Episode 40 Regulate + Connect Pillars

Your Pelvic Floor Is the Missing Piece in Your Perimenopause Care (ft. Marlene Handler)

Spotify Apple Podcasts YouTube Amazon Music

I have been waiting to have this conversation for a long time. Not because it is hard to talk about, though as you will hear, that is part of the problem, but because I was waiting for exactly the right person. And then I met Marlene Handler.

Marlene is a licensed pelvic floor occupational therapist and founder of The Lifted Lotus in Williamsburg, Brooklyn. She is also a walking success story: someone who faced her own pelvic floor challenges after childbirth, was dismissed by a well-known OB-GYN in New York City despite being a healthcare provider herself, found her way to pelvic floor therapy, and came out the other side without pain, without leaking, and with a sex life she loves. Now she helps other women do the same.

In the Perimenopause Matrix, the Regulate pillar is about your nervous system: how your body processes stress, how it holds tension, and how it moves from dysregulation back to safety. The Connect pillar is about intimacy, pleasure, and sexual health. The pelvic floor sits at the center of both. And this episode is everything I wish someone had told me sooner.

In Part 1, Marlene and I cover how she got dismissed as a practicing OT and what that means for the rest of us, why the OT lens is different from the PT lens, what the pelvic floor actually is and what it governs, why women moving from postpartum into perimenopause are being failed by a fractured system, why leaking and painful sex and prolapse have been normalized to the point where women think they are broken, and the shame piece. The one that keeps women from making that first phone call.

If any of this is landing: the leaking, the pain, the shame, the withdrawing from intimacy and exercise and friendships. You do not have to live with this. It is not normal. And as Marlene told us: so much of it is treatable and preventable.

Part 2 drops next week. We are getting into what actually happens in a pelvic floor therapy session, how to navigate insurance, and the three things Marlene wants every single one of you to do for your pelvic floor this week.

“If sex hurts, you stop. You don’t need my permission. You just stop and say, this hurts. Your body is sending a signal that something is wrong. You need to listen to it.” — Marlene Handler

What You’ll Learn

›What the pelvic floor actually is, what it controls, and why one dysfunction in this area can create a cascade of symptoms across bladder, bowel, and sexual health
›Why occupational therapists approach pelvic floor rehab differently than physical therapists, and why the biopsychosocial framework changes everything
›How perimenopause care has become fractured across specialists who are not talking to each other and not referring to pelvic floor therapy
›Why leaking, painful sex, and prolapse have been normalized for generations, and what it costs women who keep grinning and bearing it
›How shame keeps women from seeking help, and why the first phone call is the hardest part

Key Takeaways

Your pelvic floor governs bladder, bowel, sexual health, arousal, orgasm, and even lymphatic flow. When one thing is off in that tiny space, everything can be affected.
Urinary incontinence is the number one reason people end up in nursing home care. It is completely treatable and preventable. This is not just a quality-of-life issue.
Most OB-GYNs, urologists, and GI doctors were never trained on pelvic floor health. The gap starts at the academic level: Marlene had one lecture in her entire three-year OT program.
If sex hurts, you stop. You do not grin and bear it. You find a provider who will help you.
Pelvic floor therapy often requires only five to seven sessions when done well. You do not have to commit to months of twice-weekly visits.

The Perimenopause Matrix Lab Review

I’ll analyze your recent labs through the lens of perimenopause and create a personalized roadmap showing you exactly which pillar to focus on first. No more guessing. Just clear answers and one actionable next step.

Learn more about the Matrix Lab Review

Perimenopause Symptom Decoder

Download the free guide and get clarity on what’s happening in your body. You’re not crazy. You’re not broken. You’re not alone.

Get the free Perimenopause Decoder

Resources Mentioned

— The Lifted Lotus
— The Lifted Lotus on Instagram (@theliftedlotus)
— The Lifted Lotus: 202 North 4th Street, Williamsburg, Brooklyn

Full Transcript

INTRO & ORIGIN STORY

Megan (00:00)
Marlene Handler is a licensed pelvic floor occupational therapist and founder of The Lifted Lotus, a holistic pelvic health practice in Williamsburg, Brooklyn. After facing her own pelvic floor challenges following the birth of her two children, Marlene went back to school to specialize in pelvic floor rehabilitation and has never looked back. She is dedicated to helping individuals overcome pelvic floor concerns, expand their body literacy, and improve their quality of life. With over a decade of experience as an occupational therapist, Marlene offers personalized holistic care tailored to support healing, balance, and overall well-being. She holds a Master’s of Science in Occupational Therapy from NYU and has trained with some of the most respected names in the field, including the Herman and Wallace Institute, Lindsay Vestal of the Functional Pelvis, and Lynn Schulte of the Institute of Birth Healing. She also holds certifications in sex and intimacy and trauma-informed care, and serves on the board of the New York State Occupational Therapy Association, where she advocates for expanded access to pelvic health care. When she’s not in the clinic, she’s spending time with her kids, walking the Williamsburg waterfront, and doing a cold plunge. Welcome to the show, Marlene.

Marlene (01:13)
Thanks, Megan. I’m so happy to be here.

Megan (01:16)
I’m so excited that you’re here today because I have wanted to have this conversation and cover this topic for so long, but I was waiting for the exact right person, and then we met. Shout out to Alexis from Plus Brooklyn, who created the Brooklyn Female Founders community where we connected. It has been such an incredible group of women and support, and I am so glad that it exists.

So pelvic floor is a big topic. I think an often misunderstood topic, and something that is so central to women going through perimenopause. What was the moment that you realized pelvic floor health was something that nobody was talking about, even amongst health practitioners? And why did that moment, or moments, call you to this work?

Marlene (02:06)
Such a good question. I think the moment that it really dawned on me that there wasn’t support was after the birth of my second child. I felt like I really had some symptoms and things going wrong that I didn’t have answers to. And once I started talking about them to my friends, not my OB-GYN, because I was being dismissed, but my friends started telling me that pelvic floor therapy was a practice area, and not only was it a practice area, but that I could study it as an occupational therapist. That was a really big turning point in my trajectory. After being an OT for years and working with children, I decided to go back into postgraduate training to specialize, so that I could provide answers to women that I didn’t have answers to for myself.

Megan (03:02)
Going back to school after you’ve done all the things really makes a huge difference, and it means that it was something that you were super passionate about. And I just can’t believe that as a practicing OT you were being dismissed, which means that if you, with that knowledge base, are being dismissed, then what happens to the rest of us who don’t have that knowledge base? We just get sent home with a “you’re fine.”

Marlene (03:23)
Precisely. I think about this all the time in terms of access to care and equality and resources and knowledge. I know a lot of things and I have so many resources, and I was still being dismissed in 2018 by a very, very well-known OB-GYN in New York City. I will sit on top of this soapbox for probably the rest of my life advocating for this and normalizing these conversations, because if I didn’t have answers, if I didn’t have support, and I felt dismissed in 2018 in New York City, what is the rest of the world doing? They’re feeling so alone. They’re feeling ashamed. They’re feeling isolated. They’re feeling like they’re broken. I hear that time and time again. “I’m broken. Something is wrong with me.” And so much of it is treatable, and so much of it is even preventable.

Marlene (04:25)
Right, if we have the right knowledge. But as an age-old problem, women have not been studied in healthcare until the nineties, especially female anatomy. And we are really just seeing the effects of that now in 2026, in terms of the lack of access and the lack of data that we actually have to support what women are going through versus what men are going through.

Megan (05:00)
Absolutely. And that data narrows even further when we laser focus down on perimenopause and menopause and that transition. There are even fewer studies and fewer dollars going toward that research, and we’re 51% of the population. So my work lives in the functional and integrative world, which is a root cause, whole person approach. If someone comes in with perimenopause symptoms like hot flashes, brain fog, or gut issues, we’re really going to dig into the origins. What is their metabolic health looking like? Are they sleeping? Are they pooping every day? It’s not a “take a supplement and I’ll see you in three months” kind of work. When we met, I felt really connected with the way that you approach your work. You are an OT, not a PT. What does that distinction mean for how you approach this work?

OT VS. PT: THE FRAMEWORK DIFFERENCE

Marlene (06:03)
I get asked this a lot, probably every day. OTs and PTs in pelvic health are so valuable as a collaborative team because we do foundationally look at different things. The most simplified explanation is that our graduate-level training is different. Physical therapists are looking at physical function, physical limitations, physical impairments. They’re looking at the biomechanical body. OTs, foundationally, are very broad across the board. We’re looking at a biopsychosocial framework, which means biology, psychology, and how our social environment affects those other systems. What do we need to do? What motivates us? How is our mental health? What does stress look like in our bodies? So the OT lens, by foundational training, is very holistic in its approach. We’re not just looking at a physical impairment and asking what we need to do to get back to that activity. We’re asking: What motivates you? How do you sleep at night? What do you have to do during the day? Do you have to care for an aging parent and a small child? We have to look at what’s realistic in the biopsychosocial model of their lives. After we get that graduate-level training, we go into postgraduate training in pelvic rehabilitation. There is a lot of crossover at this point in 2026, but fundamentally our lens is a little bit different.

Megan (09:03)
This reminds me very much of the RD versus CNS framework. I’m more like you, the CNS, and we do this whole-person integrative approach. It brings the lens further out and gives you a larger scope of practice and a greater toolbox when you’re thinking about how to affect change in a client.

THE PELVIC FLOOR: ANATOMY AND FUNCTION

Megan (09:42)
I have this vague idea of the pelvic floor, sort of like a hammock that is supporting all of our internal organs in the abdominal area. And I know that it’s connected to a lot of things, like genitourinary syndrome, prolapse, painful sex, even TMJ. Can you explain to our peri friends what the pelvic floor is and what it does in the body?

Marlene (10:14)
It is precisely that. It is a hammock of muscles that sits at the base of our pelvis. The pelvic floor muscles spread throughout that diamond-shaped bony structure in the pelvis, and it does support our organs. It’s responsible for bladder, bowel, and sexual health: function, dysfunction, health, quality of life, and pregnancy, postpartum, and everything that entails. It also serves as a pump within our body, from the lower extremities to the upper extremities. It is a system of muscles that pumps blood and lymphatic fluid from the lower body to the upper body. Very much integrated in sexual well-being, arousal, the ability to orgasm, and the ability to accept penetrative sex. Very, very important to daily life.

Megan (11:51)
You just named a whole bunch of things that make my daily life challenging, or not challenging. And when I think about stress and where people hold it, and this is the center of our body, I wonder: if the hammock is stressed and pulling and tight or not doing what it’s supposed to do, is it true that the hammock not properly functioning is going to change how people experience their day-to-day life?

Marlene (12:42)
100%. Most people don’t know what their pelvic floors are until they have dysfunction. And then that dysfunction is very, very impactful to quality of life, to activities of daily living. And because the bladder, the uterus, the cervix, and the rectum all sit in a space about the size of two quarters sitting side by side, we have bladder health, bowel health, sexual health, reproduction, pregnancy, delivery, and postpartum all happening in this tiny, tiny space. So often, when something is impacted in the pelvic floor, it throws everything off. A lot of times somebody will come in for stress incontinence, and we start to uncover that there’s a lot more to the story. This is what we do as women: we just grin and bear it.

THE PERIMENOPAUSE GAP: FRACTURED CARE

Megan (15:56)
So much of perimenopause care feels very fractured. I think of the client I see who has been to the GI doctor for constipation, to the urologist for leaking or urgency, and to the OB for painful periods. And I cannot think of a single person who has ever told me any of those doctors referred them to a pelvic floor therapist, or even mentioned the words “pelvic floor health.” Why do you think there is such a gap in connecting pelvic floor health to perimenopause?

Marlene (17:13)
It’s wild. I think it starts with just the lack of care for women’s health in general. We haven’t been studied long enough. Doctors don’t have time to go to extra trainings. And the pelvic floor just hasn’t been studied. There is a huge gap in knowledge that starts at the academic level. As an OT, when I was in school eleven years ago, in my three-year program, I had one lecture by one man who taught about the pelvic floor. He came in for one lecture in our geriatric class to talk about how urinary incontinence is the number one cause for people going into nursing home care, and that it’s completely treatable and preventable. That was it. One lecture, eleven years ago.

Megan (19:18)
That breaks my heart.

Marlene (19:18)
So there just isn’t the awareness that this training and this specialty even exists. But I hope that’s changing. Perimenopause is having a moment. Pelvic health is having a moment. And I just hope that momentum really continues.

Megan (20:21)
A hundred percent. And this echoes what is happening with just general menopause care in medicine overall. But it also makes me think of the women who have such a hard time connecting symptoms to what’s going on in their body. They can connect cramps, period changes, and mood swings to PMS and then to perimenopause. But there is this very interesting disconnect when you start talking about painful sex, leaking, and prolapse. They don’t immediately connect those dots. Why do you think so many women assume that leaking, painful sex, and prolapse are just normal aging they have to accept?

NORMALIZATION, SHAME, AND THE PATH FORWARD

Marlene (21:47)
Precisely because it’s been normalized for too long. One generation above me, my mother’s generation, said that if you have babies, it’s normal to pee your pants. Painful sex: people don’t talk about it. So they don’t know that it’s not normal. They think something is wrong with them. I have clients sit across from me and say, “Sex hurts and it’s my fault.” I have to pick my jaw up off the floor. Because if sex hurts, what do you think you can do? They say, “Just stay quiet.” I say: no, you stop. You just stop. You don’t need my permission. You just stop and say, “This hurts.” Your body is sending a signal that something is wrong. You need to listen to it. We’ve been conditioned for hundreds of years not to listen to our bodies. It is so much of it is treatable. And there is so much support out there. It’s okay to just ask questions. Email. “Is this normal? Is this something you can help me with?” We’re going to tell you the truth.

Megan (24:38)
You have talked about your own challenges with your pelvic floor, that caused you to withdraw from intimacy, exercise, and friendships. How have you used that now to connect with clients who are dealing with the same shame?

Marlene (25:44)
I am a walking success story. A walking, living, breathing success story. I went through all of these challenges. I did retreat from my life and stopped doing things that were really meaningful to me. And then I got support. I went into pelvic floor therapy for a year. I was very, very nervous to even call. But only through that journey did I feel confident enough, less intimidated, less scared, to reach out to a pelvic floor therapist myself. And it was transformational. I don’t have pelvic pain. I don’t have difficulty with orgasm or arousal. I don’t have urinary leakage. I have pleasure and a great sex life. Everything that was really lacking when I was in my late 30s has been resolved. I’ve sat in that chair. I know how scary it is just to make that first phone call, to say, “I need help.” To me, it was like admitting defeat.

Marlene (27:58)
One new evolution I’ve been seeing is in my younger clients. I’m not seeing that same shame. I see a lot of empowered, embodied presence and comfort with talking about sexual health. Women are more informed. They’re embracing their sexuality. They’re saying when something is wrong. There’s something very exciting about that.

Megan (29:17)
It sparks so much joy deep in my soul to know that they’re not going to do the same thing. Because I have very similar experiences to you. I went to a pelvic floor therapist and it was terrifying. A doctor recommended it. They gave me no information about it. I went, and I was frankly horrified at what was happening. Nothing happened without consent, but I did not understand what was happening, why it was happening, or where things were. That could have gone so much better if I had been prepared. And that scared me away from it. I put it away and continued to grin and bear a lot of pain and discomfort and problems for a very long time. If you finally get the courage to reach out and ask for help and then someone ignores you, gaslights you, or tells you it’s all in your head, it undermines all of that work you just did to get to that moment. But it’s so hard to be heard in this climate when you have seven minutes.

PART 1 OUTRO

Megan (30:43)
That’s where we’re going to leave it for today, friends. I know. I know. We are right in the thick of it, and I promise you Part 2 is worth the wait. Marlene just gave us so much: the origin story, the OT lens, the anatomy, the shame piece, and her own walking success story. If something landed for you today, write it down. And if you have been grinning and bearing it: leaking, painful sex, prolapse, constipation, anything in that area. I want you to hear Marlene’s words. It is not normal. It is not your fault. And most of it is treatable and preventable. Part 2 drops next Wednesday, and we are getting into what actually happens in a pelvic floor therapy session, how to navigate insurance, and three things Marlene wants every single one of you to do for your pelvic floor this week. See you next Wednesday morning.