Menstrual Migraines and Pelvic Health: A FAMM Practitioner’s Story (Episode 539)

Full Transcript: Episode 539

Lisa Hendrickson-Jack: Today I’m sharing a brand new episode in our FAMM Practitioner Series. I’m sharing my interview with Dr. Josephine Razon. She is a doctor of physical therapy and she was a member of one of our most recent cohorts of FAMM. At the time that we had recorded, we had just finished our final call for our nine-month program and she was able to share some of her experiences. We talk about a variety of topics from how she completely eradicated her menstrual migraines to how the FAMM process has changed the way that she’s working with her clients.

Dr. Josephine Razon is a doctor of physical therapy and a certified pelvic health specialist. She’s also a Mercier Therapist and a FAMM-certified practitioner in training. With a holistic approach, she helps women by providing fertility support with manual therapy techniques and educating them about their menstrual cycles. She also works with women throughout their pregnancy and postpartum recovery to address issues like leaking, heaviness, pelvic pain, and helping to return to their normal activities symptom-free. Dr. Josephine has her bachelor’s degree in kinesiology from the University of Nevada, Las Vegas, and her doctorate in physical therapy from the University of St. Augustine for Health Sciences. She is the owner of Evolve Pelvic PT and Wellness in Las Vegas, Nevada, and provides mobile pelvic health physical therapy services. So without further ado, let’s go ahead and jump into today’s episode.

I’m really excited to be here today with Josephine. Welcome to the show.

Dr. Josephine Razon: Hello, thank you for having me here today.

Lisa: Well, thank you for coming on. At the time that we’re recording, we have actually just officially finished our classes. So we’ve been together for nine full months, which is crazy because it really didn’t feel like it went by so fast. I don’t know where the time — I say that all the time but it’s true. It’s like, oh my gosh, we’re at the end of the program. So really excited to chat with you today. And as I was mentioning when we were doing our pre-chat, I love starting with the question. So I’ll just go ahead and put you on the spot and you can share a little bit about yourself for listeners. So tell us when you had your first period, what that was like, and kind of share with us some of your experiences that really led you to wanting to bring fertility awareness into your practice at this stage.

Josephine: Yeah, so I actually got my first period when I was 17, which I felt was like a lot later than a lot of my friends because they had all gotten it way earlier, like around maybe 13. I think I even had a friend who got it at 10 or something like that. So I was like, I always thought there was like something wrong with me when I got it so late — I was like, where is it? But also, my mom didn’t really talk about those kinds of things. I mean, I learned it in like what, fifth grade health class, about a period and you know, what you use and everything. But so I didn’t really get it till like my late teenage years. But after actually going through our program — like, oh, I think I know why I got it a little bit later, because I actually danced competitively. And when I was a kid, like I was very active. I’d be at dance class and dance studios like all day and everything. And I was like rail thin, actually. So I probably was not eating a lot and was really active, and kind of maybe that’s — I’m guessing — why I had my period much later than a lot of my friends.

But kind of fast-forwarding to now, I’m actually a doctor of physical therapy here in Las Vegas, Nevada, and I actually specialize in pelvic floor physical therapy. And I’ve actually been a PT for 10 years. I did orthopedics for like a long time. And then when I got pregnant with my first kid, I had a lot of pelvic pain. And there’s actually not a lot of pelvic PT providers here in town. And so I was like, I want to like fix myself. So I actually ended up going back to a certification program — I did a year-long program to really get into pelvic PT. And I had my first kid and kind of had a somewhat traumatic birth in a way. And so I was really excited to start helping that patient population. So I actually specialize and see mainly women who are now trying to conceive — so fertility. I see and help women during pregnancy and postpartum with a lot of different issues like leaking, prolapse, heaviness in the vagina, constipation, pain with sex, and all of that. And I’m so excited to like start adding in the FAMM program, because I’m also trained in Mercier Therapy. And so I started seeing a lot of fertility patients beginning of like last year, and then I always thought that there was something missing that I didn’t know, which was the menstrual cycle, which is a big part of it. Because I would always ask people about their periods, like, oh, do you have a painful period, or are your cycles regular? But then I didn’t know what next to do or what were really things more about it. So when I started the FAMM program, it was like mind-blowing, to be honest, because it actually changed my practice and how I helped my patients right now.

Lisa: Well, thanks so much for sharing. There’s so much to dig into there. So I want to ask a few questions. And thank you for sharing your experience with your first period — I feel like that was a really insightful answer. Because the average age of first menstruation is about 12 or 13. And it’s a flag, right? That wasn’t necessarily brought to your attention. Did any of your — do you remember if anyone ever said anything, or if you ever had a doctor’s appointment and they asked about it? Or do you ever remember anyone being concerned about the lack of period?

Josephine: My mom, she was like not really concerned. She’s like, oh, when I was younger, I also got my period really late too. And then when I would see the doctor, it’s like, oh, it’s fine, it’ll just come eventually. So I felt like I was kind of just pushed off. Like, oh, I guess that is normal. And I didn’t think anything of it at the time. And then afterwards, I guess they were kind of also — looking back, I could never know when they were coming, or there’d be like really long stretches between my periods, which I probably just was not giving enough for my body at the time.

Lisa: Well, yeah, I know. That’s really insightful what you said about the kind of like in reflection. It’s like, oh, and I was doing the competitive dance. And so I think it is helpful just in general to be aware of that. And this is one of the reasons why there are organizations out there that are advocating for using the menstrual cycle as a vital sign — and often with a focus on teens. So like ACOG, they have that kind of statement that we should be looking at the menstrual cycle as a vital sign. And in their paper where they talk about that, they’re specifically saying that healthcare providers should be talking to teenage girls about when they’re getting their periods and things like that. So yeah, really interesting entrance, I suppose, into menstruation.

And also really interesting your decision to specialize, especially because you found that in your area it just wasn’t really that prevalent. So it’s just so good to have you as a resource for all the women in your area who are struggling with pelvic floor issues, which is a lot. So we might be able to dive into that a little bit as well. But share a little bit more — I mean, you were specifically kind of focusing a bit more on fertility and female-specific issues. So you said that kind of shifted the way that you practice. Maybe talk a little bit about that. Like, what information did you find most impactful, and how has it changed the way you practiced?

Josephine: So I think I kind of got into fertility when I first did my Mercier Therapy training with Dr. Jennifer Mercier, where we learned different visceral mobilization techniques. We did talk about the menstrual cycle a little bit, about how it works and how conception happens and everything. And then when I actually got back to Vegas and started implementing it, then I didn’t know how else to support my patients, because — okay, yeah, you do have irregular periods, okay. Then I was like, I’m not too sure what next to do. Or we learned about ovulation strips, and just that’s how we kind of learned in the Mercier Therapy training of knowing, okay, it’s ovulation time. But I felt like there was something missing. Like, what more information could I give my patients? Because they had already been wanting to try something more natural. Because oftentimes, I think when people struggle with fertility issues, it goes straight to reproductive endocrinology and IVF. And that’s what they think is like their only option when they maybe want to go in a more natural or holistic way to approach it. So I think the FAMM program really gave me a better understanding of — like, we talked so much about the foundational factors of what affects our menstrual cycles, or what to look for when someone’s trying to conceive, and knowing, oh, is someone even actually ovulating? And that’s such a big part, I think, that people don’t even know — like, they don’t understand about their bodies. And I always try to educate my patients about their bodies. Since I am a pelvic floor PT, pain with sex is not normal. Period pain is not normal. So there’s so many things that I think we just think maybe it’s like general knowledge, but a lot of people don’t know about.

Lisa: Yeah, no, that’s really helpful and really interesting to think about. I feel like there’s this whole untapped resource. I don’t think I’m objective because I’ve been in this field for a long time, so I’m pretty biased when it comes to how important the menstrual cycle is. I think it should be front and center. And it’s interesting just to hear your reflections on kind of like, what do we do next, right? But maybe for anyone who isn’t that familiar with Mercier, do you want to share a little bit about Mercier — I know we’ve had Jennifer Mercier on the podcast a couple of times — and kind of how it aligns with some of the other work that you’ve done, like physical work with your clients?

Josephine: Yeah, so Mercier Therapy is visceral mobilization with the intent to improve blood flow to the pelvic organs, like the uterus and the ovaries, because we want a good functioning organ in order to receive a baby and to conceive and all of that. So that’s how to address scar tissue adhesions, things that could be affecting the actual physical structures of the body. I’ve also done training through the Barral Institute with Gail Wetzler with more in-depth visceral mobilization. So I help people especially if you’ve had endometriosis, or a cesarean, or any type of abdominal surgery — scar tissue adhesions can happen and it’s just the natural course of healing. And when we do have those scar tissue adhesions, or if our uterus or bladder or rectum aren’t moving as freely as they should, then they can’t work optimally. And we want our pelvic organs to work optimally, especially if we’re having painful periods or if you’re trying to conceive.

Lisa: Well, and I know one of the challenges for many of our practitioners is kind of figuring out how to merge these two different worlds into what you’re doing. So maybe share with us — what are some of the ways that you’ve found so far that you’re able to incorporate what you’ve learned through FAMM with what you were doing with clients?

Josephine: Yeah, so even with all my pelvic PT patients who are also trying to conceive, or just experiencing other pelvic pain issues, with the knowledge from FAMM I’ve definitely been able to help them with other lifestyle changes. Like, we talk a little bit more in depth about sleep, or their nutrition, or what other factors could be — other than the physical things I address with my manual therapy skills — that they can also focus on to help make those longer-lasting changes. Because I’m always looking for people to have long-lasting change. I don’t want them to just feel okay for a short period of time. So, how about a couple months down the line, years down the line — what are the things you can kind of do to stay feeling good, or plan for the future if that’s what they’re trying to do?

Lisa: And I mean, part of the program involved obviously charting your own cycles and things like that. And did you want to share a little bit about what that experience was like for you, of having to kind of be part of that whole world?

Josephine: Yeah, so when I came into FAMM, I was very new to charting completely. I’d use an app or whatever to track when I had my period. But when I started learning the symptothermal method through our FAMM program, it was overwhelming at first. I think I probably said that many times during our program — it was overwhelming, because understanding how to chart mucus and temperatures, especially since I’m actually a mom of two and I have a little one who wakes up through the night, and then being able to take my temperatures in the morning — that’s another thing that we chart — was difficult at times. So it was definitely a learning process. And I definitely still use it now, of course, because it helps me understand — right now we’re not trying to conceive or anything, but trying to avoid — and it’s now a great way to not use birth control. I never actually used birth control ever in my life. But it’s now a better understanding for me to know more about my body. Because I think I mentioned in the program that my biggest issue with my menstrual cycle was I was getting headaches. I was always getting headaches a few days before my period and then the first couple of days after my period. And they were so bad that I would have to take medication. It’s just like I would be like the irritable mom that I didn’t want to be, because it was just so bothersome. But then going through the program, I actually found really quick changes when we started working together. And I don’t even experience any headaches anymore, which is really nice.

Lisa: Yeah, I remember you mentioning that — and that’s huge. I mean, do you want to talk a little bit about that? Because I don’t recall us having a specific session where it was like targeted to get rid of your headaches, right? Like, that wasn’t exactly the approach. That was one of the things you were working on, but we were focused in a bit of an overall way. So could you share a little bit about how frequently they were coming, how painful they were, and what you feel made the biggest difference for that shift? Because that’s pretty big to just not really have them at all anymore.

Josephine: Yeah. I would regularly get them — for maybe the past three years, I was regularly getting them every cycle. That’s how I knew my period would be coming — just these really pounding headaches, or even my vision would bother me. Then working through — I think I didn’t really experience any other major menstrual cycle issues. My periods were pretty regular in the sense that I would see cervical mucus, and then I would get — honestly, that’s what would be like the sign — I’d get the headache, and then I knew I’d get my period. But when we talked about how I worked through that, the changes that I made were: one, I started taking more magnesium, because that was something I wasn’t really incorporating. I also started taking beef liver capsules. I was probably deficient in my nutrients, because I’m also still breastfeeding, and everything kind of goes to our kids. I mean, I’m in a season of life where sleep is still really up and down with a kiddo who wakes up at night. So I always say I try my best — at least having better sleep quality, like having the room nice and dark and trying to go to bed at a reasonable time. And I also — my form of stress relief is really exercise, and I would wake up at 4:30 in the morning because that was my me time, that was the time I could get it in. But then it also — I really focused on my nutrition and started eating a lot more protein. Even a couple months ago I started shifting my workouts to a little bit later, because it’s just a season of life right now where if I need to get more sleep, maybe I can just push my workouts to later in the day if I can find that time as a busy mom and a business owner. It’s hard, but I feel like even just those changes have made a significant difference and really impacted the headaches I was experiencing.

Lisa: Oh my goodness, thank you for sharing that. I mean, it’s huge. When we talk about it kind of in this format it seems like, oh, she just did these things — but as you mentioned, you are a busy mom of two. I know the kiddos made several cameos on the calls. You really did make it work, right? And it’s not easy. And none of the things that you mentioned are easy to do or easy to maintain. I really love that you prioritized your self-care and your exercise. Like you said, it’s your me time. And if anyone is also a mom — most of the listeners know I’m a mom of three as well, so I’ve got kiddos running around — and it’s not easy to make that time and to carve it out and to be consistent with it. So I think that’s amazing that you’ve done that. But also that you’ve been flexible to figure out how to make sure to get your workouts and also get enough sleep and make sure you’re getting sufficient protein. And I’m just so glad to hear that you were able to — like, who wants to have headaches? Literally. So, so glad you shared that with us.

I’m thinking of other practitioners and the kinds of questions I get about the program — speaking of being a busy mom and a business owner, how did you manage to find time for this program?

Josephine: I always tell people, like, we don’t find time — we have to make time. And that was the biggest thing: when I was driving — I actually do mobile physical therapy, which means I go to all my patients’ homes and do treatment there — so I would always turn on one of our course recordings and listen to it as I’m driving from patient to patient. And I’d have to go back again and listen to it, but that’s one way I kind of snuck in our little lessons. Because it was a hybrid — we would have our live sessions and then we also had the pre-recorded stuff. So it was really easy to pop that in and I could just drive from patient to patient and listen. And then as you mentioned, when we would have our live sessions, my kiddos would be in the background but I’d pop in my earbuds and listen to the call. It definitely was hard, I would say, because it does take some time. But I was so grateful for being in this program because it’s such a plethora of information that is so helpful, especially to the people I see and the work I do.

Lisa: Well, there’s that saying — if you want something done, give it to a busy mom. I don’t know if you’ve heard that before, but yeah, we just get stuff done, right? And one thing I will say is that despite all of the things you had going on, you attended most of the calls live.

Josephine: Yes.

Lisa: So you’re amazing, is what I’m saying. You mentioned a couple of times that you found the content mind-blowing. Can you share what were some of the things that stood out — in terms of what you learned that you didn’t know, or hadn’t learned in your other training and certification programs?

Josephine: I definitely thought the nutrition aspect and how it impacts our menstrual cycles a lot — even just reading through your book, Real Food for Fertility with Lily — that is such a good resource that I now give to my patients and recommend to people if they’re thinking about trying to conceive or having menstrual cycle issues. I felt like the nutrition aspect was really impactful. Even through all the courses I’ve been through, we don’t really talk about males, and of course they’re like 50% of trying to conceive. Understanding and learning about sperm health and sperm quality and how it’s changing throughout the years — and knowing there are things you can actually do to improve that — I thought that was really interesting. And also just the whole charting thing, to be honest, because I had no experience tracking my temperatures, the in-depth difference about mucus, and then being able to confirm ovulation without having to use all these crazy devices. There are so many things out there on the market right now to track fertility, but this is like — I say simple, but it’s an in-depth method — and you don’t have to buy a thousand devices. You can just have really good body awareness and understanding of your body, which is so powerful.

Lisa: And were there any other aspects of your experience that you wanted to share? Did anything else stand out that you were hoping to share today in our conversation?

Josephine: I would just like to share that a lot of people don’t realize that pain with sex is not normal — and that’s especially important when people are trying to conceive, to think about. There are many reasons why that could be occurring, whether it’s something physical like pelvic floor muscles, or a history of birth control, which has also been associated with pain with sex, or understanding that maybe hormones play a big role — because if estrogen is low, that can affect arousal and lubrication, and all of that. I think that’s a big thing people don’t know about when they’re trying to conceive, and to also reach out to find help with that. Because that can be a big part — if you’re trying to conceive and you’re having pain with sex, one, it’s not enjoyable, and two, you may not want to do it. And then it’s like you’re going in kind of a circle. So I think that’s also like a big part — for people who are trying to conceive, to maybe address that and reach out to practitioners who can help with that.

Lisa: And a question for you — in terms of your work with pelvic floor physiotherapy, what is the number one reason why women come to you?

Josephine: Since I see kind of a broad spectrum of people who are either trying to conceive, pregnant, or postpartum, I mean I see various diagnoses. But everyone always just thinks about Kegels when they hear about pelvic floor physical therapy — it’s just Kegels, which is literally just a muscle contraction. And that can actually sometimes make symptoms worse. Oftentimes, it’s not only about the strength of the pelvic floor — maybe they actually have an overactive pelvic floor where the muscles are too tight, or they don’t know how to relax their pelvic floor. So I would say I see a lot of people with pain with sex, pain or leaking when they shouldn’t be — like coughing, laughing, sneezing, jumping — heaviness in the vagina, feeling like something is falling out, and even constipation. That’s such a big thing. And that also ties in with a lot of the FAMM content, because in one of our videos we talked about estrogen metabolism and how the way to get rid of estrogen is to pee or poop it out. And if you aren’t doing that, then estrogen is still in your body and that can also affect your menstrual cycle. So when I was seeing patients for constipation or bladder issues, I started asking them a little bit more about their menstrual cycles, and then — wow, we’re just kind of uncovering a lot of layers that we didn’t even think were impacting their health.

Lisa: No, so true. And such an important point. Because fertility challenges are so complex, and I feel like most people would assume that if a couple is trying to conceive they would just be having sex all the time. And what you find when you work with this population is it’s not always like that. People are busy, they work, they travel. And if there are other issues, like you said, with painful sex or other physical challenges, then it certainly doesn’t make it any easier. Especially given what we know about timing — there is a relatively short window. So helping couples to understand how to identify that window is crucial.

A lot of practitioners these days are wanting to find ways to specialize. And I think a lot of practitioners who are interested in the fertility awareness mentorship program are wanting to potentially specialize in that area. So maybe share a little bit of your experience of how that has helped you to specialize more, or what your experience has been — especially given that you ventured into Mercier, so you’re obviously already wanting to venture into the fertility space.

Josephine: Yeah, so I think now that I pretty much market myself and see people for fertility and pelvic health conditions, it’s also nice to be able to help others who are just interested in their menstrual cycle, even if they’re not ready to conceive or don’t have pelvic health issues. Like, yeah, I think the FAMM program and being able to teach people the symptothermal method and understanding their menstrual cycles has also been a great addition to my practice. Because then maybe they weren’t seeking out help for painful pelvic issues — they didn’t think anything of it, like leaking, for example. A lot of people dismiss a lot of these things. But I had a call the other day from someone who reached out because they’re experiencing painful periods, which can also be helped with visceral mobilization. But then we talked a little bit more and — how she’s also having irregular periods. And I think the FAMM program is such a great addition to having people understand a lot more and teaching them about those lifestyle changes, what they can do in addition to the manual therapy things I can provide, and really partnering. Because if I’m seeing someone in their reproductive years who is still having a period and they’re having irregular periods, that’s something that needs to be addressed and not dismissed. Because if they’re having other pelvic issues and we’re not resolving or addressing that one, maybe we’re not going to get full resolution of symptoms.

Lisa: So as we start wrapping up, I would love for you to share a little bit about your practice, where you are in the world, if anyone is local or not local, and just share a little bit about how anyone who’s listening can connect with you.

Josephine: Yes, so I am the owner of Evolve Pelvic PT and Wellness here in Las Vegas, Nevada. And I’m a mobile therapist, which means I go to all my patients’ homes and do physical therapy there. It’s a nice addition because since I see a lot of pregnancy and postpartum women, it takes that barrier out for them to go out and see a practitioner — I come to them, which makes it more convenient and easier for them. You can reach out to me at www.evolvepelvicpt.com, or you can find me on Instagram at evolvepelvicpt. And I also work virtually with patients for certain issues.

Lisa: Great, thank you so much. And one last question — if somebody was in similar shoes to you and was thinking about joining the FAMM program, what would you want them to know?

Josephine: I would just tell them to do it, to be honest. I think I was always on the fence before we started the program — should I do it, should I not do it. And I just really encourage people who are working with anyone in this patient population — any pelvic issues or menstrual health issues — to really just dive into the FAMM program. Because it’s so much information. I love doing the little in-class sessions where you get to hear the actual application of cases, of people going through clients. And it’s so much more, honestly, than just learning about charting. We go into so many different topics throughout the program, and you have so many great speakers. And it’s really nice to hear all this information from you and all the other people, and just even the cohort kind of sharing experiences with all of that.

Lisa: Thank you so much, Josephine. It has been a pleasure chatting with you today. And yeah, I’m so excited to share this episode.

Josephine: Thank you so much for being here.

Lisa: Thank you for having me. Thank you for listening. If you enjoyed today’s show, please share it with a friend. You’ll find the show notes page for today’s episode over at fertilityfriday.com/539.