What Menopause Does to Your Pelvic Floor

Get ready to take notes today, frendos!Dr. Cait Van Damm and I are talking how pelvic health changes in menopause, including painful sex and bladder symptoms, and when to ask your provider about vaginal estrogen.We also get into…What autoimmune fatigue changed about Cait’s own trainingLeaking during a lift, and what she looks for in your breathing and bracingUpper-body strength and calf work in pelvic floor rehabHow menopause affects pelvic tissuesPelvic floor tension and why she wants to look at the way your hips moveGetting back to a movement that’s hurt you beforeStatic stretching and warming up for a liftBody grief and hope when you can’t train or work the way you used toAbout Dr. Cait Van DammDr. Cait Van Damm, OTD, is a licensed pelvic floor occupational therapist, sexual health counselor, and advanced pain reprocessing clinician specializing in complex chronic pelvic pain. She writes Adventures in Vaginas (and other parts) and offers therapeutic movement through Tidal Work, along with one-on-one virtual care.Find CaitAdventures in Vaginas (and other parts)Tidal Work movement classesCait’s website and one-on-one workFollow The Menopausal MeatheadSubstack + podcastInstagramTraining LabTime Stamps00:00 Introduction and Cait’s bio01:23 Autoimmune fatigue, hypermobility, and how Cait teaches05:11 Connecting with your glutes and using isometrics07:58 Leaking on the platform and the role of strength training14:40 Where Cait starts with pelvic floor rehab17:00 Breathing cues and managing pressure22:04 How pelvic health changes in menopause26:03 Estrogen, tendons, and hip pain28:41 Calf strength and the pelvic floor33:56 Hormones and pelvic pain40:38 Movement optimism and finding another way to train45:47 Pain rehab and graded exposure49:20 My Bulgarian split squat self-talk53:01 Static stretching before lifting58:36 Symptoms to discuss with your provider1:00:39 Body grief and changing bodies1:02:34 Where to find Cait1:04:07 Subscribe and shareA few useful things from this conversationCait describes how she changed her training when autoimmune fatigue made her usual workouts too much. Supported and floor-based exercises let her work her muscles hard without the same level of whole-body fatigue.My best friend calls lifting cues “weight thoughts.” Cait has a lot of them, including several different ways to cue an exhale. She tries different cues with a person to see what makes sense to them and what helps them manage pressure.When we get into pain, Cait explains how she uses gradual exposure to a movement someone’s afraid of. She’d rather start with something that feels too easy than give them too much and have them leave hurting. We use my knees as an example.This conversation is educational and isn’t individual medical advice.Have you had to change how you lift because of pelvic floor symptoms or an injury? Tell me in the comments what’s helped, or what you’re still trying to figure out.If you listen on a podcast app, hit follow. And if you can leave a rating or review, I’d appreciate it. That helps someone who’s never heard of me decide whether to listen.The cage you’re in isn’t locked. Get full access to Michelle Burleson | The Menopausal Meathead at menopausalmeathead.substack.com/subscribe

“Lift heavy” gets prescribed to midlife women like that’s all we need to know.Sports scientist Patricia Siegel and I spend a good chunk of this episode putting some actual meaning behind it.* How heavy should a set feel?* How close to failure do you need to get?* And why can a 15-pound dumbbell be heavy for one woman while the woman next to her needs twice that?We also get into training for bone versus training for muscle, where impact belongs, and why walking around in a weighted vest isn’t the bone-building magic trick it’s sometimes made out to be.Cranky knees make their inevitable cameo, which leads us to the Spanish squat and ways to keep training your legs when a regular squat leaves you limping.Pat has also lived a lot of this from the athlete side.She was a competitive middle-distance runner, trained in Kenya, competed in Ironman, and went through an eating disorder severe enough that she eventually had to stop training for two years.We talk about that, the spectacularly fucked-up ways female athletes were sometimes treated around weight, and what endurance athletes need from the weight room even when lifting isn’t their first love.We get into…* What “heavy” should actually feel like, and why somebody else’s dumbbell number tells you almost nothing* Strength training for muscle versus the heavier loading used in bone-focused training* Impact training, starting with something as basic as heel drops* Why weighted vests can be useful without doing what some of the menopause marketing says they do for bone* Spanish squats and wall sits when knee pain is interfering with lower-body training* How to fit lifting around high-volume running, cycling, swimming, or triathlon training* What Pat learned from competitive running, Ironman training, under-fueling, and being forced away from sport* GLP-1s, losing weight without throwing muscle overboard, and the return of skinny as an ideal* Why women need cardio too. Yes, even the Meathead is allowing this discussion.About Patricia SiegelPatricia Siegel is a sports scientist and coach who works with women through perimenopause, menopause, and beyond.Her own athletic history runs from competitive middle-distance running to Ironman, which gives her a useful perspective on the place where performance, health, and occasionally doing way too fucking much all meet.She writes The Menopause Training Blueprint and has a book on strength and endurance training through menopause forthcoming in 2028.Work with Pat: 20% offPat is offering The Menopausal Meathead listeners 20% off one-on-one coaching.You can find her and her coaching information here:The Menopause Training BlueprintThe Spanish squat we talked aboutPat explains how the band changes the setup and lets you hammer the quads while keeping the shins more vertical. She also talks in the episode about starting some people with wall sits before progressing from there.Find The Menopausal MeatheadSubstack + podcastInstagram https://instagram.com/menopausalmeatheadTraining Lab https://menopausalmeathead.substack.com/p/training-labTime Stamps00:00 Three hours of sleep. Do I train anyway?03:13 My shitty knees enter the chat: Spanish squats07:19 Knee collapse, feet, breathing, and the pelvic floor09:22 Can you keep lifting with disc problems?11:03 What does “lift heavy” actually mean?13:33 Training for strength versus training for muscle15:34 Bone density, heavier loading, and impact19:28 Getting endurance athletes into the weight room22:14 What counts as impact training?23:01 Weighted vests and what the bone research actually showed24:47 Pat’s Ironman years27:27 Competitive running in Germany and training in Kenya34:34 Eating disorders in sport and my college “fat list”39:01 Pat’s body finally made her stop43:33 Starting over in California47:03 GLP-1s, muscle loss, and skinny coming back49:01 Pilates, yoga, cardio, and where they fit51:27 Heavy is relative. Cardio still counts.A few useful things from this conversationIf you’ve been told to lift heavy, stop looking for a magic number.Pat’s working definition is a weight that becomes genuinely challenging during the set while leaving roughly two or three reps in the tank. A 15-pound dumbbell can be heavy for one woman while another needs twice that.Muscle and bone don’t get trained with exactly the same recipe. Pat gets into the heavier five-rep work used in bone research and why impact deserves its own place in the conversation.A weighted vest can make a walk harder. The research Pat discusses doesn’t support treating the vest itself as a replacement for impact training when the goal is bone.And an angry knee doesn’t necessarily mean abandoning your quads. Pat walks through wall sits and Spanish squats as options she uses when appropriate, with the fairly important caveat that new, sharp, swollen, or unexplained pain deserves to be checked out.What does “lift heavy” mean in your own training right now?And if you’ve had to change how you train because of knee pain, bone health, or something else your body has opinions about, tell me in the comments. I’d love to hear what’s actually working for you.The cage you’re in isn’t locked. Get full access to Michelle Burleson | The Menopausal Meathead at menopausalmeathead.substack.com/subscribe

I used to teach intermittent fasting. I wrote a book around it. A lot of women lost a lot of fat with it.I don’t recommend it anymore as my default for women over 40 who want to build more muscle.In this episode, I explain what changed in my own training and nutrition, what the research actually says about intermittent fasting and muscle loss, and why eating enough protein, calories and carbs became a bigger priority once I got serious about hypertrophy.I also get into protein distribution, fueling harder training, why menopause doesn’t mean your muscles have stopped responding, and the newer problem I’m watching with GLP-1s: women becoming much smaller without ever being taught how to preserve or build muscle.Intermittent fasting can work. I used it successfully myself. I just stopped seeing a good reason to make eating enough food harder when muscle became the thing I wanted most.In this episode:Why I taught intermittent fasting in the first placeWhat changed when I started training for more muscleWhat current research says about fasting, muscle and strengthHow I think about protein distribution nowWhy carbs become more useful as training volume climbsIntermittent fasting and GLP-1 appetite suppressionWhat we actually know about menopause and resistance-training resultsWho can probably keep fasting without worrying about itWhy I don’t use it anymoreThe Menopausal Meathead with Michelle BurlesonEvidence over hype. We’ve got muscles to make.💪🏽 Join The Menopausal Meathead Community: https://menopausalmeathead.substack.com 💪🏽 Get inside the Training Lab:Training LabLifting Tips You Might Have Missed…Seated Hamstring Curl HackSecret to 3D ShouldersLearn a Proper Lat PulldownLeave a comment Get full access to Michelle Burleson | The Menopausal Meathead at menopausalmeathead.substack.com/subscribe

Testosterone is suddenly everywhere in menopause care.It’s being pitched for libido, energy, brain fog, muscle, bone, mood, and that general feeling that your body has stopped cooperating.I wanted to know what testosterone has actually earned.In this episode, I get into the strongest evidence we have for testosterone in postmenopausal women, what HSDD actually means, and why a low testosterone result doesn’t automatically explain how you feel.I also went looking for the muscle claim. Obviously.Then there’s the stranger part of this story: there still isn’t an FDA-approved testosterone product for women in the U.S., some women are using a fraction of medication packaged for men, and the long-term breast and cardiovascular safety questions still aren’t settled.We also get into pellets, dosing, monitoring, and what I’d want to know before anybody put testosterone under my skin.Join The Menopausal Meathead Community: https://menopausalmeathead.substack.comGet inside the Training Lab:Training LabLifting Tips You Might Have Missed…Seated Hamstring Curl HackSecret to 3D ShouldersLearn a Proper Lat PulldownLeave a comment Get full access to Michelle Burleson | The Menopausal Meathead at menopausalmeathead.substack.com/subscribe

Creatine has survived decades of supplement shenanigans for one very good reason: it works.But women still get warned it’ll make them bloated, wreck their kidneys, make their hair fall out or turn them into something resembling a waterlogged linebacker.So I went through the evidence.In this episode of Muscle Over Menopause, I get into what creatine can realistically do for muscle and strength, why five grams a day makes sense, what that early scale bump actually is, and what we know about kidneys and hair loss.Then there’s the brain stuff.The research there is interesting, especially as we age, but interesting and proven are not the same thing. I’ll tell you where I think the evidence earns some excitement and where people have gotten fourteen miles ahead of it.And before I go, something different.A personal coda about midlife, regret, relationships, careers, your body, and the spectacular amount of life we can waste with our foot on the gas while staring into the rearview mirror.When you have effing idea what comes next, there’s one question worth asking:What is the next best step?In this episodeWhat creatine actually does when you liftThe new data in postmenopausal womenMuscle and strength gainsWhy the scale may go upWhether creatine causes bloatingThe emerging brain and cognition researchHair loss and DHTCreatine, creatinine and your kidneysWhy I wouldn’t buy it for bone densityWhy I use creatine monohydrateWhy five grams a day is plentyWhy you don’t need to load or cycle itOn agency, regret and starting from where you areGet inside the Training Lab:Training LabLifting Tips You Might Have Missed…Seated Hamstring Curl HackSecret to 3D ShouldersLearn a Proper Lat PulldownLeave a commentStudies & sourcesPubMedCreatine monohydrate for lean mass, strength, and bone density in postmenopausal womenPubMedCreatine and Cognition in Aging: A Systematic Review of Evidence in Older AdultsPubMedCONCRET-MENOPA randomized controlled trialPubMedSystematic review of creatine supplementation and cognitionPubMedDoes creatine cause hair loss? A 12-week randomized controlled trialPubMedCreatine supplementation and kidney function: 2026 systematic review and meta-analysis Get full access to Michelle Burleson | The Menopausal Meathead at menopausalmeathead.substack.com/subscribe

Red-light masks are everywhere, and some cost enough to require selling a vital organ.So do they actually work for wrinkles?I dug through the better trials, including a 2025 randomized sham-controlled home-mask study, and the answer is: yes, with a buyer-beware asterisk.In this episode:What changed in the strongest home-mask trialWhy the researchers saw an improvement that the people wearing the masks didn’t clearly see themselvesWhat industry funding does and doesn’t tell usWhy results from one red-light device don’t automatically apply to anotherWhat FDA clearance actually meansFour questions to ask before spending several hundred dollars on something that makes you look like a relaxed homicidal maniacFull article, studies and source links at Deep Kimchi.Get inside The Training Lab: https://deepkimchi.substack.com/p/training-labMore at Deep Kimchi: deepkimchi.substack.comStudies & sourcesPark et al., 2025 randomized sham-controlled home-mask trialWunsch and Matuschka, 2014 controlled trial with randomized treatment arms and a nonrandomized controlCouturaud et al., 2023 uncontrolled mask studyGlass, 2021 clinical reviewFDA explanation of the 510(k) clearance processAmerican Academy of Dermatology consumer guidanceWSJ Buy Side shopping guide that prompted the question — market context only, not scientific evidence Get full access to Michelle Burleson | The Menopausal Meathead at menopausalmeathead.substack.com/subscribe

How do you know when it’s actually time to add weight?I hit a 65-pound weighted pull-up for my 53rd birthday, but I didn’t get there by making every workout heavier. Sometimes I added weight. Sometimes I added a rep, used less assistance, cleaned up the movement or left the damn thing alone.In this episode, I break down how to decide what to change in your next workout, including what to do when the next dumbbell is too big a jump, why more weight isn’t your only option, how hard a set needs to be, when another set makes sense and when your smartest move is to repeat the workout you already did.The companion article includes the video of my 65-pound pull-up plus the written progression guide.And if you’d rather not make these decisions yourself, Training Lab uses the sets, reps, load and feedback you log to adjust your progression from workout to workout.See the pull up: https://deepkimchi.substack.comGet inside The Training Lab: https://deepkimchi.substack.com/p/training-labMore at Deep Kimchi: deepkimchi.substack.comStudies & sourcesACSM: Progression Models in Resistance Training for Healthy Adults. This is the source for the guideline to increase load roughly 2–10% when you can perform one or two reps beyond the target. PubMedRead on PubMedACSM 2026 Resistance Training Position Stand. An overview of 137 systematic reviews covering more than 30,000 participants. Relevant here for training volume, full range of motion, training to momentary fatigue, time under tension and resistance-training frequency. PubMedRead on PubMedResistance Training Load Effects on Muscle Hypertrophy and Strength Gain. This meta-analysis found similar hypertrophy across low, moderate and high loads, while heavier loads produced greater strength gains. PubMedRead on PubMedSTOP-EM trial. Forty peri- and early postmenopausal women were assigned to nine months of twice-weekly supervised heavy strength and impact training or a wait-list control. The intervention improved strength, lean mass, leg power and lumbar-spine bone density. PubMedRead on PubMedResistance training in middle-aged women before and after menopause. Women averaging about 52 completed a 10-week resistance-training phase. Both pre- and postmenopausal groups increased squat and bench-press strength, while the muscle-mass response differed by menopausal status. PubMedRead on PubMed Get full access to Michelle Burleson | The Menopausal Meathead at menopausalmeathead.substack.com/subscribe

Women hear plenty about walking. I’m more interested in whether your legs will still get you off the toilet at 80.This week: one five-rep chair test you can do at home, what to notice, and what to do if it’s harder than expected.Try it: Use a regular chair, cross your arms, stand up and sit down five times. Time it. Use the same chair when you check again later.Pain, dizziness, or feel unsafe doing it? Skip it.Get inside The Training Lab: https://deepkimchi.substack.com/p/training-labMore at Deep Kimchi: deepkimchi.substack.comSourcesGoldberg A, Chavis M, Watkins J, Wilson T. The Five Times Sit-to-Stand Test: validity, reliability and detectable change in older females. Aging Clin Exp Res. 2012. PubMedU.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd ed. Adults should include muscle-strengthening work at least two days per week. GuidelinesAmerican College of Sports Medicine. 2026 Resistance Training Position Stand. ACSM Get full access to Michelle Burleson | The Menopausal Meathead at menopausalmeathead.substack.com/subscribe

Some days the dumbbells haven’t changed, but your access to strength has. Sleep loss and mental fatigue slow the lifts, raise perceived effort, and make an ordinary session cost more than it should. I’m talking what grief, heartbreak, and four hours of sleep metabolically do inside a workout, and how to adjust the training without turning one bad week into a verdict on your body.Get inside the Training Lab: https://deepkimchi.substack.com/subscribeIn this episode:* What happened to ten resistance-trained women held to five hours in bed for nine nights* Why lower-body lifts moved up to 15 percent slower while the logbook still looked normal* Total training distress rose 84 percent on almost identical total work* How mental fatigue cuts training volume, and which lifts take the bigger hit* A scaled warm-up that tells you what kind of mood your muscles are in: 60 percent for ten, 80 for five, 90 for two* When to drop the load, swap to the leg press, and go home after thirty useful minutes* Why “easy, right, or too hard” needs an honest answer the week your life is on fire* Why the mood benefit showed up without notable strength gains* The way to get over somebody is to get under some ironThe warm-up is data, not character evidence.Clinical depression deserves clinical care. Resistance training can support treatment. It cannot replace a qualified clinician, medication, therapy, or immediate help when you cannot care for yourself. A training plan is not crisis care.If one woman came to mind while you were listening, send her this episode. She may not need a pep talk. She may need a place to put her body for a while.Training LabThe Lab asks how every set felt: easy, right, or too hard. Your program adjusts from that answer, which matters most on the weeks you can’t trust your own read on things. Six programs, autoregulated, built for bodies with mileage.Get inside the Training Lab: Resources:Knowles O, et al. “Sustained Sleep Restriction Reduces Resistance Exercise Quality and Quantity in Females.” SportRxiv. https://doi.org/10.51224/SRXIV.157Solon-Júnior LJF, et al. “Mental Fatigue and Resistance Exercise: A Systematic Review and Meta-Analysis Including GRADE Qualification.” European Journal of Sport Science, 2026. https://pubmed.ncbi.nlm.nih.gov/42168782/Gordon BR, et al. “Association of Efficacy of Resistance Exercise Training With Depressive Symptoms.” JAMA Psychiatry, 2018. https://pubmed.ncbi.nlm.nih.gov/29800984/Agudelo LZ, et al. “Skeletal Muscle PGC-1α1 Modulates Kynurenine Metabolism and Mediates Resilience to Stress-Induced Depression.” Cell, 2014. https://pubmed.ncbi.nlm.nih.gov/25259918/Every paid subscription supports Save Our Paws, the Romanian rescue pulling dogs and cats off the street and into warm laps. Strong women, saved animals. That’s the deal. Get full access to Michelle Burleson | The Menopausal Meathead at menopausalmeathead.substack.com/subscribe

Stop Doing Math Mid-LiftTwo new programs are live in the Deep Kimchi Training Lab. The Complete Physique for your regular workout weeks, Anywhere Strong for everywhere else. Both adjust to you session by session, so you stop doing your own programming at 5:45 in the morning.Get inside the Training Lab: https://deepkimchi.substack.com/p/training-labIn this episode:The two leaks draining most women's training: guesswork at the rack, and travel weeks written off as a lossWhy slow results are a programming problem and not a character flawAutoregulation in plain English, and how rating a set easy, perfect, or too hard sets your next session's weightsProgressive overload as it actually gets applied: 2.5 lb jumps on smaller muscles, 5 lb on the big compound liftsWhy the week five deload is built in, and what tends to show up during itThe four training blocks, and why rotating them keeps your body from settling into complacencyWhat all of this means if you're on a GLP-1 and want to keep the muscle while you lose the fatAnywhere Strong: bodyweight, bands, and hotel dumbbells that still progress week over weekAsk Michelle Anything: the coaching that ran over a thousand dollars a month, now inside a subscriptionResources:The Deep Kimchi Training Lab: https://deepkimchi.substack.com/p/training-labQuestions: [email protected] paid subscription supports Save Our Paws, the Romanian rescue pulling dogs and cats off the street and into warm laps. Strong women, saved animals. That's the deal. Get full access to Michelle Burleson | The Menopausal Meathead at menopausalmeathead.substack.com/subscribe