Menopause: time to pause

Are we priming the system to expect an experience of menopause?

Are we creating the experience of menopause?

Does it become predictive in nature?

The word menopause refers to a woman’s last menstrual period. When a woman has had no period for twelve consecutive months, she is considered to be post-menopausal.  What do we really know about menopause?  What do we hear about? How can we manage this natural transition in our lives differently?  It is something that all women living into and beyond their sixth decade, will experience.

What if menopause was framed differently.  What if menopause was framed as a time of transition in a woman’s life, an opportunity to literally pause, breathe, feel and reflect. What if menopause was an opportunity to feel the repressed anger, anxiety, frustration. An opportunity to use your voice, speak your truth.  An opportunity to make changes in your life. To be your authentic self.

What if menopause was framed as an opportunity to own your sexual health, pelvic health, emotional health.. your whole self.  An opportunity to improve your lifestyle and to experience your world through a different lens.

We keep thinking of the phrase “ancient bodily wisdom”.  There is wisdom in this transition phase, there is an intelligence to this passage of time.

What if we celebrated this time, instead of fearing it.

And what could happen if we make all these changes before menopause even begins!!

Team Consano explore new frontiers at GWM Ironman 70.3 in 2023!

The start of December at Consano represented an exciting new venture for our close-knit team, as Jocelyn, Malina and I travelled to beautiful Busselton in the south-west of Western Australia to compete in the GWM Ironman 70.3 event.  This well-organised triathlon includes a 1.9km swim, 90km cycle and 21.1km run.  The reflections by our team on this event, inspired me greatly, and I carry this energy and openness into the New Year as we seek to expand our place of healing at Consano.

Jocelyn:

Why did I choose to participate?

Swimming almost 2km in the ocean is something I never thought I would do – I’ve never done an ocean swim before. Since having my two daughters I felt like I was on the sideline when it came to ‘active fun’. My back and pelvis were too sore, I felt too weak, I couldn’t run, jump, and play. The pain was a physical and mental barrier, and I took on the role of observer on the sideline. My daughters would even say to others that ‘mum is too sore to play’. And it broke my heart, but I just accepted it.

My journey at Consano has immersed me in an environment where I am supported to build and expand my emotional and physical capacity, not just accept that I ‘can’t do’ certain things anymore. This opportunity gave me a tangible goal to work towards, with two inspiring humans by my side.

I also wanted my daughters to see their mum taking on a challenge, not on the sidelines, working hard to achieve a goal and no longer making excuses.

What was my most significant learning from this event?

My main challenge was putting aside the excuses that have been my safety blanket for so long and just doing what I had to do.

I learned that I was already so much more capable than I thought. I swam 1.9km in 43 minutes, a good 10 minutes faster than I thought I would. I was tired, but also felt I still had more in the tank. I do feel I held back a bit because I thought I would be in pain and fatigued afterwards. But I wasn’t. That truly surprised me in the most wonderful way. It was a significant reminder of how far I have come in the last year, emotionally and physically.

Would I do this again, and why?

Yes!! I’ve achieved my goal of simply crossing the finish line, but there’s definitely room for growth. I want to finish in under 40 minutes, go harder, feel stronger.

I also feel that as a team we have unfinished business – I’m looking forward to all three of us crossing the finish line next year.

Malina:

Why did I choose to participate?

When Alison asked if I would like to participate in this event doing the cycle leg I don’t think I paused before saying yes, but the yes was laced with doubt at my ability to do this. It had been 10 years since I’d cycled 90km.

I was looking for a reason to get back on my bike. One of my favourite possessions, it had carried me thousands and thousands of kilometres as I pushed and sweated. It came with me from Kalgoorlie to Perth three years ago despite selling or giving away most of my belongings.  It has sat in my house waiting for me all that time.  What better reason could I have to get back on my bike than to participate in this event with two of the most wonderful women I know.  I was getting back on my bike a vastly different person emotionally, mentally and physically than the ‘me’ of ten years ago.

What was my most significant learning from this event?

I learned a few wonderful and difficult lessons from this event.

First, it is possible to find the time to physically challenge yourself.  When there is a will and you have support, there is a way.  Not only is it possible, but it is also important to reconnect with the things you love, and to continue to make time for them in your life.  I had quite forgotten the feeling of riding fast down a hill in the early morning air; the feeling of freedom, speed, strength – complete joy.

I also learned that it just takes a moment of not being in your body, a moment of distraction and things can change.  I broke my foot the night before the event and I was unable to ride the next day, I was devastated.  I felt disappointed, angry, sad.. and reflective. I also felt very loved and supported.  I think if there’s two people you want on your team when something like that happens, it’s Jocelyn and Alison.

The most important lesson I am continuing to learn from my experience is to slow down and ask for help. This is an ongoing physical and emotional challenge for me.

I feel so proud to be a part of Team Consano, proud of Jocelyn and Alison’s achievements, proud of my own.

Would I do this again, and why?

I think Jos summed it up nicely, the unfinished business.  I would love to cross the finish line in 2024 as part of Team Consano.

Alison:

Why did I choose to participate?

When I first heard about this event, it was relatively close – just a few months away.  I suggested it to our team, knowing Jocelyn had been a swimmer and Malina had been a cyclist – both some years past.  I was delighted when they both agreed to join me in doing this half ironman, as I thought it would be a new and profound experience for our team.  I presented the idea knowing it would challenge us all – Jocelyn to get back in the pool, and Malina to get back on her bike – and myself, to open to a new experience of ‘team’.  This was my first triathlon, having previously only run solo.  For the three of us, it also presented one of the great challenges faced by all working mums – making it all work!  Being there for our kids, and all the logistics of day-to-day life; being present at work; fitting in training to extend our physical capacity; and opening up to the emotional challenges in all of the above.

What was my most significant learning from this event?

At the start of 2023 I had excitedly set out to expand Consano as a place of pelvic health healing, with these two women by my side.  Then what I seemed to observe over time, was contraction, as members of our team came and went.  It was confusing, frustrating and at times, very stressful.  Now, on reflection, what I can see is that the expansion was within us, our core team.  The three of us rose to the challenges that came our way during the year, as we opened up to feeling the lows as well as the highs, and continued to ‘walk’ together.  We built capacity in this way – by opening up and feeling.  I already knew I worked with two incredible women – intelligent, dedicated, passionate, healthy – are words that come to mind.  What I learned after this challenging half ironman event, the ‘icing on the cake’ in 2023, is that our capacity is greater than any of us knew.  We have grown, we have expanded, and that is ongoing.  I also learned that I am not alone as I carry our Consano vision forward into 2024.  I am part of a team.

Would I do this again, and why?

Running this distance is never easy for me, and yet I keep going back for more!  I find that I face significant physical, mental and emotional challenges in every long distance run.  I  also find this to be the most wonderful opportunity for growth and learning.  When I run I am challenged to explore pain on every level, and have changed my relationship to pain in this way. On a daily basis I encourage patients to open up to feeling their bodies, including their pain.  I am committed to the idea that humans need to feel, to heal.  With this in mind, and with a supportive, energetic, passionate team, I am curious to see what we can achieve as we approach this event together again in 2024. Bring it on.

I’m also really looking forward to seeing Malina ride like the wind 🙂

All about breastfeeding

In November, both Alison and Malina attended Abreast conference at the University of Western Australia (UWA).  Abreast is a one-day showcase of research presentations exploring breastfeeding in many of it’s wondrous facets.  Topics were broadly categorised into milk production, mastitis, milk composition and outcomes.  This year’s conference opening also marked the opening of the Centre for Human Lactation Research and Translation at UWA – a world-leading centre of excellence for breastfeeding research.  Consano is proud to have sponsored this conference.   We are grateful to have benefited over many years from the translation of this quality research into our clinical practice – helping women at the coalface, to work their way through breastfeeding challenges.  A few take-home ‘nuggets’ that stayed with us:

-colostrum IS breast milk!  So often we hear about waiting for a woman’s milk to ‘come in’ after she has first birthed her baby.  However as Professor Valerie Verhasselt (UWA and Telethon Kids Institute) shared passionately with us all, this beautiful protein-rich fluid is the FIRST milk, and is the ideal ‘body-builder’ nutrition for newborn babies!

-a mother’s own milk is the best nutrition for preterm babies, and is unique for each baby.  Dr Marie Bendix Simonsen (University of Southern Denmark) made a case for antenatal expression of colostrum to facilitate feeding of preterm babies immediately post-birth, where their mothers may not otherwise be able to provide this valuable source of nutrition.

-a new point-of-care breastmilk testing device may help better target treatment for mastitis.  As Melbourne physiotherapist Emma Heron (UWA and Curtin University) completes her PhD we will hear more about this interesting device which easily measures both sodium and potassium concentrations in breastmilk, to determine the presence of mastitis in breastfeeding women.

-over the past century most of the research into lactation and breastmilk has been in cows, due to the importance of milk production in this industry.  Dr Luoyang Ding (UWA) explored whether we can transfer some of the research findings from low milk supply in cattle, to humans.  Watch this space!

Consano Pelvic Health Centre is sponsoring ABREAST Conference 2023!

Common (medical) testing of the bowel -what the tests involve and why they are done

Colonoscopy

How is it performed?

A colonoscopy involves passing a long, thin, flexible tube (a colonoscope) which has a tiny camera on the end, through the anus to look inside the rectum and colon (lower part of the bowel). Before having a colonoscopy, the patient will be given strict instructions on bowel preparation beforehand to clear bowel contents, which will usually include fasting, drinking a bowel prep and the use of an enema. They will generally be under moderate or deep sedation during the procedure. While a colonoscopy can just involve looking inside the colon and rectum, often a biopsy (typically of a polyp), is taken for further laboratory analysis or an internal haemorrhoid may be banded during the procedure. This video shows the procedure in animated form.

Why is a colonoscopy performed?

A colonoscopy is typically done to look for any abnormalities in the rectum and colon. This can include haemorrhoids, polyps (which can be harmless but are sometimes pre-cancerous), cancers, diverticulitis, Crohn’s disease, or ulcerative colitis. Typically, a colonoscopy will be performed to investigate reasons for the patient’s particular signs or symptoms (e.g. if they have bleeding, chronic diarrhoea, or pain, to see if an obvious cause can be found). Colonoscopies are also performed as a screening investigation (e.g. if the patient has a strong family history of bowel cancer, or if they have a past history of disease themselves).

How are the results presented?

Vaginismus leaves many women in pain and avoiding sex, but it can be treated

Recently our practice principal and clinic director, Alison Wroth, was interviewed by ABC news journalist Grace Burmas.  Well done, Grace, for shining a light on a sensitive and distressing issue that is common to many women’s experience.

ABC article –

Navigating pain for women can be a twisted maze of questions, referrals and specialists, but amid the ever-growing list of diagnoses lies a silent condition that is experienced by many.

It’s called vaginismus.

Six months ago, Sophie*, 22, started to endure painful sex with her long-term partner.

“It’s just like a heavy pressure,” she said.

“I thought it was because I left it too long, like a month between intercourse, but then that shouldn’t really change anything.

“I was looking for answers with the gynaecologist being like ‘it must be PCOS’ (polycystic ovarian syndrome), but PCOS doesn’t actually cause pain.

” I think I was just looking for a reason because I didn’t want it to be vaginismus.”

What is vaginismus?

Vaginismus is when vaginal muscles involuntarily contract in anticipation of penetration.

It causes immense pain or discomfort during intercourse, physical examinations or inserting a tampon and is psychologically triggered.

Those triggers vary greatly, from a general fear of penetration, to medical conditions like endometriosis, to a past trauma such as sexual assault or a distressing childbirth.

Equal to the physical pain can be the emotional toll it takes on women, the isolation they feel and the pressure it places on their relationships.

“The anxiety that came with it, because one time would be painful and then if you’d leave it for too long, it would just build up in my head more than anything,” Sophie said.

A cycle of pain

She thinks of vaginismus as a cycle, where one painful experience builds fear for the next time, which feeds the muscle tension and leads to more pain.

“My boyfriend doesn’t feel like I want to be intimate with him, which I do, and then I had to explain to him I get anxious because of the pain, not because of the situation,” she said.

“It’s so tiring having the conversation, it’s exhausting.”

The prevalence of the condition is blurry but health professionals, like sexologist Melissa Hadley Barrett, believe the numbers are much higher because of under-reporting.

“In a clinic like mine it’s between five and 17 per cent … but in the general population, they say between one and six per cent,” she said.

“It’s just not something people talk about, so people don’t know that it even exists until they come across it.”

Ms Hadley Barrett helps women and their partners work through the condition, which she said takes time but is achievable with a comprehensive approach and open communication.

“The partner often blames themselves and I think it’s about getting them to understand that it’s nothing they’ve done, it’s just the person has anxiety around having pain in general,” she said.

“You’re not going to touch a hot oven if it burns you.”

Ms Hadley Barrett said a lot of women try to work around the symptoms of vaginismus instead of seeking professional help.

Like many women’s health issues, knowing where to go can be overwhelming — and there’s often a cloud of shame surrounding sexual complications.

Finding the trigger

Pelvic floor physiotherapist Alison Wroth said along with a psychological approach, health professionals can work to retrain and relax the pelvic floor muscles.

“It’s thought that the pelvic floor muscles have a protective response … it makes sense to think if a woman is feeling unsafe, that these muscles would tense,” she said.

Ms Wroth helps her clients understand what the initial trigger may be and how to address that fear emotionally and then physically.

“I think it’s really confronting to go and see someone about this part of the body,” she said.

“Sometimes even in taking a really thorough history, we don’t really get to what the initial onset was, but we can still work with the body and how it’s responding now.”

Seeking help can be hard

Sophie is yet to seek professional help, because of the barriers a lot of women face when dealing with pain and complex health complications.

“It always puts me off because of the amount of money it costs and it’s intimidating, I don’t know I’ll just cry, but I think it’s worth it,” she said.

“It’s been months of trying to fix it myself, which is not happening.

However difficult treating vaginismus may seem, there is hope in overcoming the condition, Ms Wroth said.

“I’m constantly amazed at humans and the complexity of systems that are all working together just to keep us functioning in the body, and how quickly they can change if that person is ready, with the right practitioners to help them,” she said.

ABC News: Women speak out about birth trauma and poor pelvic health care in public system

It found that three months after giving birth:

• one in three women struggle to control their bladder
• one in 10 suffer faecal incontinence and
• one in two experience pain with sex

Valerie Slavin, a midwifery researcher at Griffith University who led the project, says pelvic injury isn’t being addressed because the health system doesn’t ask women about their symptoms.

And she says until we start systematically collecting national data about the problem, women will continue to suffer.

‘No-one mentioned prolapse’

The first time Samantha Coughlan became aware of prolapse was when she did an internet search about what she was feeling.

She was out walking with her husband a few weeks after the birth of her first child when she says she felt like her insides were falling out.

Previous studies have estimated half of all women who have given birth experience some degree of prolapse — a condition in which one or more of the pelvic organs drop into the vagina — but there is no clear national data.

That’s despite her daughter being delivered using forceps to pull her through the birth canal, which led to a severe vaginal tear. Both are linked with a higher risk of pelvic floor dysfunction.

The Melbourne mum had given birth in a public hospital, where she was told if she had any problems she could go on a waitlist to see a physiotherapist.

Unwilling to wait, she found a private women’s pelvic physio.

Four years later, Samantha still struggles with activities that strain her pelvic floor, including lifting her kids.

“I want to be that fun mum who jumps on the trampoline … and goes down the slide, but I can’t physically do it,” she says.

The former schoolteacher also experiences urinary incontinence when she coughs or laughs.

“That’s actually stopped me going to work.

“It’s not worth the embarrassment.”

          Samantha Coughlan still struggles with activities that strain her pelvic floor, including lifting her kids. (ABC News: Mary Lloyd)

Women’s health physiotherapist Lyz Evans runs a clinic in Sydney and says physical birth injuries can be catastrophic.

Women might avoid exercise, leaving the house because they’re not sure where the next bathroom is and intimacy with their partner, she says.

A ‘hidden epidemic’

The ABC has heard from nearly 4,000 women as part of the Birth Project.

Hundreds of women described devastating pelvic injuries and expressed dismay with the standard of care in the public system.

Many said they resorted to spending thousands of dollars seeing specialist physios in the private sector.

Access to publicly available pelvic physiotherapists across Australia varies from state to state and between urban, rural and remote areas.

Ms Evans believes the rate of pelvic floor trauma is higher than acknowledged and can be dramatically reduced if women were given access to pelvic floor physio before and after giving birth.

Physios can help prevent birth trauma by working with women during pregnancy to assess their risk of pelvic injury and help prepare their pelvic floors for labour.

They also help women recover from birth using pelvic floor muscle training and guidance on how to safely return to activities such as exercise.

The Australian Physiotherapy Association (APA) is calling on the federal government to provide all women with five Medicare-funded sessions with a pelvic physiotherapist during their child-bearing year.

Catherine Willis, chair of the APA’s advisory council, says this will help women prevent and recover from birth trauma.

“The cost of five physiotherapy appointments for women birthing in Australia has a much better economic value than the future interventions that they might need, including surgery, and also the inability to return to work due to their pelvic floor symptoms.”

Ms Willis says she’s seen women in their 60s and 70s who have endured pelvic floor problems since the first time they gave birth.

“That’s really sad to think that possibly for 30 or 40 years they’ve been putting up with these symptoms.”

‘Holding women back’

Emma Elder’s second pregnancy put twice as much strain on her body, but sessions with a physio made it a much better experience than her first.

After delivering twins it took her only a few months to return to running and jumping.

Following her first pregnancy, it took two years.

“I found [pelvic physio] extremely beneficial, not just for my recovery, but also for the preparation for birth,” she says.

Several months after giving birth to her first baby, which caused a severe vaginal tear, she was dismayed she couldn’t skip, jump or lift weights at the gym without wetting herself.

“I had to make sure that I was always carrying a spare change of clothes,” she says.

Unwilling to accept a weak pelvic floor as an inevitable and irreversible consequence of childbirth, she spent thousands of dollars on private physios and now wants that available to more women.

“I think this issue really holds women back,” says Emma.

‘What we don’t measure, we can’t improve’

Dr Slavin says one of the reasons women aren’t getting access to better pelvic care is that the scale of the problem is not known.

Australia has a clinical care standard for the 3 per cent of women who deliver vaginally and experience a tear that extends into the muscle of the anus.

Many more women than that experience life-altering pelvic injuries, but there is currently no way to evaluate how many women are affected and no national standard for the care they should receive.

Dr Slavin wants to see the public health system routinely collect data from women about their experience of pelvic floor disorders, as well as the model of care and procedures used during their delivery.

She believes that will drive improvement in maternity care.

“What we don’t measure, we can’t improve on,” says Dr Slavin.

Assistant Minister for Health Ged Kearney says she would be interested in discussing better data collection with her state counterparts.

“Collecting data is an incredibly important part of improving our health system,” she says.

Experts say women will continue to suffer until Australia starts collecting national data about pelvic injuries.(ABC News: Mark Leonardi)

Ms Kearney says many women have told her they don’t feel their experience has been heard and want birth trauma to be taken seriously.

Both Samantha Coughlan and Emma Elder think the first step towards this is rejecting the stigma of talking about pelvic disorders.

“I would love other women to know that there’s nothing to be ashamed of,” Samantha says.

“We need to talk about it so we can make things change.”

Understanding Your Core – Article for Ostomates Magazine 2022

Vaginismus