughts are. We have lied to women about their pelvic floors and said to them, just, do pelvic floor exercises and if you leak after having a baby or you have an oops moment, don't worry, it's okay, here's a pad and you can treat yourself. Actually, no, you can do as much pelvic floor exercises and I'm not discounting pelvic floor exercises. You know, I do them and I encourage people to keep doing it. But that's only 50% of the argument. Estrogen is the other bit that you need to give women. Yeah, so I totally agree. I would say

to add more nuance to it at different points in the female lifespan. we can get those low estrogenic states. So we talked about low energy availability in female athletes. I don't think you're going to be able to get topical estrogen at that point because it would be very much that you need to change your diet and kind of fuel yourself better and that might have an impact on your pelvic health. Postpartum, particularly if women are uniquely or solely breastfeeding, we again can see a very low estrogenic state.

So in order to synthesize breast milk, the body produces something called prolactin. and prolactin suppresses estrogen. So postpartum, I will see so many women, is almost like a mini menopause, and we call it the genitone urinary syndrome of lactation. Basically, everything that would happen to a vagina vulva in menopause can happen when they are breastfeeding, because that estrogen is so low.

Plus the fact that you might have had a vaginal delivery, so you then might have a tear and you're healing from that. So what happens is women will report kind of leaking more, which we might account to the fact that they've had the vaginal delivery. Equally, if they're breastfeeding, that estrogen is low, which means that there's vaginal atrophy or thinning of those tissues which can lead to the leaking. A lot of women returning to sex postpartum may have a lot of pain, equally from vaginal deliveries or tears or things like that,

but also because when estrogen is in the vagina, it's a lubricant. So if I see a woman who's gone back to sex postpartum, they're leaking, things aren't getting better, you know, they're having a lot of, painful sex, I might be thinking, have you got low estrogen? And then we can ask, is your menstrual cycle back? Because, you know, what happens is we don't have a menstrual cycle when we're breastfeeding for the most part. I know there's individualities within that. But when they don't have a menstrual cycle, it could because that estrogen's low. Now, there's a lot of emerging literature in that women who are breastfeeding and wanting to get back to those things or

worried about that can use topical vaginal estrogen alongside doing pelvic floor rehab. is quite new and with anything new it can take a while for people who are prescribers to want to prescribe that and I understand that but we know that it doesn't have any effect on breast milk and actually it can be really helpful for women postpartum to have some topical vaginal estrogen which basically means just estrogen it's a very low dose that goes into the vagina it can really help to plump those tissues up lubricate them and reduce a lot of the symptoms postpartum of pelvic floor dysfunction and then perimenopause, menopause, we have the same thing. Estrogen is dwindling and that can mean that even if we do hundreds of pelvic floor

exercises, they are never going to replace the estrogen. And so having that topical vaginal estrogen alongside pelvic floor physio is literally their best friends and you get so much better results. Like if I see a woman in my clinic, I work in primary care, so I work in a GP setting and they haven't been given vaginal estrogen. I'm like, I write to the doctor straight away. I'm like, please give her vagina. It's going to make this so much better.

And nine times out of ten, that estrogen with the pelvic floor exercises is such a winning combination. So I totally agree with that video. Okay, coming on to the community questions. Are there any long-term impacts of having a weaker pelvic floor as we age? If you have a weaker pelvic floor from being younger, I would definitely say go and get that checked. Why do you have a weaker pelvic floor? What is going on? Sometimes they're learned behaviours.

and sometimes we can really help with like bladder retraining and things like that. But I think ultimately if you're younger and you are wanting to have children and yet to have them, that could increase your risk factor of having worsening symptoms. Equally menopause. So we know that, you know, childbearing, menopause, age, all of these things impact our pelvic health, chronic constipation. So if you think that, you know, you might, you're going to go through menopause, everyone does. but if you think children might be on the cards for you,

then I would say, whilst you're young, understand why you are leaking with the help of a pelvic health physio, because that is always going to improve things. I don't think we can necessarily say it's always going to get worse, but we do know there's those risk factors that exist. So I would say now is the time to find out why and get some solutions most definitely. Next community question.

Any tips to train your pelvic floor? Yes. So I would say the first thing is if you don't have symptoms of leaking of prolapse, which is like a heaviness feeling of issues with your bowels, I don't necessarily think you need to go for the optimal which is described in the literature, which is like, you know, a 10 second hold, 10 times 10 quick pulses, three times a day. You don't need to do that because I think really until there's an issue, we don't need to be that stringent with it. I would say learning how it feels to do a pelvic. floor exercise could be a great place to start. What it should feel like is basically, I don't know, you had a curry last night and now you're in the middle of a meeting and you don't want to fart, right? So you're trying to stop a wee and a fart at the same time. That's what it should feel like to activate.

So they're very much like kind of that pull up inside. So learn what it feels like to do that. You can self-assess. You can check if you're doing it. You can have a look. Your perineum, the gap between your vagina and your back passage should move up and away from the mirror when you squeeze, or you can put your finger into your vagina and you should feel like a closing around your finger. If you have penetrative sex, you can ask your partner if

they can feel you squeezing. And that's the way to know if your pelvic floor is working. So I would say that can be a good thing. If you are struggling with pelvic floor symptoms, you might want to start being a bit more kind of disciplined with pelvic floor exercises. And as I said, we do two types. We do a slow hold. Imagine you're stopping a fart and a wee. You hold for up to 10 seconds and you repeat that 10 times. Now, if you can't do 10 seconds, don't worry. It's actually quite a long time.

So if you can do two seconds, five seconds, eight seconds, start there, build up towards 10. Then we also do quick squeezes, which is where we squeeze up and we relax down. You squeeze up and you relax down. So you might want to try doing those. When someone has a dysfunction, we say three times a day. But look, if you haven't got a dysfunction and you're just doing them,

look, once a day, a couple of times a week would be great. There's so many accounts online now that have kind of like timed pelvic floor exercises. Again, in the pelvic health community, they're kind of polarised. Some people really like them and promote them. Some people don't like them because people haven't had an assessment. But look, I think there's a nuance and I think if you're just trying to activate your pelvic floor, get used to what it feels like and they pop up on your feed, give it a go. And then the final thing I would say is looking after your bladder health and your bowel health is always

going to be really important for your pelvic floor function. So not dehydrating yourself because I see so many women that think, oh, I don't want to leak. So what I'll do is I won't drink. But if you don't drink, your urine is then concentrated. And concentrated urine irritates your bladder lining and you leak more. So you want to keep hydrated. You want to avoid constipation. That's a real big thing. chronic constipation straining to open your bowels puts a lot of pressure down onto the pelvic floor. And so I would say high fibre diet, lots of water or hydration and keeping active are some of the best things you can do for constipation. So I would say, and then if you're already resistance training or you're already exercising, your pelvic floor is working. It can't not.

You know, your pelvic floor has to engage if you're squatting or you're deadlifting or you're lunging. It has to work. So don't think you have to have this kind of individualized pelvic floor plan because actually you'll be working your pelvic floor in all of that exercise that you're doing. This episode is brought to you by Accenture. When your advertising operations fall out of sync, everything else follows. Spotify and Accenture are working together to reinvent the rhythm of ad sales, using automation, analytics and smarter workflows to simplify campaign delivery and access better data across the business. The result? Less time spent on operations, more time connecting brands with the moments and fandums that matter most. Learn more at Accenture.com slash Spotify.

And it'd be rude given your PhD is on resistance training. It's not asking you some questions about resistance training on women's health. So imagine I'm a listener and I do not do any resistance training whatsoever. I've never been able to find exercise enjoyable. I struggle to get into a habit. I'm a busy, busy googly. What would be your advice on where to start? There were some guidelines that came out last, maybe last month or the month before, and I loved those guidelines, right?

Because I think, again, in the online space, unless you're at CrossFit gym, deadlifting, double your body weight, it's not good enough. You know, we all have to lift heavy. That rhetoric is not true. You know, actually resistance training can be really, really accessible. Body weight exercise as a starter is absolutely fine. resistance bands as a starter,

absolutely fine. Doing it at a home, fantastic, right? And so this idea that you have to lift heavy is dead in the water because actually all you need to get to is a place where it feels fatiguing. So those last few reps should feel like, oh, you're really challenged.

And whether you do that with a bottle of water and you do 50 reps or a resistance band and you do 20, or you've got two 10 kilo dumbbells at the gym, it doesn't matter. As long as you're getting to that place where it feels fatiguing, fantastic. right? The main thing we see time and time again, particularly with women, is lack of consistency.

And there's so many reasons to this. And particularly in menopause, which is what I'm researching, you know, it's lack of access to good spaces or inclusive spaces. It's busyness of life. It's competing demands. You know, children, aged parents, careers, all these things. Never think that I have to have an hour. You can do so much in 15 minutes with your mat at home and some resistance back. So I would say resistance training can be really, really accessible. There's so many things on YouTube. You can just type in resistance band workout and do it at home. And so I would say if you feel more comfortable in those sort of environments, that's the

place to start. We want you to try and do it twice a week. So you want to try and hit all major muscle groups twice a week. At the end of those repetitions, it should feel really fatiguing like you're almost going to fail and you're in a really good place. So I really hate to see it online where, you know, people are like, or you have to lift heavy because it's just not true. The data time and time again says that actually you just got to reach that place of fatigue,

whatever way that is for you and you've got to be consistent. Nice. And it makes it so much more attainable. I just find when the bar is so, so, so high, so many people just don't try in the first place. Yeah. Yeah. So it doesn't feel like it's for them. When actually resistance training is for everyone, if you're picking, you know,

cars eat out the car, you're picking up your shopping. You're doing resistance, right? So everyone can find a way to do resistance training definitely. Final question before we come on to the question that we ask all of our guests. What are the number one mistakes you see women in their 20s making that if they fix them, that would severely positively impact their health in the future? From a pelvic health perspective, I would say it's ignoring symptoms. Common and normal are not the same things.

And it is common for women to leak urine or have prolapses or have. have pelvic floor dysfunction. And you know, it's one in three women that happens to, but it shouldn't be normalized. And I think the more we normalise it, the issue is, if we're normalising it, we're saying that you don't need to do anything about it. And so if you know that you're the friend that, as I said before, always needs the toilet, or you're always having to wear a panty liner, or you're leaking with exercise, or you're not able to have penetrative sex because it's too painful,

these are all telltale signs that there's something going wrong with your pelvic floor. and I would really encourage you to seek advice because it won't get better on its own nine times out of ten, right? It's not something that should be ignored. And actually, you know, there's so many people out there that can help you. And it might even just be really small things like maybe a bit of pelvic floor exercises, maybe a bit of bladder retraining, maybe like we've said, some breathwork that can help you to have like pain-free sex. So I would say my main thing is go and seek the advice of some pelvic health physio if it's a pelvic floor related issue. because often it's very much we're just giving people the right advice

and giving them a safe space to talk about these things. But I would say my biggest thing is common and normal do not mean the same thing. And I would really encourage you to seek out the help of a pelvic health physio. Just goes against everything we're taught as women, isn't it? Yeah. To ignore things and not, you know, just keep going, press on, especially when it comes to a lot of women's experiences and healthcare.

So I think that's a really important take-home message. you've been absolutely wonderful and shared so much valuable information. That brings us on to our final question. Chloe, what do you wish every woman knew by the time she was 25? I wish every woman knew that by time she was 25 that leaking isn't normal and that we should do something about it. And even if you are postpartum or menopausal, it is not normal. And if that happens to you at any stage of your life,

there are definitely things that you can do about it. I know we see a lot of adverts on the television for pantyliners and pads. And whilst I encourage us reducing the stigma and talking about those things, I always think it should be caveat with, you know, just wearing a pad shouldn't be allowed. You know, I think there should be kind of small print there that says go and get some help because it's can nine times out of ten be very easily helped and fixed. Brilliant. Thank you so, so, so, so much.

Thanks for having me.