What is Perimenopause?!https://resilient-rx.com/wp-content/uploads/2025/08/Screenshot-2025-08-12-112025.png593597ResilientRxResilientRx//resilient-rx.com/wp-content/uploads/2024/06/ResilientRx.png
In this episode, Dr. Mary Grimberg invites Dr. Andrea George to illuminate what perimenopause actually is—and, importantly, shed light on why so many people feel stuck or left in the dark during this transition.
What You’ll Take Away (And Why It Matters):
Perimenopause Isn’t a Quick Event. It’s not a sudden switch—it can stretch across 4 to 8 years.
You Might Be Experiencing This Earlier Than You Think. If you’re in your late 30s or 40s and noticing shifts in your cycles, mood, or energy, this could be it—not an unexplained mystery.
Symptoms Can Be Easily Misread. Mood swings, irregular periods, low libido, foggy thinking—these are common during perimenopause, yet often dismissed or misdiagnosed.
The Right Care Isn’t Always Easy to Find. Dr. George discusses the challenges of accessing informed, compassionate providers—and what direct care models offer instead.
Hormonal Treatment Isn’t One-Size-Fits-All. The conversation covers the difference between bioidentical hormones, compounded prescriptions, and standard HRT—and how to decide what might be right for you.
There Are Smart, Sustainable Non-Hormonal Options—Too. Stress management, strength training, and lifestyle shifts can be powerful tools alongside or instead of hormones.
Strength Isn’t Just Physical. Building muscle, mitigating insulin resistance, and understanding how body composition changes in this phase—these are foundational to both physical and emotional resilience.
You Don’t Have to Accept “Just Get Through It.” With the right support, tracking your body, and trusting your experience, this transition can be navigated with clarity—not confusion.
Why This Episode Resonates
This isn’t your typical “yield to menopause” messaging. It’s a smart, empathetic talk that rejects ageism, normalization of symptoms, or casual dismissal of real pain. Dr. George and Dr. Mary bring nuance, honesty, and a sense that your body’s wisdom matters.
Bottom Line (Because You Deserve It):
Perimenopause isn’t something to ride out. It’s a demand—to stop settling, advocate for yourself, and seek care that honors your experience.
If this episode spoke to you, and you’re ready to be seen and supported—you’re not alone. Our Menopause & Perimenopause Treatment program is designed to meet this moment—not gloss over it. You deserve a plan that gets you, not just your symptoms. Empowerment is waiting.
Perimenopause Isn’t a Diagnosis—It’s a Midlife Shifthttps://resilient-rx.com/wp-content/uploads/2025/08/tmi-perimenopause.png594596ResilientRxResilientRx//resilient-rx.com/wp-content/uploads/2024/06/ResilientRx.png
Dr. Theresa Pugh joins Dr. Mary in this episode to peel back the curtain on perimenopause—with no fluff, no dismissal, and absolutely no judgment. Their conversation isn’t about pathologizing a natural life shift; it’s about unpacking it with clarity and integrity.
What We Cover (And Why It Matters):
It starts earlier than you think. Many people in their 30s and 40s are already navigating this transition—and often getting told they’re “too young” for it.
Hormones are… complicated. Estrogen dominance and low progesterone can coexist, creating confusing symptoms like insomnia, anger, or waking at 3 a.m.
Symptoms aren’t just “in your head.” Think tight shoulders, constipation, frozen shoulder, hip pain, or anxiety—they can all link back to hormonal shifts, stress, and nervous system overload.
Labs don’t always give the complete story. Instead, Dr. Pugh recommends looking at symptoms in patterns, considering fascia, stress, and nervous system health as part of the bigger picture.
Supplements & tools (when used wisely). Expect thoughtful discussion around DIM, methylated B-vitamins, hormone detox, and what to do if progesterone doesn’t agree with you.
Track symptoms like a pro. Because when your experience matters—and the system often minimizes it—you need to show up for yourself with clear documentation and advocacy tools.
Why This Episode Feels So Different
This isn’t the usual “just wait it out” script. It’s a smart, human-first conversation grounded in integrative medicine. Dr. Pugh—who brings the lived-in wisdom of someone who’s navigated autoimmune illness herself—gives us nuance, not narratives. Her reflections aren’t just informed by medicine; they’re informed by compassion and real-world complexity.
Bottom Line (Because You Deserve It)
Perimenopause isn’t a broken code or a diagnosis to passively accept—it’s a phase that asks us to pause, understand, and intentionally respond. You don’t have to go it alone, and you don’t have to pretend everything is “fine.”
If this conversation resonated with you, and you’re ready to get real answers—and real relief—our Menopause & Perimenopause Treatment program is designed to address root causes, not just mask symptoms. Together, we’ll create a plan that supports your body, your energy, and your quality of life through every stage of midlife.
Because this isn’t just a shift—it’s an opportunity to feel stronger, clearer, and more connected to yourself than ever before.
The Connection Between EDS & Pelvic Floor Dysfunctionhttps://resilient-rx.com/wp-content/uploads/2025/07/eds-pelvic-floor-dysfunction.jpg16001067ResilientRxResilientRx//resilient-rx.com/wp-content/uploads/2024/06/ResilientRx.png
What is EDS?
Ehlers-Danlos Syndrome (EDS) is a group of genetic connective tissue disorders that can cause pain in joints and muscles, excessive motion in joints, fragile but stretchy skin. Hypermobility Spectrum Disorder (HSD) differs from EDS, where patients do not meet the full criteria for EDS but have many similar symptoms of joint hypermobility and pain. Despite not qualifying for the stricter diagnosis, HSD is still a valid and clinically recognized diagnosis that benefits from appropriate management.
What is the Pelvic Floor?
The pelvic floor is a foundational group of muscles, fascia, ligaments and connective tissue that attaches to the bones of the pelvis. These tissues form a supportive internal sling that holds up internal organs like the bladder, uterus, and rectum. In addition to organ support, the pelvic floor plays essential roles in core stability, respiration, sexual function and waste elimination.
Pelvic Floor Dysfunction in EDS and HSD
In individuals with Hypermobility Spectrum Disorder (HSD) or Ehlers-Danlos Syndrome (EDS), along with the connective tissue in the rest of the body, the tissue within and surrounding the pelvic floor sling is affected which can lead to pelvic floor dysfunction. However, pelvic floor dysfunction in EDS isn’t always about being “too loose.” In fact, more often than not, it’s actually the opposite.
People with EDS/HSD often don’t have the same stability or proprioceptive feedback that other bodies provide due to their altered connective tissue. Because of this, people with HSD or EDS can compensate unconsciously by over-recruiting or gripping their pelvic floor muscles. While this creates stability for the trunk and increases proprioceptive awareness in daily life, if left unchecked it can create chronic tension and shortening of the muscles. Ultimately, these shortened muscles can lead to imbalances and eventually pelvic floor dysfunction.
EDS and pelvic floor dysfunction common complaints:
Urinary urgency or leakage
Sensation of a UTI without a positive test
Chronic constipation and/or diarrhea cycles
Chronic pelvic pain
Pain with sex or reduced interest in intimacy
Pelvic pressure or heaviness
Pelvic Organ Prolapse (POP) in EDS and HSD
Pelvic Organ Prolapse occurs when the pelvic floor tissues weaken and one or more of the pelvic organs begin to protrude and press against the vaginal walls. Patients often report symptoms like a feeling of pressure, discomfort, or a bulge in the vaginal region that can be more pronounced during or after physical activity.
Prolapse is an issue that can often occur in individuals with EDS and pelvic floor dysfunction, especially during post-partum. During pregnancy, increased laxity occurs to assist in carrying and delivery of the baby, and in a hypermobile body, it can take 6 to 9 months for the ligaments to return to their previous state, or as long as the mother continues to breastfeed.
But prolapse isn’t limited to just postpartum, all too often the chronic tension and gripping of the muscles lead to the eventual inability to keep internal organs properly supported. Individuals who have never been pregnant can still develop prolapse from lifelong issues with constipation and straining, chronic stress or trauma, or from poor intra-abdominal pressure during activities like weightlifting. Chronic pelvic floor tension, as opposed to laxity, can be the root cause of pelvic floor dysfunction weakening support over time.
EDS & Physical Therapy
Frequently treated pelvic floor dysfunctions in the HSD/EDS population:
Pain with sex: Often due to chronic gripping or muscle spasms that compress the pudendal nerve, which can mimic the burning sensation of a UTI
Recurrent UTIs: Can be connected to poor bladder emptying from painful or tight pelvic floor muscles causing bacteria remaining in the urethra
Prolapse: Often presents as heaviness, pressure, or visible bulging
Chronic low back or hip pain: When massage or stretching helps temporarily but the pain returns, it may be linked to pelvic floor dysfunction.
EDS Key Take Aways
The pelvic floor is one of our greatest supporters. Like all muscles, it requires the right relationship between length and strength to function optimally. EDS and pelvic floor dysfunction aren’t doomed to occur together, but a hypermobile body requires more awareness surrounding potential injuries and these imbalances can often hide in plain sight.
If you suspect your pelvic floor may be contributing to symptoms, especially if you might be hypermobile, pelvic floor physical therapy with a therapist who understands connective tissue disorders, can be transformative. To learn more about Jill’s approach to treating hypermobility, watch or listen to Episode 50 of TMI Talk with Dr. Mary.
Kciuk, O., Li, Q., Huszti, E., & McDermott, C. D. (2023). Pelvic floor symptoms in cisgender women with Ehlers-Danlos syndrome: an international survey study. International urogynecology journal, 34(2), 473–483. https://doi.org/10.1007/s00192-022-05273-8
