Perimenopause, Pelvic Health & Resilience – What Every Woman Needs to Know with Dr. Heidi Gastler

Heidi Gastler 

The following Wednesday, I got a brain scan and had to be called to be told that I had a brain tumor literally the size of a softball. You cannot, in so many instances, prevent cancer from happening. You can be a non-smoker, sure. You can eat healthfully, you can do that stuff, right? Those lifestyle factors, but there’s a lot of cancers. It doesn’t matter if you’re the healthiest of healthy. And I would describe myself as the healthiest of healthy. And the fact that I went into this as a healthy, strong, physically fit individual allowed me to fight it better.

Lorne Brown

By listening to the Coherence Code Podcast, you agree to not use this podcast as medical advice to treat any medical condition, either in yourself or others. Consult your own physician or healthcare provider for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Welcome to the Coherence Code Podcast, where we explore how the mind and body work together so you can move from stress and inner conflict to clarity, calm, and alignment. My name is Lorne Brown. I’m a doctor of traditional Chinese medicine and a clinical epitherapist. And through my work, I’ve seen that healing happens when you remove what gets in the way and allow the body and the nervous system to do what they’re designed to do to heal. Welcome to the Coherence Code Podcast.

Joining me today is Dr. Heidi Gastler. Now, she is a pelvic floor physical therapist, a cancer survivor, and she’s the voice behind, Hey, Dr. Heidi and the podcast, Menopause Unscripted, which we did a swap. I’m also on her podcast. What I appreciate most about Heidi’s work is that it’s deeply embodied. What I mean is that she really understands that pelvic health, hormones, and menopause aren’t isolated body parts or events. They’re expressions of the nervous system, lived experience, and how well we’re able to stay in relationship with our bodies during change. And she brings science without rigidity, honesty, without drama, which I really like, and creates space for conversations that restore coherence rather than add that noise, that more noise that we don’t want to have that causes incoherence. And so this is a grounded, real conversation about listening to the body, reducing resistance, and meeting this phase of life, perimenopause and menopause with awareness instead of fear.

Heidi, welcome to the Coherence Code Podcast.

Heidi Gastler 

Thank you for having me. I’m so glad we’re doing this swap today.

Lorne Brown 

You too. And I get to interview a lot of people and many have professional experience. They’re trained professionally and they have the knowledge. And then there’s a few I have like you today that also have lived experience. So you have this history with fertility diagnosed with premature ovarian sufficiency, cancer, medically induced menopause. You’ve done lots of integrative approaches for your healing. I really wanted to hear your story because I think it’s important for listeners because you’ve gone through it all. If you can share your story before even the diagnosis and the labels, when you were just hiding the pelvic floor PT, what was your relationship back then with your body and how did you understand pelvic health back then, just to start from there?

Heidi Gastler 

Sure. So when I went to physiotherapy school down here in the States, we had one class for one hour on one day on peltive floor PT and essentially served to scare the daylights out of all of us thinking this is not anything that any of us want to do. Now, fast forward a number of years in my career and I kept having these patients that I would describe as the medical mystery patients where they get sent to me and I’d almost be a last stop shop as a physio because people were destined for a knee surgery or back surgery or hip surgery or some sort of pain people couldn’t figure out. And I could tell you that nearly every one of these people had seen maybe 10 physios before me and I saw them and went, “Hey, listen, I’m still not the right person for you.

I need you to go to pelvic floor physical therapy.” And because I hadn’t been trained in internal work, I was doing a lot of referring to an internal work physiotherapist that was trained in pelvic health PT. And after a few years of this, I was like, “This is really dumb. Why were we not taught this? And I need to learn how to integrate this as part of the rest of my care because the pelvic floor really is the basis of our core. And it’s so integrated in with so many other aspects of our physical being, I went back and became a Herman & Wallace trained pelvic floor physiotherapist, so I could be doing this as part of my own practice.” So the way I practice now and the way I think about my own body is that this is really just another muscle group inside of our body.

It’s just what we can’t see very well. And helping people know where that is in their body, learn how to both relax it because so many of us hold so much tension there or trauma, and also how to utilize that for both general health, performance, return after pregnancy, dealing with symptoms as we’re going into perimenopause or menopause has become really integral to my practice. And I do see, I would say, mostly women for this. However, my male pelvic health patients almost always start as an orthopedic condition that then has a pelvic health component to it that we address here. So that was kind of my background. But then in my mid-thirties, I started having symptoms myself that were originally diagnosed as premature ovarian insufficiency, POI. And I was told that I was going into premature menopause at 37. The symptoms I was originally having were missed periods, really inconsistent periods, lots of problems with that.

I went and saw my OB- GYN. My FSH was in the 50s, and then I was sent through traditional Chinese medicine, my acupuncture, fertility clinic, and essentially saw five practitioners who all agreed that this was what was going on. What we didn’t know then was that I had this brain tumor that had been growing and essentially was pancaking my hypothalamus.

Lorne Brown

When I hear about brain tumors, did they not look at your prolactin because sometimes those tumors push on that? Did you have hyperlactin in hindsight when they looked?

Heidi Gastler 

I would have to go back to my lab. There was nothing ever mentioned. But what I did ask at that time is, do you think that I have something wrong with my pituitary? Do you think that I need to do an MRI?

And every person said your pituitary is fine, which it was, but my hypothalamus wasn’t working, so then therefore nothing downstream could work as well. So a couple years later then we got into mid- COVID times and I started having left foot drop. And my PT brain wasn’t tying these things together and said, “Oh, I’m working full-time. We’re essential workers down here. I’m treating patients. I’m not getting treated. I’m powerlifting. I’m hiking on the weekends. I just have a pinched nerve in my lower back.” So that went on for a few months, but then I had this incident where I really knew something was not right and it’s an incredibly boring story, so I won’t go into it, but it essentially led me to calling my primary and saying, “Hey, listen, I think you need to scan my brain. There’s something wrong. I don’t know if I just had a stroke.

I got TIA. I’m not sure what happened, but something is not right. So in abundance of caution, can we do an MRI?” 

Lorne Brown 

Did you intuitively, there’s that sense of something’s not right. So what were some of your experiences or was it just knowing or I know you had the foot dropsy, anything else? So I’ve

Heidi Gastler 

I had migraines consistently since I was a teenager, and they were very consistent with my hormonal cycles. I hadn’t changed over the years, but since I was 17 and I was then 40, I had never once had a migraine that had resolved without an intervention. So the foot drop came on simultaneously with a migraine aura, and five minutes later, the foot shop went away, migraine aura went away with zero intervention. And that was the thing that I was like, there’s something wrong because this has never once happened to me. And is there something with my brain and my foot that are happening together? And I started thinking, maybe I’m having little mini strokes or something. I’m stressed, I’m working out a ton. Maybe there’s something and intuitively I knew something wasn’t right. So that was a Sunday. The following Wednesday, I got a brain scan and had to be called to be told that I had a brain tumor literally the size of a softball.

And that had shifted my midline to the side and my brain. Hypothalamus was basically pancaked, and I had emergency brain surgery three weeks to the day later. One of the most interesting things for me was that I had the surgery, the pressure was removed, and my cycle completely normalized. So the POI, premature menopause, everything just completely righted itself.

Lorne Brown 

Right. So that was a symptom of a structural issue in your brain. And that was why I was asking, you talked about the hypothalamus, the pituitary being off. Sometimes when they’re, and I’m sharing this with the audience, when people are missing their cycle of all the common and cheapest ways to evaluate, one of them is they’re looking at the pituitary hormone prolactin because a tumor can push on the pituitary and we get hyperlactum, which causes delayed or no more ovulation. And if they have that, often that stress can do that by the way, but a tumor can do that. And that’s how we rule out something like that to … We always look to do no harm. So when somebody’s having irregular cycles, we rule things out like make sure it’s not the very bad stuff. And unfortunately, you had a very bad thing, a tumor in your brain.

Heidi Gastler 

Yeah, and that just was never caught.

And I don’t harbor bad feelings about this time in my life because I really feel like obviously I’m doing very well. So I feel like things may have happened at the right time. And I think back of it and go, okay, well, if we caught it then, would I still have gotten to the right surgeon and the right care team to take care of this? So I try not to harbor a lot of bad feelings about it, but you have to wonder, but there’s more frustration about why didn’t anyone just look? Especially when I asked, “Is there something wrong with my pituitary?” And was told no.

Lorne Brown 

And maybe they did look at your blood and your pituitary as normal, which is why they said probably not. Like you said, you don’t harbor because that creates resistance and doesn’t serve you the blame game. So you had the surgery and that premature ovarian sufficiency diagnosis and all the weird stuff happening with your cycle changed. So now you’re back to ovulating again. You’re no longer told you’re menopausal.

Heidi Gastler 

No. And at this point, I’ve got my regular 27-day cycle on the nose every month, things are fine. And so I recover from that surgery and I get 15 months. Things are great and I have no more symptoms, nothing could trigger anything, but I was just having brain scans every three months. And 15 months later we saw that it was coming back and metastasizing. And quite rapidly within December to February, I had three separate tumors growing all at a fast rate. And at this point I was upstage. You’re no longer stage two, you’re now stage three. And so I had another brain surgery, and at this point we knew that they were going to want to do chemo and radiation. And I was told by my oncologist, which thankfully she was thinking this way too, as soon as you start this chemo, all bets are off.

You’re probably going to go into chemically induced menopause, and this is kind of a now or never. If you think you might want to have kids, then this is the time. So part of the interesting thing was that when I was doing, and I skipped over this, is that when I was doing that fertility stuff before surgery one, the IVF drugs weren’t working to do egg retrieval. I was doing acupuncture, I was doing all the things, but really my body wasn’t responding. And looking back at it, it couldn’t respond. It couldn’t respond to the medications, it couldn’t respond to the other therapies because it didn’t have an organ to go to. So after the pressure was off, my body responded to the meds and I thought that that was a really interesting thing because I was like, “Oh, this is such a different experience in time one.” So I got a couple of cycles in and at that point the acupuncture was helping, the drugs were working, I had a couple successful cycles and very literally the minute I started high dose chemo, the cycles stopped.

I mean, that was it. There’s nothing more. And that was the beginning of a chemically induced menopause. And my particular experience with going into a menopausal transition was so abrupt that my symptoms were incredibly severe. So we kind of got from that October when that started to the following August, and we elected to put me on HRT. And so my neuro-oncologist was working hand in hand with my OB- GYN to then start me on HRT so we could see, was it my brain that was creating these symptoms? Was it hormones or was it my brain without the hormones? And I think that the third thing was really the big deal because as we know, the brain has so many hormonal receptors and I just had nothing left in the tank. So my experience with going on HRT was incredibly positive. And in that time before, I mean, I’ve been trying to do every lifestyle factor I could to try to combat this.

And I still do all of that, but adding in that hormone replacement therapy for me, it basically felt like it saved my life. So that brings us to now.

Lorne Brown 

It’s different now. So you went through everything. So you’ve had IVF, so egg retrievals, you did lots of integration. You’re trained as a pelvic floor therapist, but you did acupuncture, some body work, I’m sure some supplements, and even HRT, hormone replacement therapy. And now that you’re still on the HRT now?

Heidi Gastler 

Yes.

Lorne Brown

And how did this shift now, how do you practice and how did it shift you? And where I’m going as, so many people when there’s life-changing events like you have had, I call them wake-up calls. Something happens and it just shifts. You take a new trajectory in your life, a new path because it’s such a wake-up call. And I never call them gifts. Some people say it’s a gift even after I say, well, I like gifts and I wouldn’t last for that. I call them opportunities. I like to be, if I can, impeccable with language here on this part, they’re opportunities. It happened to you. It is what is. Knowing you and doing some preparation before our interview, you’re doing well because of it, I would say. And I’d like to hear or have you share how this was a wake-up call and has it changed you from Heidi before that diagnosis to Heidi now, how you live and how you practice?

Heidi Gastler

Absolutely. So I feel like it’s important to backtrack a little bit and go into this and tell you that I had been doing a lot of self-work and a lot of work on my mental health since I was in my 20s, so that was already a really big part of my life. And so I feel as though I came into this very mentally well and with a lot of tools for stress management and for just deliberate coping. And I have been an endurance athlete for a long time, and I’ve talked to a number of other friends of mine who have shared lived experiences being endurance athletes, and I’ve then also gone through different cancers and treatments like myself, and we’ve all agreed on the same thing that through that endurance activity stuff that we did before this and hopefully continue to still do, we essentially have learned how to be really comfortable with being uncomfortable.

Lorne Brown 

Oh, that’s key. You had to say that again.

Heidi Gastler 

Yeah, I feel like we all agree that we’ve become really comfortable with being uncomfortable. To put it in a different phrase, one guy told me, “We really know how to suffer better than other people. ” Endurance athletics, I mean, there’s a certain amount of acceptance you have to have that this is going to be type three fun.

Lorne Brown 

We called it acceptance. I got to unpack this because we’re going to talk about this probably later in your episode with me, but in that notice, accept choose, again, in my process, except so I’m going to say that’s the key, being comfortable in your discomfort. So you have to lean into the discomfort. So Buddhism has a beautiful expression for this, Heidi, is pain is inevitable, suffering is optional. I love that. So endurance athletes, it’s painful. You’re experiencing the discomfort, but you’re not fighting with it. “Oh, why? You shouldn’t be this way. I don’t want to be this way. “That creates suffering when you’re not accepting what is. So when I do my conscious work, the question I have is, are you willing to be uncomfortable? But now you have some agency. When you are doing endurance training or racing, you are choosing it. It hasn’t been forced upon you.

It’s still uncomfortable, but you’ve chosen it. So I call that letting go or acceptance, meaning it’s not that you’re at peace in that unhappy situation, or in this case, you’re uncomfortable and you’re accepting the discomfort. Therefore, that Buddhist expression, pain is inevitable, suffering is optional, it’s uncomfortable, but you’re not amplifying it by thinking,” I don’t want this. I shouldn’t have this.

Heidi Gastler 

“Or that, ” Why is this happening to me or feeling like some sort of victim idea? Exactly. And in reality, when it comes to a cancer treatment type of thing, I’ve chosen to not do radiation and chemo. I had that agency, but I was also informed by people who are way smarter than me about cancer that for my condition, this is the recommended protocol that we have at this time. And obviously medicine is always evolving and changing. So if I have to go through this again, the protocol might be different, might be better, might be worse, but I can kind of accept, do I want to fight this? And in that, there’s going to be discomfort, or do I want to let go and go, “I’m done.” And I’m nowhere near that. And I’m so fortunate that I have practitioners who really encouraged me to continue to live my life.

And I always feel very fortunate that my doctors wanted me to do everything I could to remain strong, encouraged me to continue to do my athletics and do my recreational pursuits. They encouraged me to work if I could, versus giving me the like, well, you’re going to be carpet slippers in a bathroom here pretty soon. Because I have heard that too, where everyone’s expecting me to get sick. And in some ways, I almost think from a social perspective, if I had looked sick at some point or acted sick, maybe in a way socially people would’ve been more comfortable with my condition, but in no point did I accept that stopping my life or being sick was what I wanted to do. And so I was using that as a, this is how I want to approach this and I want to approach it from a perspective of, I went into this healthy, I did everything I could to be healthy.

I know how to be uncomfortable as an athlete and I can accept that discomfort and I can continue to move forward and I don’t have to just wallow in this discomfort. I think there was one week during the entire thing that I missed work, and it was simply because I was so fatigued at that point that there’s no way I could work. But every other day, I came in, I treated my patients, I did my athletics, I went for mental health hikes and did forest time on the weekends. My dog, I can’t stress this enough having a dog and no matter how crappy I felt on any given day, telling myself, I’m having a bad day, but I’m going to make sure my dog has a really good day. He and I are going to go for our walks and we are going to get him outside and play and I can focus on giving someone else a good day, even just your dog.

But I mean, he’s my baby and doing that and spending time and energy focusing on that versus focusing on me feeling crappy, it was just an absolute mental game changer.

Lorne Brown 

You remind me of a book I read by, it was called Tuesdays with Maury. I’m trying to think of the author now, but it’s a famous book, Tuesdays with Maury.

Heidi Gastler 

I’ve Read. It was a long time ago.

Lorne Brown 

But he asked, because I think he has Lou Gehrig’s disease, ALS, the guy who’s interviewing, and he says, “I don’t understand how you do this. You seem to have a better attitude and life and spirit than most people, and you’re going to die the most horrible way.” And he says, “Oh, I feel sorry for myself, but I only give myself one hour a day. So I have my pity power for one hour because again, we’re not talking about spiritual bypass or denying here.” He accepted it. So there’s me, I tell you, I see an AC everywhere I notice except he was able to accept, he was able to lean into, “Oh, I don’t like this. I hate this, da, da, da.” Go through it and then he chose again. “Now like you, I’m going to be with my dog. I’m going to give my dog a great day.

“Because you’re not saying if you’re fatigued, you need to push through. You’re not saying that, right? No. But you were trained as an insurance athlete, so you’ve been trained to push yourself when you don’t want to do something. And so you had that training physically and mentally, which a lot of people, unfortunately, who get cancer are insurance athletes, so they need the extra support because they don’t have the background. Like you said, in your 20s, you’re already working this way mentally, and because of who you were, you had trained for cancer treatment.

Heidi Gastler 

Yeah. And that’s the best thing I can tell a lot of people going into it, that it’s like you cannot in so many instances prevent cancer from happening. You can be a non-smoker, sure. You can eat healthfully, you can do that stuff, those lifestyle factors. But there’s a lot of cancers. It doesn’t matter if you’re being the healthiest of healthy. And I would describe myself as the healthiest of healthy. And the fact that I went into this as a healthy, strong, physically fit individual allowed me to fight it better. And I think that that’s something that we need to think about as we’re aging too, is we’re creating this resilience when we’re younger so that we can tackle things as we’re older, whether it be cancer or be osteoporosis or what have you. They’re all chronic diseases. And so if we are stronger going into it and more healthy, both physically and mentally, you can then have the resilience then to get through it.

Lorne Brown 

And this brings me to your menopause journey and your professional, how you support women. And so because you said the word resilience, and I often think of you need to have that resilience capacity internally to go through perineal menopause and menopause smoothly. Yes. And we’ll talk about that possibly later, definitely on your episode with me. We can talk about that. I want to hear your side of it. So you’re a pelvic floor therapist, and we often in my clinic, we refer people like you for our endometriosis and pelvic pain patients. And then a lot of perimenopausal women are having issues with urination, frequency, urgency. So what is your approach? And I’m actually going to ask you some more questions around this. So I’m going to want to know about your approach, the urogenital, where are you as a physio? Because some people with menopause go, physiotherapists.

So I want to bring that awareness to them. In my practice, I don’t know if it’s your practice, but women that I’m seeing often have been dismissed, unfortunately, in the medical system by female and male physicians, by the way, it’s not. And they come in because they don’t have hot flashes, night sweats, but they have other things, brain fog, start to get skin rashes, vaginal itching, urination issues, painful sense, doctor sex.

And they come in with medication for their pain. They come in with medication for their depression, medication for their sleep. So they’re on a lot of different medications. And I will usually assess them. I say, oh, you’re in perimenopause or it’s menopausal related, so there’s other ways we can address this. So I’m curious now, your way, when somebody comes in with these cascade of symptoms, what is your approach? How do you assess them? You talked about having tools for stress management, maybe you’ll share some of those. But as a physiotherapist, who are you integrating with? What tools are you using to, A, make sure these women feel heard and seen and not just feel seen heard, but get assessed properly and get the modalities and treatments so they can stop suffering unnecessarily?

Heidi Gastler 

Sure. So during the first assessment, when I’m first meeting somebody, we probably talk for 45 minutes out of an hour session. This is usually pretty unexpected for people, but I want to hear their story, I want to hear about their lifestyle, I want to hear about their complaints, I want to hear about their relationships. And oftentimes I start people with incredibly simple tools. And when I say simple, I mean, not easy to do, but the baseline foundational pieces. If women are coming in and they’re telling me that they do nothing for stress management, I talk with them about what are things that you’d be willing to do that you like because the tools I use might not be the tools that you use, but I’ll use myself as an example and go, “Hey, this is what I do. What do you like to do? ” And I want to get them thinking about what things I could be doing to help to reduce my stress.

The second thing I’d ask them about is diet, exercise, and hydration. Because I would say that the majority of my patients, especially when we’re talking about perimenopausal and menopausal females, and then also my postpartum mothers, which postpartum moms are another big group that I see in the pelvic health space. They’re eating terribly. They’re not drinking enough water, so they’re not getting basic nutrition, they’re not getting basic hydration, and they’re getting little to no movement. A lot of times they’re very sedentary and they’re high stress, whether that’s because they’ve got a family they’re taking care of and maybe they’ve got a newborn and two other kids at home, maybe they got the newborn, two other kids and they’re trying to return to work. Maybe they don’t feel like they’re supported by their partner at home. And I want to hear those things because those help to clue me in as to what we have going on psychosocially that we need to address in order to make them whole and treat them as a whole person.

And that might be professionals that are not me. Oftentimes I’m referring to dietetics or nutritionists. And I’ve been registered as a nutritionist that I love to work with that I refer to often, especially for my older women, because this nutritionist is a 72-year-old triathlete and she walks the walk, but is the correct age. So instead of sending my patient in their 70s and their 80s to a 20-year-old, they feel much more connected to somebody who’s more age appropriate. So I really like to send someone, and I try to match patients to other providers that I think are a good personality match, as well as a match of what they need to learn professionally. The other things that I do during the first of this is I really want to hear about what they’ve already tried, what’s worked, and what hasn’t, because I’m not trying to beat a dead horse.

If you have already tried all of these things, I try to come in and think, “What haven’t we tried?” If I’m the first stop, first stop, the other thing is that we’re doing an initial assessment is looking at where do you have pain, doing a pelvic Mapping with palpation, if someone’s comfortable and if they’re not, we just wait until they are because I tell people I’m not here to add trauma for you. So if you’re not comfortable doing a vaginal exam today, we just wait until you feel ready for that. I’m a stranger to you. You might’ve walked in my door and five minutes later I’m doing a vaginal exam and I understand that that can cause people a lot of stress, tension, trauma. And if I’m a perceived threat, we’re not going to develop a good professional relationship. So if that’s the case, we might be using external biofeedback to look, can they contract their pelvic floor at will?

Can they relax? Can they coordinate their breathwork with it? And can they do it by laying down, sitting and standing? And so we usually have a lot of talking and just the basics of where we are. And then that helps to guide me in terms of other professionals I might need to refer out to being therapists. Sometimes that’s a sex therapist. Sometimes that is somebody who does somatic therapy or cognitive behavioral therapy. Sometimes that is an orthopedic surgeon because I need to get them involved. Maybe that’s a urogynecologist or some sort of other QIN who can help me do more internal testing that I don’t have the ability for. Sometimes that’s neurology because I suspect there might be some sort of neuropathic component for someone maybe like myself who maybe had chemotherapy or something and there might be some sort of neuropathic pain. But that initial assessment helps me to guide what spokes in the wheel I need to pull from to create a care team around that individual patient because I recognize that I can’t do it all.

But also it’s a lot having to do with that first visit about making sure they feel seen and heard, making sure that they feel safe in my office. And I really try to have this be a warm, safe space. And this is like a podcast background, so you can’t really see my office. But every patient who comes in here, they’re the only patient that I see for an hour. And the space is theirs once they come in. So once they come in, the space is theirs. I want people to just take a load off, be able to have this be their space for that hour and really feel as though they have my one-on-one personal attention for that whole time. And I think that that’s part of what makes me really different is that there isn’t somebody on another partition of another wall that can hear them.

So they can really let it all go, whatever that is. And that allows me to start the process. And I think that my own personal experience bringing this in has really been, I started this practice because I wanted to treat patients the way I wanted to be treated as a patient. And that was before I ever turned into the patient per se from this avenue. But then my personal experience has only really increased my empathy and understanding for the difficulty of the exam, the difficulty of being patient and realizing that this isn’t going to be something that just fixes itself overnight, really understanding the impacts on personal life. And I’ll say this with no hesitation, that huge part of my conditions have become things that have to do with menopausal and vaginally related issues, that that has been a big part of my post-chemo journey and recognizing how much that impacts my personal life and my relationship at home and recognizing how these patients are going to be exact same thing and how alone I have felt multiple times because my peers and my best friends aren’t going through this yet.

So if I’ve got a patient coming to see me for something like that going, okay, this is how I felt, and really trying to make sure that person does not feel the same way. And that has really led me into these other aspects of my career, creating these online educational platforms and groups of trying to help women find community and helping them also to bring their partners in if their partners are willing to, so that their partners start to learn so that they can become better partners for their female counterpart so that the woman doesn’t feel alone and crazy at home either because I think that’s so important. I have so many men I see, and a lot of my male patients who are not pelvic floor patients, they come in and they’re telling me, “Oh my God, this is what’s happening at home.” And I’m like, “Let me tell you about something called perimenopause.” And almost universally, every single one of them is like, “Tell me more.

I want to learn more. I want to learn how to be a putter partner.” And recognizing that we as women don’t know enough, we as providers are learning because we had this kind of 20-year gap in knowledge that we weren’t educated in school, so everyone’s kind of trying to play catch-up. So if the doctors are trying to play catch-up, the women are trying to learn how on earth are there male partners who aren’t going through this going to know? Or if it’s a female partner who isn’t in the same life stage, how are they going to know? And helping to provide this educational resource to expand general knowledge base and be another voice of service here and hoping that then this has to trickle down to the next generation that maybe they have more knowledge coming into this and can handle it better than we have, and certainly how my elders and my mother and my aunts.

Lorne Brown 

Your patients are so fortunate to have you because of your experience, so you can have that empathy. And from the guy’s perspective, I have a large group of guys I go with regularly and all of our wives are either perimenopause or menopausal, and there once was a discussion of how the wives, some of them have changed, and it wasn’t a beat on your wife’s dinner. A few of them were genuinely scared of their wives, like what has happened?

Heidi Gastler

The rage.

Lorne Brown

And after we chatted and people were experiencing, one of the guys was so grateful we shared because he thought it just isolated his relationship and he wasn’t sure whether he should stay in the relationship or whether she wanted to … He just couldn’t understand it. And then when he started to learn about what’s this perimenopause, because a few of us are health professionals, he said, “I can stay in it now. This doesn’t last forever.” We’re like, no. And then how do you support her and how do you not support her? So it was a really interesting conversation. He literally said, “This is going to help,” because he thought it was unfixable and basically an alien had taken over his wife. It’s not the same person he was married to. He was like, “I don’t know what happened.” But when he understood there was a shift happening hormonally and what’s happening, he stopped taking it personally and now he could have empathy and compassion and patience and understanding.

So this goes back to you being one of those people that people can go to. You understand you have a community. We’ll put some of that information in the show notes so people can find you as well. Please, too. I’m curious then, because you mentioned a bunch of different modalities, have you or do you, because you’re a physiotherapist, do you ever do the acupuncture or dry needling for pelvic health and low level laser therapy? Because I think of the pelvic wand that’s put out by fringe. Is that something that gets used in your practice? Because we offer that to patients. We don’t use it in our practice. We offer it that they can buy and take home to use the pelvic one low-level laser therapy. And I’m curious about acupuncture and dry needling for pelvic health.

Heidi Gastler 

So dry needling and acupuncture is interesting. So California is one of the few states that does not allow physios to dry needles legally. I did dry needling in Minnesota before I moved to California, and I moved out here in 2010 and has not changed in terms of legalities much to my dismay. So I generally refer out to acupuncture for pelvic health because we simply can’t do it. I’d love to, but we just simply legally can’t do it. And then with that being said, I refer out to acupuncturists often, whether it’s for pelvic pain, neuropathy, orthopedic pain, fertility, you name it. And I have several acupuncturists that I really like locally that I kind of have part of that scope of my network that I will add to the patient’s care team. The low level laser therapy, the fringe wand. Oh,

Lorne Brown 

Let me find one.

Heidi Gastler 

I have mine here and I refer to this very, very often. And I also, their show and tell hot approach.

Lorne Brown 

We both have our fringe wands out, everybody.

Heidi Gastler 

I was going to say,  hold on, let me get mine out. It’s like a Lightsaber. 

Lorne Brown 

When I first started, I’m carrying the pelvic wand here, so I’m holding the pelvic wand. Mine’s not charged. But Tracy, a midwife colleague, I made a post to build the pelvic wand for my women patients, et cetera. There she goes. Howdy’s holding it up and it does blue, red, infrared. And I’ll find

Heidi Gastler 

Yeah, so it was the high power and then that’s still medium power. That’s red.

Lorne Brown 

Yeah. 

Heidi Gastler 

And then you’d have the blue, which is kind of hard to see on your note, actually turned off. Hold on a second. There we go. There’s the blue. It’s just out of

Lorne Brown 

Frame. Yeah. So I’m curious about your experience with this and with patients, because the people at Fringe and Tracy were really excited about it, and we could talk a little bit about the mechanism of it. But I was sharing that, Tracy, I was talking about blah, blah, blah, the women, the women, women, and she posted, there’s a place men can stick this too. They do have a prostate and they do have issues with that. So I was like, “Fair enough.”

Heidi Gastler 

Fair enough. And I mean, it is not very big. And I’ll tell you, I was on the team helping with the physical design of this. 

Lorne Brown 

Alright, so you helped design this. 

Heidi Gastler 

I did.

Lorne Brown

Great. 

Heidi Gastler 

I was not on the side that does the science behind the lights and stuff. That was all them, but I have so many light therapy wands in my office right now

That it looks slightly ridiculous because I was trying all the ones that were on the market because the whole idea here was how to make a better product. And we purposely made it so there’s a graduated end. So it’s narrower before it gets wider because so many of the other ones were so wide that if you’ve got somebody who’s coming in with pelvic pain, that looks incredibly intimidating or is just not doable. And so I will use this with patients often, not in clinic, I’ll have them get them for at home, but sometimes I just have people start with a light therapy panel that they’re shining externally in between their legs for the red light therapy because they might need more superficial care and they might need more superficial inflammation reduction before they can do something internally. But as we know, proximity matters. And so it’s awfully hard to get light therapy at a low level into the vaginal tissues from the outside.

So sometimes we need to do more of the labia, we need to do more of the vulva and that vaginal introitus. So we’ll do light from the outside. And I may instruct somebody that you’re going to do light from the outside and use a much smaller dilator kit to get started, especially when we’re dealing with a vaginal pain issue if I’m wanting to add light therapy in. And then from there, once they graduate to a dilator kit size that they can use light therapy intervaginally, I think it’s a fabulous treatment both for vaginal dryness, vaginal inflammation, painless sex, lubrication because dryness becomes such a problem with perimenopause and menopause and postpartum. And we don’t want to forget about that. The reduction in estrogen postpartum can really create that vaginal dryness and discomfort as well. As well, if someone has a vaginal birth, the healing internally that might need to be happening.

And I love the fact that you can let this one sit in the internal canal. You can just let it sit there, or you can also use that end and we made it a kind of a gentle palpating end so people can actually use that for trigger point release and therapy and vaginal stretching internally of those internal muscles that are very difficult to stretch and open up externally. And it’s easier to access through the vaginal canal. And I actually just recommended this for the blue light therapy specifically to a patient yesterday who’s been dealing with chronic recurrent bacterial vaginosis. And the blue light, because of the antimicrobial effects, is fabulous for things like chronic yeast or if you’ve got something that has to do with a BV and just helping to normalize and regulate that vaginal pH, which again, can get off because of hormonal shifts and changes.

Lorne Brown

Yeah. When we brought this in, we were excited about it because A, for our perimenopause, menopause women, as you’re sharing, blood flow lubrication, but my endometriosis, pelvic pain patients, and then theoretically fertility, because with light as there’s distance, it loses its power, its edge, right? And there’s an inverse relationship with distance to the target tissue. So right now, currently light therapy for fertility is over the lower abdomen and the sacrum, but there’s a lot of distance to get to. And if you have a probe, you push into the abdomen to try and get close to the ovaries. But it was an REI many years ago when I gave a presentation on light therapy for fertility, he said, well, why don’t you just put a laser diode on the end of the camera that we do for an egg retrieval, but rather than a needle, it’s a diode and just pointed at the ovaries.

I said it doesn’t exist. That would be great. And when I saw this, I was like, “Here’s an opportunity to put light into the pelvic bowl through the vaginal wall because it’s thinner.” I mean, nobody studied it, so I don’t know the benefits, but theoretically this looks great. And I did take their device and we have a light reader for photons

Heidi Gastler 

Because

Lorne Brown 

A lot of them that people bring to me to assess my patients, I can’t get a reading off of them, meaning they’re not sufficient and power given off photons because the photons have to reach the target tissue to have benefit. The fringe wand does, so we get to read.

Heidi Gastler 

That’s awesome.

Lorne Brown

Now I’m seeing this as an opportunity for pelvic health, for pelvic pain, and then menopausal women and fertility. So it’s a really interesting device. And like you said, it’s got blue, red, and red combined with infrared, so three options to use it.

Heidi Gastler 

And I’ll tell you to choose because I have no TMI. With my own personal pelvic health stuff, I use the Wanda myself because of having all of these chemo-related vaginitis, vaginismus, vaginitis types of things, this has really made a big difference for me. And I have no problem saying that because I have tried probably every device on the market at this point, and this one has not only helped more with the pain, but also the inflammation I’ve been having and some of the modulation of the neuropathic pain. And right now I’m not trying to retrieve more eggs, nor am I trying to get pregnant, but those things have been such a gift. And so I refer to these patients often because I think that it really is a fantastic device and opportunities for us to get into those deeper tissues. And you mentioned endo, and I had mentioned that before, but that part of it.

And I also think even some things like potentially like interstitial cystitis or things where you could have bladder stuff or having overactive bladder just because you can get it closer from a different angle and getting it towards that bladder neck could also be helpful.

Lorne Brown 

So the light therapy for IC, so interstitial cystitis, as you mentioned, just externally where we give the array and they place it on the lower abdomen over their pubic bone in the sacrum, we’ve been able to get great resolution for that for patients. And I haven’t had patients try this yet, but yes, theoretically it’d even be better if you got it closer. So intravaginally would be really beneficial. For our Canadians, we buy, because of the tariffs we now have in Canada that buy it in the air and the exchange rate, we often buy some bulk orders so we can keep them cheaper than if you go directly to their site. So check in with us, we go in and out of supplies for people to buy in Canada, just to let you know, especially in the Vancouver area. And for the acupuncture, I do want to share, Heidi, it’s unfortunate that you can’t practice that in California, but I will share on the site that I run the platform Healthy Seminars, we have an acupuncturist in California named Denise Wiesner, trained as an acupuncturist and trained in dry needling, and her whole thing is on pelvic health, pelvic floor health.

And so she has a course in healthy seminars for physios and acupuncturists that want to learn to treat pelvic health, pelvic pain. And she teaches a combined dry needling approach and traditional acupuncture using distal points as well just to shout out for those that are interested in acupuncture. And if you’re looking for some of your colleagues to get trained, that’s available on Healthy Seminars through Denise Wiesner.

Heidi Gastler 

I appreciate that. And trust me, the minute that we’re allowed to do it here, I’m going to be taking a pelvic pain force because I get at least two emails a day, “Well, come join a seminar for a dry new link for your pelvic pain.” I’m like, “I would love to. I legally can’t do it here.” So I’m like, in a minute I can, or if I move states, I will absolutely be doing it.

Lorne Brown

So what do you think from the nervous … Because you talked about tools for stress, and I often see, and I’ll share with you my observation for women in perimenopause and menopause, I often share that it’s not just the hormones. The underlying cause is not so much the hormones. And I say it this way, is that if it was the hormones shift as the issue, then every woman would have symptoms and pretty much the same symptoms. But we know some women, they use the expression sail through perimenopause, menopause, and some people don’t. And what I share, and I bring this in from my clinical hypnosis background as a clinical hypnotherapist and conscious work and Chinese medicine, is this idea of resilience. You brought up this word resiliency as well. And this is on a cellular level, so it’s not like it’s the biology part here.

If there’s resilience in the body, then it has the capacity to deal with change. We’re all familiar with external change, change in work, change in city, relationship change, that’s obvious, but there’s internal changes happening all the time that we don’t even know because the autonomic nervous system is dealing with everything. And what I see with perimenopause and menopause, which is why I like to address the resilience part is all of a sudden you’re having fluctuating estrogens in perimenopause with a decline in progesterone. And then in menopause, like in your case, medically induced, you actually have a drop now in estrogen and progesterone. That’s a change. And if your body does not have the internal resilience, and I don’t know why, there’s not a judgment here. It’s just that the body’s giving you messages, then you don’t have the capacity to deal with the change and now you suffer.

So first of all, I don’t know if that aligns with you or resonates with you, and if it does or doesn’t, let’s discuss what is part of your approach?Because we talk a lot and people are pretty familiar with the physical approaches. “Oh, I can do dry needling, we can do PT, we can take HRT. There’s all these things that can help a lot. And it may not be actually addressing the underlying, underlying cause, but you got relief. So I’m all for that. The reason I say the underlying cause is if we just treat and the symptoms go away by giving you hormones and your hormones are balanced, this is great. You sleep well at night, you get your mental capacity, everything feels good, but if that internal resilience is low, then at 70 or 75, new diseases are going to show up because that underlying resilience was never addressed.

And as we age, we’re going to have a less resilience capacity and then there’s more breakdown. If we address the resilience in our 40s and 50s and learn to maintain that, then we live well longer. And so how do you look at the mental, spiritual, or the autonomic nervous system approach, if at all? And my idea of resilience and capacity to adapt to the internal hormonal shifts, is that something that you’ve seen or is there agreement or disagreement on that?

Heidi Gastler 

I absolutely agree. And I can tell you, it’s probably the same things for myself that I also impart upon my patients. And again, I like to use myself as a personal example and then just say,” Listen, this is what I do and these are my tools, but what do you like to do? “Because I’m not going to push myself onto them, but the things that I like to do are … The first thing I’d say is exercise. Second thing I say is time outdoors. Third thing I say, it’s friendships and relationships. Exercise, I power lift and that’s like I like to lift heavy. It helps me be present and focused. And for me, it’s like a meditation through movement. Some people like to do yoga. I don’t dislike yoga at all, but when I’m lifting heavy I have to be very focused and present, so I’m doing this thing right here, right now.

It helps me to ground, recenter, be super focused, and then get all the happy hormones afterwards. So having consistent lifting practice has been very helpful for me because again, for me, it’s meditation through movement and it’s just being very focused and present in the moment. The second main thing that I do for exercise, which also coincides with my time outdoors currently, is hiking. And my best friend here in California, she and I hike almost every single Sunday, anywhere from five miles to 20 miles, just depending on how we’re feeling, weather, et cetera. And we call it our cortisol reduction walks. We’re not going for time, we’re not sprinting. We look at flowers and we’re looking at the rocks and we’re solving the world’s problems through talking for five hours. My dog was with us until we’re just outside enjoying nature for a day.

And that reset on Sundays before starting my week is just invaluable. In the weeks we miss it for whatever reason, I feel it the entire week. And then that kind of also goes into friendship time and having very solid friends and in that kind of emotional support group, and I’m very fortunate in the fact that I have very good, very long-term friends, especially for me having my solid female friendships and having had that support through these difficult times and just on a daily basis and having time speaking with friends, talking with friends, talking through what’s going on in our lives and having that support, I think is really my big three. And of course there’s other things, but those are kind of my big three. It’s like exercise, time outside, friendship, connection.

Lorne Brown 

Yeah, I’ll summarize that because it aligns with the Chinese medicine idea as well and what we do in our practice. So movement, and you talked about different types, but movement, community, and then getting outdoors, being in nature, getting your morning sunlight and just fresh air. So yeah, and those are the simple things. In Chinese medicine, lifestyle is one of the pillars of Chinese medicine, diet, lifestyle, movement, rest, sleep, and then stress management, like community, connectivity with other people. So you’re doing it.

Heidi Gastler 

And that third one, well, I guess any of these three pillars are things I see breakdown with patients that are struggling with their own resilience. But of those three, the thing that I see the most clinically is people not having that connectivity and having that support and people feeling isolated, especially with my older folks who feel like they’re kind of increasingly isolated from my younger folks that they just get really isolated for whatever reason. That is the one thing that I try so hard and there’s nothing I can really do about it, but I can encourage people to find ways and help them to find tools to find groups to connect with and get out of their own heads and have that connectivity. Because when that fails and when that’s lacking in my patient’s lives, they really feel it and I really see it in the clinic.

Lorne Brown 

You have an abundance of clinical experience and knowledge. As we wrap up, what would you like to share from the host of Menopause and Scripted? What would you like to share with this population of just any closing remarks or suggestions, advice, and also where they can find you?

Heidi Gastler 

Yes. So you can find me at www.hey, H-E-Y, Doctor, just D-R, Heidi, H-E-I-D-I.com, or menopause unscripted. Either of those places were all social. If you want to come and watch the podcast, there’s a video podcast on YouTube. It’s on every other channel you can imagine. And the conversations in both of these spaces really have to do with midlife women’s health, but don’t be thrown off on the fact that I say women, because again, it’s very inclusive. If you are a gentleman or if you’re with a female partner who’s going through this and you aren’t, you can certainly learn a lot about how to be a better supportive partner. So that’s where you can find me, but you’re welcome to come in if you happen to be in the Los Angeles area. I also do virtuals for people as well. As I recognize that a lot of people may live in an area where finding a pelvic floor physical therapist is challenging, I’m happy to help you that way as well.

And in terms of last closing notes, I just really encourage people to learn more about what they’re going through and become more educated as a consumer so that you can be a better advocate for yourself with your healthcare providers. Learn some questions and go into your doctor’s visits with a list of questions so you get the questions you have answered and you go out leaving feeling as though you’ve been seen and heard. Because a lot of times if you don’t know the questions to ask, then you don’t get the information you’re actually seeking. And so I think going in and having some preparation for that visit is really helpful because we all do need to be our own best self-advocates.

Lorne Brown 

Yeah, be an advocate. And I like when patients come organized with a list and then they rapid fire, it’s like, great. It’s nice. Be organized. I appreciate it. Dr. Heidi, I want to say thank you very much, A, for sharing your personal story and then bringing it to your community so they get to benefit and heal and thrive. So thank you very much. Everybody, we will put all those links, social media or website’s going to be in the show notes. So do check that out as well. I’ll ask my team to put information about that pelvic wand as well if you’re interested to know more about that. And we are doing a swap, so I’m also on Heidi’s podcast so that menopause is unscripted, you can see what we talk about over there on hers as well. Heidi, thank you very much for today.

Heidi Gastler 

Thank you so much for having me. I look forward to seeing you in one minute.

Lorne Brown 

Thank you for spending this time with us on the Coherence Co-Podcast. I’m Dr. Lorne Brown, and I will see you next week for another conversation on coherence and healing. If this conversation resonated with you, please like, subscribe or follow the show, and also share it with someone who might benefit from it as well. Remember to take a moment to breathe, reflect, and stay connected. Welcome to the Coherence Code Podcast.