Pelvic Floor Physical Therapy and Fertility Awareness (Episode 438)

Full Transcript: Episode 438

Lisa Hendrickson-Jack: Welcome to the Fertility Friday podcast, your source for information about the fertility awareness method and all things fertility. I’m your host, Lisa Hendrickson-Jack. I’m the author of the Fifth Vital Sign and the Fertility Awareness Mastery Training Workbook. I’m a certified fertility awareness educator and holistic reproductive health practitioner with over 20 years of experience teaching women to connect to their fifth vital sign through menstrual cycle charting, balancing hormone health and optimizing the menstrual cycle without hormones. I have been consistently outspoken about hormonal birth control over the past two decades and its impact on fertility and overall health because you have the right to know how your body works and how artificial hormones disrupt that natural process. I teach women’s health professionals how to utilize the menstrual cycle as a vital sign in their practices and I host live coaching programs to help you achieve optimal fertility and health because it’s important to have healthy menstrual cycles regardless of whether or not you want to have babies. I’m also a wife and mother of two beautiful boys and a brand new baby girl. This podcast is designed to empower you to take full control of your cycles, your fertility, and your overall health. And I’m so excited that you’re here with me today.

I’m sharing the first episode in this year’s FAM Practitioner Series. This is my Fertility Awareness Mastery Mentorship Series where I’m sharing interviews with my current practitioners. I have so many great episodes for you in the series with such a wide variety of topics with my practitioners sharing their own personal stories with birth control, with fertility awareness, what brought them to want to introduce fertility awareness as a vital sign in their practice, to some episodes specifically related to their professional designation and on the topics of their specialty. So lots of great episodes in store for you. Today I’m sharing my interview with Melissa Thompson, a member of the FAM class of 2022.

And because her specialization is in the area of pelvic floor health and pelvic floor physiotherapy, we spend a lot of today’s call going deep into pelvic health. Although in some parts of the world, pelvic floor PT is the standard of care, particularly for women postpartum, what I found living in Canada and my knowledge of North America in particular — so Canada and the United States — it is not necessarily the standard of care. All women aren’t necessarily referred to a pelvic floor PT as just the way things are done. And many women struggle with the issues associated with this, such as bladder control issues, painful sex, uterine prolapse, a lot of different things that can happen post-birth, and it’s not necessarily common knowledge what to do about those things. I think many women are just left with the thought that they just have to deal with it. So in today’s episode we delve into some of these topics and Melissa shares her experience, expertise, and some really important pieces of information and a lot of hope and encouragement if you’ve ever struggled with any of these issues, or if you are pregnant or thinking about having a baby in the future — even that is a really good time to learn a little bit more about this so that if you do encounter any challenges, you have at least a bit of a road map for where to start looking.

So before we jump into today’s episode, I’ll just tell you a little bit more about Melissa. Dr. Melissa Thompson is a board-certified Doctor of Physical Therapy with a specialty certification in Manual Therapy, a tool for hands-on treatment. She is also a pelvic health specialist with an advanced certification in fertility awareness. Melissa helps connect her clients’ menstrual cycle health to their pelvic health so they can heal pelvic pain, relieve bladder issues, and take charge of their fertility. Melissa was born and raised in Louisiana and she now lives in Houma, LA, with her husband, and they are enjoying getting to know the community and giving back with her practice Louisiana Pelvic Health. So without further ado, let’s go ahead and jump into today’s episode with Melissa.

And I’m really excited to be here today with Dr. Melissa Thompson. Melissa is a member of the 2022 FAM program. And so by this point, at the time that we’re recording, we have been together for a solid eight months. And so we’ve had a number of in-class sessions, hot seat sessions, client sessions where she’s had the opportunity to share about her practicum clients. So we’ve had just a wonderful opportunity throughout this program to get to know each other. And really excited to have you on the podcast. So welcome to the show, Melissa.

Dr. Melissa Thompson: Thank you. I’m really excited to be here.

Lisa: Well, I’m glad to have you, and I feel like a great way to start our conversation today is to let the listeners know a little bit about yourself. So maybe we can start there. Let us know what your background is, your professional designation. Talk to us a little bit about the work that you do, and then tell us what prompted you to join the FAM program and want to basically bring the deeper fertility awareness knowledge into your practice.

Melissa: Yeah, so my name is Dr. Melissa Thompson. I’m a Doctor of Physical Therapy. So I practice as a physical therapist in Louisiana, and I have a women’s health clinic. So I focus a lot of my caseload on pelvic floor conditions, on the pregnancy, postpartum, post-menopause kind of transitions, and then also I do see a strong amount of those who are trying to get pregnant and have things like endometriosis or these more chronic, really multifactorial conditions. And so in my clinic, I went off on my own because I was just kind of tired of the approach of just lying on the table, kegeling, and having a biofeedback machine inserted into your vaginal opening for half the session and calling that therapy. And when are you really leaking urine when you’re just laying down in bed doing nothing? It’s not really functional. Most people are having their issues when they’re up and about and doing activities and doing things. So my clinic in a nutshell is just kind of putting things into a more functional perspective, combining the best of orthopedic hands-on physical therapy with expert pelvic health and just really getting people better faster.

Lisa: Well, yeah, thank you for that summary. I want to go a little bit deeper into what you said, because from what I hear in Europe, it’s standard procedure postpartum for women to be referred for pelvic floor physio, physical therapy. But in North America, obviously, that’s not a standard of care. And so I feel like a lot of people don’t necessarily have a good background knowledge of what it is. So when you shared with us your kind of displeasure with the standard approach, maybe talk to us a little bit more about that. For someone who just goes in to a pelvic floor PT, maybe share with us some of the reasons why a person would end up in your office, what the standard approach is, what a person would expect, and then go into a little bit more about how your approach is different.

Melissa: Yes. Certainly in North America, we all wish more people were coming to us, and we wish more of our doctors in our community were just making women more aware. The typical approach is to really kind of zone into one body part. So my neck hurts, let’s look at your neck. My back hurts, let’s look at your back. My vagina hurts, let’s look at your vagina. But what we know is you’re not just a walking vulva. It’s your legs, your core, your ribcage, your neck. It’s how you move as a full body unit. And so I would say like pretty standard of care — years ago, pelvic PT was more known for having an internal vaginal exam and just getting directed vaginal treatments, usually in a static posture. So lying on the table and then giving exercises that would be more of like kegeling in nature, which is kind of like the pelvic floor contraction, or what you hear all over social media, all over Instagram: did you do your kegels today because you’re pregnant and you’re going to have a baby?

Lisa: And what are kegels, for the six people who don’t know?

Melissa: Yeah. So a kegel is when you isolate just the vaginal muscles and you contract them. So it’s analogous to a bicep curl, but just for the pelvic floor muscles. And there’s some theory to that — that if you’ve had a vaginal birth and things are really stretched out and your pelvic floor is just weak and you’re feeling pressure and you’re leaking, well, yeah, maybe we need to reconnect with how to perform that kegel. But what’s happening when you’re lifting your 20-pound child? You’re now having to use your legs, your core, your breath, and your pelvic floor. And those should be automatic. So kind of moving away from that dogmatic approach of just do your kegels and look at a machine that shows you if you’re kegeling or not, and really moving into: what’s your pelvis doing? What’s your diaphragm doing? What’s your core doing? Are you holding your breath all the time? And then what’s your pelvic floor doing in conjunction with all of that?

Lisa: Yeah, that’s really — it makes a lot of sense when you break it down that way. And I know the whole kegel conversation, I feel like it’s changed over the past 20 years. When I was younger there was this whole thing of you need to do your kegels all the time. And it makes me think back of an interview that I did with Isa Herrera, and she talked a lot about how the kegel is the contracting part, but that a lot of women have issues with relaxing, and how if you always do the contractions it might make issues worse for women who are having, say, pain with sex or things like that. So maybe share with us some of the most common reasons why people do end up in your office.

Melissa: Pain with sex is the number one reason for someone that I see personally. So I find that a lot of these people, we spend more time trying to let go of the pelvic floor and tapping into the nervous system and all of the other contributions to everything. So pain with sex and then stress urinary incontinence, which is basically like I’m trying to get back to exercise and oops, I peed all over myself — that’s super, super common, but a lot of people just don’t want to talk about it. Prolapse, which is where one of your pelvic organs is just not in the right spot, and so then it causes a lot of mismatches with peeing, pooping, and just feeling like something’s always in your pelvic region like hanging out. Low back pain and sciatica and hip pain are also super common reasons to come see me because sometimes the missing link is the pelvic floor and how everything’s behaving together. And then constipation and poo problems. And then a lot of this kind of comes up during the fertility years, pregnancy, postpartum, post-hysterectomy. So it does tend to all overlap with a lot of people having goals to get pregnant, or maybe to prevent pregnancy, or to one day like — how do I transition into menopause? So we’re constantly having the hormone conversation as well.

Lisa: Well, when I think about — there’s so much in what you said that I could ask questions about, but in general, when I think about as a practitioner when to really be thinking about referring to a pelvic floor PT, I often think around the birth years as you said, postpartum, and obviously with pain with sex and things like that. So maybe you can speak to a little bit about why birth itself, the process of birth — and I would imagine that it’s not just vaginal birth. Maybe you could speak to that as well, because of course that would be the thought of oh, only if you have a vaginal birth would you need a pelvic floor PT. But I’m sure pregnancy does things as well. And also outside of birth — maybe because pain with sex is the number one — what is causing these problems?

Melissa: Yeah, I love these questions. So I view pregnancy as more of a wellness preventative type of treatment, which is what I’m really promoting in my clinic, because it is so cool to be able to proactively do therapy on the front end, prepare for birth, and then basically improve maternal outcomes from all sides. So that’s how I set up my in-person and my digital programs for pregnancy. And you have to think about the ten months that your belly is growing — your thoracic spine is getting stiff, you’re probably more forward in your shoulders, changing your neck position. We haven’t even started talking about the pelvis yet. And the belly starts hanging forward and all the pressure just starts going all up and down and front to back. And so that causes just a ton of changes muscularly to the pelvis, pelvic floor. And so in my opinion, everybody who’s pregnant should be going to see a pelvic PT at least to get a check and to make sure all that stuff is kind of crossing your T’s and dotting your I’s, and that you know how to push. A lot of moms are actually doing the opposite with their pelvic floor. And there’s some research out there that shows that when you ask somebody if they don’t know how to kegel and then you cue them, 70% can learn within session how to do it correctly. So how cool is that — to be able to just have a little bit of teaching to make sure that you know what you’re doing with your pelvic floor.

So that’s how pregnancy itself relates to pelvic PT. And then of course with the birth, it just all depends on how it goes. And yes, if you have a C-section, you still have that abdominal scar that affects the mobility of the pelvic organs. And then it causes a reaction sometimes with the pelvic floor where things don’t want to let go because of those adhesions and scar tissues. And then a total disconnection with the abdominal cavity and the abdominal muscles.

So that’s like pregnancy in a nutshell. I know a lot of people do associate the pelvic floor treatments with pregnancy, but a lot of my people with pain with sex — this has been going on forever, like ever since they became sexually active, and there was no real insult or injury. And so what happens is they start to go on a health journey and they start to ask the questions: is this normal? It’s always been like this, this is my only experience. And they start to branch out and realize that sex can be pleasurable, it can feel good, and it doesn’t have to be that way. And for a lot of these people they go down the rabbit hole of getting a lot of gynecological exams, a lot of infection swabs, their cervix looks normal, they don’t really have any conditions so to speak that can be ruled in. And so then they come to me and we find lots of tension in the pelvic floor, lots of maybe tension in the abdominal cavity and in the hips. There’s always these gripping patterns and I’m able to say okay, I think this is coming from a hormone contribution, or this might be consistent with endometriosis, or a pudendal nerve irritation. So that’s kind of my job — to say why do we think this is happening, and then what do the next steps really look like from there.

Lisa: Well, and just to give us a general sense of it — as someone who has not personally experienced pelvic floor PT, I’ve done a lot of interviews with the abdominal therapy modality folks, so Mercier Therapy or Arvigo, and those are a completely different thing where you’re going on the top of the abdomen, you’re not going internally, and you’re doing more in terms of alignment and circulation and things like that. Whereas obviously you’ve already mentioned and alluded to it that with pelvic floor PT, there’s often an internal exam, and it’s a very different approach. So maybe you could just share a little bit about the approach itself, how it’s different, and maybe some of what happens. How do you get better? Just for the woman who’s listening who does have pain with sex. And I know for me, I often talk about that possibility of hormonal contraceptives playing into that, because that’s certainly in the research. But obviously there’s a lot more to it than that. Maybe share a little bit about what you do for your clients who have pain with sex, or what you do for your clients who are peeing when they exercise.

Melissa: Yeah, so this is everybody’s kind of favorite question. Like, what is going to happen if I go see — what are you doing to my vagina? I’m too scared to do this. And I want to say that nothing is required in the exam. It’s a fluid collaboration between myself and the patient. We all want to be comfortable before we move forward with internal exams. But it is the gold standard way to assess the pelvic floor — with an internal exam. So that would be your top notch, like if you really want to know what exactly is going on, and if a muscle in there or the pudendal nerve is involved, definitely an internal exam is something you should think about.

So when you come to the clinic, we do lots of talking. It’s probably lots more questions than you’re used to being asked. I’m going to ask you all about your history because these issues don’t manifest overnight. There’s not pain with sex today and there wasn’t yesterday. It’s usually something that has been going on for a long time. So we really do have to dive into all the different body systems in your history of everything. And then after we kind of get to know each other and your goals and what your priorities are, I will plan the exam based on the priorities. So if I do think that an internal exam is the most appropriate for you, I usually bring out my model Ophelia and I tell you how the pelvic floor shows up in this way and how pain with sex is potentially involved or leakage. And then we would move to the vaginal exam and I talk you through it — you’re in control. If you decide you know what, I’m halfway through this and I’m over it, then you’re over it. We move on. There’s no requirement there. But I’m able to use one gloved, lubricated finger to feel all the different layers of the muscles vaginally, all the way into your deep pelvic floor and your hip muscles. So the hip courses in and out through the pelvic floor along that pudendal nerve path as well. And a lot of people are holding a lot of their emotional trauma and their trigger points, and their lumbar spine stiffness is kind of manifesting into some of those layers.

So once we kind of identify exactly what the pelvic floor is telling us, then I zoom out, because your treatment may not necessarily need to be just going internally every time. So I do a lot of lumbar work, thoracic spine work, because if your spine is not functioning at its optimal capacity, then it’s potentially putting the pelvic floor in positions that it becomes the victim — where maybe we’re seeing the symptoms at the pelvic floor, but it’s not really the true cause. So I do a lot of spinal work, a lot of hip corrective exercise work. And I do some visceral and abdominal massage work, but not to the level of the Mercier or the Arvigo — I’m not trained in that. So that in a nutshell is kind of how a session goes. And then for all follow-up sessions, we will prioritize together what we want to do — if we’re doing more myofascial work along the spine and joint work or along the abdomen, and then there might be a component for like ten or fifteen minutes where we do the internal work, if we’re doing release work or if I’m helping you connect your vaginal area to your core area. Which a lot of postpartum moms — it’s just very disconnected. Because for ten months there was tension on the abdomen and you could really feel the feedback of activating those muscles, and then all of a sudden when the uterus starts to shrink and there’s no baby in there anymore, everything just feels like it’s hanging out. And muscles that have been stretched to that capacity are not in the appropriate length-tension relationship to get a good contraction. So we have to intentionally focus on how we’re going to accomplish that and do it correctly, and put it into activities like lifting your baby and picking up items and laundry and things.

Lisa: Well, and then in terms of outcomes — maybe share with us some of the outcomes for a client who had pain with sex and/or a client who did have bladder control issues.

Melissa: Yeah, so I would say bladder control issues is the fastest track to improvement. A month or two of therapy and you should not be leaking. That is actually really cool, because people call me and they’re telling me like, I just don’t even think anybody can help me with this issue. My OB told me, well, what do you expect? You had a baby. And I’m just here to tell everybody that that’s just not true and that this can be fixed. Pain with sex — it honestly depends on the root cause of it, but that’s more of an ongoing thing. I would say that if you’re experiencing that, sometimes you might kind of graduate from coming more often to more of like a wellness or a home program that you’re going to have to keep up with. But outcomes are really good if you get the right program, you get the right tools, and you have the right support system, and you’re motivated and willing to slowly kind of address all the pieces of the pie. Because with the pain piece, there’s always more to the story. So then there’s going to be more for us to work on and more things for us to do.

Lisa: Yeah, the pain is complex because then there’s pain, so then you start to wince and tighten in anticipation of pain, and that makes it worse. So it makes sense that there’s a lot to work through there. That’s really helpful. I feel like that really opens the window into pelvic floor PT. One of the things I encounter with my clients is that often, many of us just think it’s just doctors. And if they don’t have anything for us, then we kind of just like, well, now what? So one of the things I always like to do on the podcast is to kind of open it up so that we know that we can have a care team. It’s not just the doctor. And there are plenty of things that doctors can’t necessarily help us with that other trained professionals can support us with. And it doesn’t always have to be drugs and surgery. So let’s switch it up a little bit and talk about what prompted you to want to bring fertility awareness into your practice. And obviously the FAM program teaches fertility awareness, but it also goes a lot deeper into utilizing the menstrual cycle as a vital sign and having it there to help you as a diagnostic tool to some degree. So maybe share with us a little bit about the why — why you wanted to bring that into your practice — and then you can share a little bit about how this experience has changed what has happened now that you’ve been incorporating these really cool fertility awareness tools into your practice.

Melissa: Yes, so the why behind it was that I started charting, and I felt like everybody that I had questions for just told me, well, you have to ovulate on day 14. And if you don’t, then oh, you’re irregular, your cycle’s irregular. And I felt like I need to dive deeper into this. I might want to get pregnant and I want to understand what my hormones are doing. So it’s kind of twofold — I wanted to learn a lot for myself and kind of what I could do in my own hands. And then all of my patients have really deep goals. Like it might start with pain with sex, but then it might come out that I’m scared to get pregnant and if this is like foreshadowing that there’s going to be a potential issue with my fertility. And I like to be able to use my holistic background and kind of look at things from all sides. And there are things that I can definitely do without referring them out — like, are you eating breakfast? Are you going to bed at the same time every day? I can have those conversations. And I can also — a lot of times when I get some people with these issues, I can tell right away there’s a hormone contribution. And so to be able to go deeper and just have that education and awareness and be able to offer more solutions without just going back to the gynecologist who often tells them, don’t worry, we’ll just send you on some Clomid or letrozole if you’re not ovulating when that time comes. And I just offer people, well, let’s look at it as a different approach — why don’t we spend these months before that time comes on really optimizing things instead of just treating with an intervention in the immediacy based on what’s going to happen later.

Lisa: I thought of a question that’s more of a curiosity. Because obviously you have had your professional practice for quite a while, and obviously you have an intake process of your own where you would find out extensive history to help you support your client with their pelvic floor issues. So I’m curious — because the FAM process then has its own intake and its own kind of history and obviously lots and lots of questions to try to get a sense of what has led the person to wherever they are now in terms of their birth control history and their health history and all that. Did that add to what you were already doing? Did it provide additional history and background that you weren’t necessarily getting already?

Melissa: Yes, it definitely did. There are not a lot of patients that come to my clinic who have ever been asked to explain what they eat, or to talk about how much water they’re drinking, or the reproductive history of what has really gone on since menarche up to this point and how that all might be playing into a role. Because traditional physical therapy — if someone says, well, fifteen years ago this and this happened, traditional physical therapy would probably go, ah, it might not be relevant. But thinking about everyone’s life journeys kind of shaping things up to today — I think it is relevant. And I especially think it’s relevant when it becomes tied up into the hormonal and the nervous system.

Lisa: So part of the program — I would say probably fully half of it or something along those lines — is the practicum. And I think that’s obviously the opportunity to apply what you’ve learned in the class with your clients in real time and have support with that as you go. Maybe share with us what that’s been like to incorporate that aspect of it into your clinical work. I know we’ve had a lot of conversations about it because it can be challenging — you already have an existing way that you work with clients and now you’re adding an extra feature. But maybe share with us how that has been and what it has done to your client work.

Melissa: Yeah, so I think it’s really interesting because since I started sharing on my Instagram that I’m now taking fertility awareness clients, even people who come see me for physical therapy — in my intake form I have like, do you use contraception? And almost everybody says natural family planning or some level of Creighton or fertility awareness. And I just think that’s like super cool that I’m attracting these people without even necessarily getting into the weeds of do you want to chart, do you not. So I think that’s been a really cool organic magnet that has happened. And then I have played around with different ways to incorporate true physical therapy with the charting, and I’ve decided to keep them separate just because we don’t want to take time away from either avenue — we want to make sure we do it right. But it has given me a new lens. When someone comes in and they think it’s their pelvic floor, and we dive into it, and what they’re telling me is maybe they have abdominal cramping and pain around ovulation and hip pain — and they think that it’s all related to their pelvic floor after they’ve had a kid and a recent miscarriage. So we checked the pelvic floor and it’s actually nothing like what I thought I was going to see based on those symptomologies. And so, okay, we need to dive deeper into this. And I actually do have a client with that history. And what we found is through charting there’s just other hormonal things going on. I think her estrogen is really high and I think she’s getting a lot of ovulation pain and inflammation. And you know, she’s on this new journey now where she’s keeping up with her rehab exercises but she’s also really loving the charting and seeing the results, and she wants to get pregnant again. But of course she wants to improve her chances of having the live pregnancy go to term this time. And I think she’s on a great path.

I have a client with HA right now and she’s on cycle day eighty-something since her IUD. And that’s been really interesting because she also had pain with sex and we weren’t sure if it was her pelvic floor. Well, I didn’t think it was her pelvic floor — I thought it was the IUD. And after she removed the IUD, now there’s no pain with sex in any of the times in the eighty days. And so I think it’s really cool to be able to kind of add another layer of almost like differential diagnostics — of how much of this is really the hormonal inflammatory GI issues, how much is the pelvic floor, and me designing which avenue someone would benefit from going down.

Lisa: And when you were saying that, I was thinking about it in terms of — I think a lot of practitioners, especially as the knowledge of the menstrual cycle and the importance of it is very popular right now, very hot topic — a lot of practitioners might start asking about the person’s periods and really feel like they’re delving deep into it. But obviously with this program, you know exactly what day of her cycle she’s on because she’s tracking. And you also have insight into the fact that that’s highly problematic to have 80 days without ovulation and what that could mean. So maybe share with us the difference between having a general understanding of the cycle versus now actually having some of your clients chart and seeing with your eyes what their cycle really is like.

Melissa: Yeah, so I was asking more period questions in relation to pre-menopause or endometriosis, but very few questions maybe about period pain or how heavy are your periods for pre-menopause. A lot of times when we’re going through the menopause transition, there’s a lot of vaginal atrophy and vaginal thinning, which leads to a new onset pain with sex presentation. So I would kind of ask them and say, okay, it sounds premenopausal, and I would almost move on from the hormone thing. I might recommend one of Lara Briden’s books or something like that. But now I have people charting. And like with the person with HA — she just had three peak mucus days on days like 75, 76, 77. So I’m able to have the conversation with her that what we’re doing is working, we just need to continue the path. And I don’t think she ovulated those three days because things dried up and her temps didn’t go up. But the fact that there’s some ovarian function, some follicular development, and we were able to see that with the mucus — and she’s getting negative LH tests, which a lot of people are relying on to see if they’re ovulating or not — this is really positive. And so I’m spending a lot of time back and forth with the chart telling her we just need more time, stay the course. Versus maybe someone who’s not charting is just looking at it as 80 something days without a period — do I do a jump start, whatever the hormonal — I forget — the progesterone challenge test. I feel like I have a leg to stand on to give more advice: it’s working, and you don’t necessarily need that jump start if you want to stay the course, because I think your follicular development is on its way.

Lisa: You’re hitting on one of my favorite parts about charting and utilizing it as a vital sign. One of the things that I really appreciate about charting is kind of the longer term feedback. So for example, you have that chart, you see what’s going on — which in your client’s case was nothing. No ovulation, no mucus, nothing — which is classic HA presentation potentially, depending on the situation. And then you start to see feedback. You make changes based on the baseline chart, and then you see what is actually happening and whether or not your actions are causing the changes that you’re wanting to see. So in that respect it gives you feedback, and I find it to be a very excellent motivational tool for clients. Have you had similar experiences with your own charting, using the chart as a feedback tool for motivating yourself?

Melissa: Yeah, I think that’s the coolest thing. My chart doesn’t vary a whole lot, so I have to be really trained in interpreting it now because it’s subtle changes. But I’m able to see when I eat a lot of high glycemic carbs I delay my ovulation a few days and then I have lower progesterone in the luteal phase. And then I can see whenever I cut things out or I have really focused on my stress management — I run a business, and I realized through charting that I prioritized the business for the majority of the time that I started it and I wasn’t really eating lunch and I wasn’t planning my own workouts and I was coming home and doing work. And you could really see my progesterone just kind of hovering and not thriving. So the chart was a really good way for me to see how stress manifests and how stress literally robs me of my estrogen, thyroid, testosterone, progesterone. And so that’s one of my biggest things that I’m personally using my chart for. And I’ve created a lot more boundaries. I deleted my work phone off of my personal phone. I have office hours to check Instagram. I block out lunch on my schedule. I eat breakfast. And suddenly my business is like booming. Amazing what boundaries can do in self-care.

Lisa: So I want to ask you about something because when we first started in the program at the beginning of the year, your chart and cycle was in a different place than it is now. I wanted to ask you about that because you had an initial hurdle and a great win at the beginning with respect to your luteal phase. Maybe share a little bit about that — because I remember you shared something about the luteal phase and everyone was like, wow, that’s great. And now it’s kind of just normal. Now you just normally have a fourteen-ish day luteal phase.

Melissa: Yeah, so when you and I started working together it was actually before the FAM program started, and I had been charting just not with this particular mucus methodology. And it was like every other month my cycles were bouncing back and forth between the overall length and then the day of ovulation and then the amount of days in the luteal phase. So it was like this month looked great, that month looked short, this month was back to great — just super all over the place and not consistent. And so pretty much at the three-month mark of me getting my calories up, prioritizing protein, adding some additional supplements — it was 14 days, like every month. Which I think was a result of what I was doing. I was working on improving the progesterone and it seemed like the progesterone really improved. And I personally seem really sensitive to these little changes, and I’ve got a lot of underlying inflammation going on. So anytime that inflammation reaches a threshold, my temps are like closer to the baseline and I’ll shorten in my luteal phase a little bit. But now I just finished, I’m in a new cycle, and I had a solid 14-day luteal phase. And I got a blood draw just for fun on eight days after ovulation and my progesterone was like 17. Which is good — I think 15, 16 is like what we’re the target, right?

Lisa: So you’re good.

Melissa: Sometimes I’m extra. This is not part of the charting and people don’t have to do this, but I like to pee on PdG strips, which is a urine metabolite. I don’t do it as much now. But I was like, oh, since I got my blood drawn, let me just be on a stick and see if it matches. And it was like the top of the threshold. So I was like, okay, I’m pretty good with that. Things are going well.

Lisa: I love that. And that’s again one of the things I love about it — seeing what you can do with your own cycle by making certain changes. So as we get to the end of our interview today, I would just love to get some final thoughts from you. For someone who’s listening and who is thinking about the FAM program — this program is designed specifically for women’s health professionals who have an existing practice who are wanting to bring fertility awareness into the work they’re doing with clients. What would you want them to know about your experience in terms of how it potentially has changed your practice or changed your outlook or changed the way that you relate to your clients?

Melissa: That’s a great question. I think the biggest thing is that, A, it makes me unique. People are coming out from hiding. Like, well, okay, I have pelvic pain, chronic back pain. I also just had a baby and I wanted to ask you about my progesterone. So I think that’s really cool in like setting yourself up to be a little more unique in your practice. And I think the biggest thing that I hear from my patients is constantly: no one told me this. I’m going to my other doctors asking if there’s anything else I can do besides the pill or the IUD, and they’re literally telling me no. And you actually listened to me for an hour and you’re telling me I have decisions I can make on all these different routes. And so I think being able to be confident in charting — not just know about it and what it is — it’s two different things. And so I’m able to break it down for people and give people the exact road map of today we’re starting here and we’ll talk about the rest later. And I’m really watching these women step into their own and really take charge of their health and kind of break down that dogmatic belief that my period is just my period and it happens to me and pain just happens to me. And I’m really empowering people to take action even if it results in small baby steps along the way. So I think that’s the biggest thing that sets you apart if you decide to do this kind of a program.

Lisa: Well, and then one of the questions which makes a lot of sense for busy practitioners — obviously it is a program, there are assignments, there are calls. That does require time. Would you share a little bit just about your experience as a practitioner in the program, from that practical standpoint of what it’s like inside?

Melissa: Yes, so I have been working my full caseload since we started. I found some of that a little challenging, but I’m glad that I did it because the calls are recorded. So I prioritize — when it’s like a client case presentation, I watch it later on one and a half times. And so that way I’m able to time manage for myself a little bit better. But I really enjoy having this number of calls because I saw a fertility for pelvic PT’s course come out and it was one day long and there was a nine-minute video about cervical mucus. I was like, oh my God. Like, I feel like I’m just so comfortable with all the different types of mucus, what it means — I just don’t understand how you would learn anything in nine minutes about what mucus tells you. So what I’m saying is that I appreciate how long the program is, really getting the amount of calls, being able to re-watch the calls, even diving into the assignments. They did take me some time, but it said go to chapter 10 of The Fifth Vital Sign and answer these questions. It kind of makes you slow down so you’re not just binge reading everything and then forgetting it.

Lisa: Well yeah, I appreciate that. And so just to kind of break it down — the course itself is about nine months, so that’s about the length of it. And the call frequency — there’s a call a week, and then there are additional calls as needed. There’s an additional monthly call that’s optional for question and answer, and there have been times when if everybody wants to have a deep dive into topic X we’ll do an extra one. My goal with the program has always been to cut out the fluff and keep it to what we really need to know. And so towards the second half of the program, a lot of the calls are the hands-on: bring your charts or your clients’ charts, their history background, and we go through and answer a bunch of questions that are really pertaining to you and your clients. So as we’re wrapping up, any last words? Anything you wanted to share, whether it’s for the practitioner who’s thinking of joining or for the woman who’s listening out of interest and who’s thinking of diving in and learning how to chart her cycles?

Melissa: Yeah, I would say I’ve had a number of clients who came from another functional medicine doctor or other type of doctor who told them, well, don’t worry, you don’t need to know when you ovulate. It’s too much work. Well, it’s going to be too much work if you think it’s too much work. But I’m literally like doing it in my sleep. I just wake up, take my temperatures, I check the mucus. I don’t even remember what I wrote down yesterday. It took me like two seconds. And so I would say don’t let people make you feel some kind of overwhelm. It’s just a matter of breaking things down, learning every day, and then having someone to tell you you’re on the right track and kind of validate what you’re seeing. So don’t listen to that stuff.

Lisa: Yeah, it’s like that patronizing — I always picture that paternalistic patting on the head like, oh no sweetie, that’s too much work for you. It’s like, I’ll tell you what’s too much work for me.

So share with us where you are located, where’s your physical practice — share all the details for all the lucky people who are close to you who are now going to want to run to your clinic. And share with us where we can find you also on socials.

Melissa: Yes, so my Instagram is where I’m most active. It’s Dr. Mel Thompson, Dr. Mel Thompson. And my website is LouisianaPelvicHealth.com. At this time, my clinic is in Houma, Louisiana, which is about an hour from New Orleans. And I also have online digital coaching rehab programs for women. So I’m able to do assessments and consults virtually from anywhere in the world. So if that is something you’re looking for, I can also help you with that.

Lisa: Cool. Well, I’ll make sure to put the links to all of the places. So for anyone who’s listening on the go, you can just scroll in your app or whatever and you’ll see all the details. And hopefully you’ll connect with Melissa on the socials. And yeah, it’s been a great opportunity and so much fun talking to you today. I always love doing these episodes. It was really fun to pick your brain and to learn a little bit more about the nuance of the work that you do in your field. So I really appreciate you taking the time to share that with us today.

Melissa: Yeah, I think it’s been fun.

Lisa: 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/438. I hope that you enjoyed today’s episode with Melissa. It was such a treat for me to be able to pick her physiotherapy brain and highlight the importance of treating and being aware of issues related to pelvic health and pelvic floor health, and listening to Melissa talk about the most common issues that she sees in her practice and just thinking about how many women are struggling with these problems who aren’t necessarily talking about them and may not know where to go for support for them. I feel that it’s just so important to continue to raise awareness. And having given that — as I’m recording this episode in real time here in fall of 2022, I have just recently given birth. And given that it’s my third baby, I’ll share at some point on the podcast what my experience has been post-birth. But I’m feeling very thankful that I was aware of many of these resources and that I have been able to access any resources that I need within my community. Knowing where to go or where to turn is the first step. And so hopefully this podcast has been helpful to you. If you know somebody who could really benefit from hearing this information, then I do encourage you to share it. Again, the share link is fertilityfriday.com/438.

And I think one of the most encouraging aspects of today’s episode is knowing that not only is there support available for some of these difficult challenges that we may or may not be comfortable talking about, but also that there’s a really good success rate. So hearing Melissa talk about how she is able to support her clients in so many of the cases — it can be really scary if you’ve given birth and you’re starting to have some of these issues, whether it’s bladder control issues or whether you have some degree of pelvic organ prolapse. That can be terrifying. The idea that your organs could be out of place or potentially falling out is just one of the most terrifying thoughts. And so to know that not only is there support, hopefully close to where you live, but also that there’s a high rate of success is just so comforting, especially if you have dealt with an issue like this or had concerns and you have spoken to a doctor who’s presenting the surgical options. It can be really helpful to know the other less invasive options that are available to you before you have to go down that route. So with that said, I hope you have a wonderful week. And of course, as always, until next time, be well and happy charting.