I am a healthy 78 year old mother of 2 with mild urinary incontinance, particularly when my bladder is fairly full and I cough. My MD, who is a DPC physician, has suggested 2 different approaches. Either the Emsella Chair, or pelvic PT. Insurance would pay for the PT but not the Emsella (a starting fee of $1000.) The PT is a few towns away and the Emsella is down the street. What do you think is the better choice for the long run? Any advice on how to make a wise decision?
I’m on long-term treatment for metastatic estrogen+ breast cancer. I’ve always thought vaginal estrogen therapy was contraindicated. But I have significant vago al atrophy and get frequent symptoms of UTI (not always positive for UTI). What is the best thinking on this issue?
Fantastic question and one that I get a lot. We used to tell women, unequivocally, that a personal history of breast cancer, esp if ER+, that vaginal estrogen was not okay. That has changed. As you know, the risk of topical estrogen is lower than the risk of systemic estrogen in patients with ER+ breast cancer. While the risk of topical/vaginal estrogen isn't zero, there are major risks of *not* taking vaginal estrogen, too-- as you clearly know well. So when I am counseling a patient I want to make sure they understand the latest data on the relatively low risk of vaginal estrogen (see expert statement/summar here: https://www.menopause.org/docs/default-source/professional/management_of_genitourinary_syndrome_of_menopause.pdf) and I want to understand how the absence of local estrogen is affecting their quality of life. It's only *then* that the patient can make an informed decision about risk/benefit. Nothing in life is risk-free. We cannot make risk zero. We can only mitigate it -- and make sure that patients' quality of life counts in the decision-making rubric - always. I hope that helps!
I was so psyched to see this subject line. But as a woman who has never carried a pregnancy to term, I was shocked to learn in my 40s that -- as my GP said at the time -- age and gravity comes for us all. Even women who have never been pregnant can develop pelvic floor issues, from mild incontinence to pain during intercourse. Please don't make nulliparous women invisible!
You are exactly right .. which is why I wrote “Pelvic floor weakness can be caused by pregnancy and childbirth but also can occur in women who have never been pregnant.” ☺️
I am a healthy 78 year old mother of 2 with mild urinary incontinance, particularly when my bladder is fairly full and I cough. My MD, who is a DPC physician, has suggested 2 different approaches. Either the Emsella Chair, or pelvic PT. Insurance would pay for the PT but not the Emsella (a starting fee of $1000.) The PT is a few towns away and the Emsella is down the street. What do you think is the better choice for the long run? Any advice on how to make a wise decision?
Gosh - that’s really a personal decision. In my opinion there’s no substitute for personalized PT… if you are willing to drive!
I’m on long-term treatment for metastatic estrogen+ breast cancer. I’ve always thought vaginal estrogen therapy was contraindicated. But I have significant vago al atrophy and get frequent symptoms of UTI (not always positive for UTI). What is the best thinking on this issue?
Fantastic question and one that I get a lot. We used to tell women, unequivocally, that a personal history of breast cancer, esp if ER+, that vaginal estrogen was not okay. That has changed. As you know, the risk of topical estrogen is lower than the risk of systemic estrogen in patients with ER+ breast cancer. While the risk of topical/vaginal estrogen isn't zero, there are major risks of *not* taking vaginal estrogen, too-- as you clearly know well. So when I am counseling a patient I want to make sure they understand the latest data on the relatively low risk of vaginal estrogen (see expert statement/summar here: https://www.menopause.org/docs/default-source/professional/management_of_genitourinary_syndrome_of_menopause.pdf) and I want to understand how the absence of local estrogen is affecting their quality of life. It's only *then* that the patient can make an informed decision about risk/benefit. Nothing in life is risk-free. We cannot make risk zero. We can only mitigate it -- and make sure that patients' quality of life counts in the decision-making rubric - always. I hope that helps!
I was so psyched to see this subject line. But as a woman who has never carried a pregnancy to term, I was shocked to learn in my 40s that -- as my GP said at the time -- age and gravity comes for us all. Even women who have never been pregnant can develop pelvic floor issues, from mild incontinence to pain during intercourse. Please don't make nulliparous women invisible!
You are exactly right .. which is why I wrote “Pelvic floor weakness can be caused by pregnancy and childbirth but also can occur in women who have never been pregnant.” ☺️
Ah, I see now. Since the essay is centered around motherhood, I didn't get all the way to the end. Thanks for trying to keep us in the picture.