Unboxing the Black Box: The FDA has removed or revised the boxed warnings on many estrogen-containing menopause therapies, but what does that actually mean?

In this episode, I explain what a black boxed warning is, why it was applied decades ago, why newer evidence shows the situation is more nuanced, especially for low-dose vaginal estrogen, and what the label change means for people in perimenopause and menopause. Links to FDA, HHS, and JAMA commentary in the episode notes below.

⏱️ Timestamps:

[00:00] — Major Change in Women's Health

[01:27] — FDA's Black Box Warning Removal

[02:04] — Understanding the Black Box Warning

[03:04] — Personal Prescription Example

[04:00] — What is a Black Box Warning?

[05:49] — Detailed Breakdown of the Black Box Warning

[11:43] — The Women's Health Initiative Study

[13:34] — Media's Role in Spreading Misinformation

[15:33] — Scientific and Advocacy Groups' Response

[16:36] — Key Factors in Reversing the Black Box Warning

[23:22] — The Unboxing Menopause Campaign

[24:45] — FDA's Official Announcement

[25:52] — Impact on Perimenopausal and Postmenopausal Women

[26:21] — Challenges in Accessing Hormone Therapy

[27:18] — Dr. Rachel Rubin's Personal Story

[30:00] — The Importance of Advocacy

[31:57] — Steps to Advocate for Yourself

[32:56] — Resources for Hormone Replacement Therapy

[36:47] — Client's Story: Empowerment Through Advocacy

[40:15] — Encouraging Conversations and Education

[41:15] — Conclusion

Resources and Readings:

FDA announcement and fact sheet on the label changes:

https://www.fda.gov/news-events/press-announcements/hhs-advances-womens-health-removes-misleading-fda-warnings-hormone-replacement-therapy

HHA press announcement and fact sheet on the removal of black box warnings:

https://www.hhs.gov/press-room/fact-sheet-fda-initiates-removal-of-black-box-warnings-from-menopausal-hormone-replacement-therapy-products.html

JAMA article Nov 10 2025, Updated Labeling for Menopausal Hormone Therapy

https://jamanetwork.com/journals/jama/fullarticle/2841321

Book The New Menopause by Dr Mary Claire Haver MD

Dr Rachel Rubin’s Education Resources for Clinicians and Patients:

https://www.rachelrubinmd.com/education

The Menopause Society website, includes Practitioner Directory

https://menopause.org/

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Do you need a special device to strengthen your pelvic floor?

In this episode of Down There, Pelvic Floor Physical Therapist Laura McKaig PT, explores 7 tools, some unconventional, some everyday, that actually support pelvic floor strength. Inspired by a viral Instagram reel from urologist Dr. Kelly Casperson, Laura shares three expert-recommended “devices” and four additions based on clinical insight and experience.

You’ll learn why orgasms, lifting weights, and even breathing matter more than you think and how consistency, intention, and movement are more powerful than any “quick fix.”

⏱️ Timestamps:

[00:00] – Top 7 Pelvic Floor Devices

[01:33] – Dr. Kelly Casperson's Surprising Recommendations

[03:27] – Why Use Devices?

[03:48] – Biofeedback and E-Stim Devices

[05:02] – Considerations Before Buying a Device

[06:46] – Dr. Kelly Casperson's Top 3 Recommendations

[07:00] – Recommendation 1: Orgasms

[07:21] – Recommendation 2: Lifting Weights

[08:19] – Recommendation 3: Pelvic Floor Physical Therapy

[08:58] – Laura's Additional Recommendations

[09:05] – Laura's Recommendation 1: Pilates

[09:43] – Laura's Recommendation 2: Yoga

[10:13] – Laura's Recommendation 3: Mindful Movement

[12:34] – Laura's Recommendation 4: Breathing

[13:47] – Summary of Top 7 Recommendations

[14:52] – Final Thoughts

🎧 Connect & Share:

Have questions or want to connect?

👉 Subscribe on YouTube:

The Pelvic Connection with Laura McKaig PT

https://www.youtube.com/channel/UCE7zyN28inZxCovuMqInzSA

👉 Follow on Facebook:

https://www.facebook.com/lauramckaigpt/

👉 Follow on Instagram:

https://www.instagram.com/lauramckaigpt/

👉 Visit for programs, resources, or in-person support:

https://www.pelvicconnection.com/

👩‍⚕️ Find a pelvic floor therapist near you:

https://pelvicglobal.com/directory/

🎵 Music Credits:

Original composition “Down There” by Forest Stewart

***DISCLAIMER***The content of this video, description, links, and comments, is intended for educational and informational purposes. It is not intended as medical advice or a personalized treatment plan. Pelvic Connection Physical Therapy & Wellness LLC is not liable for any injuries or damages related to the practice of any exercise or activity shown on this video. Injury risk is possible if you do not follow due diligence and seek qualified professional advice about your medical condition or injury. Please consult your healthcare professional for specific concerns. No guarantees of specific results are expressly made or implied from this content.

If you had told me a few years ago that I’d be grateful for rejection, pain, and almost losing my career… I wouldn’t have believed you. But today, I can honestly say: I’m thankful for the hard stuff. And I want to share why.

In this deeply personal and reflective episode, Laura McKaig shares a tradition she’s carried for over a decade, her annual “Thankful for the Pain” letter. You’ll hear the real story behind how challenges, physical, emotional, and financial, sparked the founding of her pelvic health practice, reshaped her mindset, and deepened her empathy for others.

This isn’t about toxic positivity... it’s about learning to face discomfort and still choose gratitude. Whether you’re in a season of struggle, rebuilding after a setback, or just need encouragement, this episode offers raw honesty, hope, and practical reflection.

⏱️ Timestamps:

[00:00]  – People just need to be heard

[01:50] – Personal Vulnerability and Tradition

[02:14] – The Start of a Gratitude Journey

[03:14] – Reading from Past Emails

[04:27] – Thankful for the Pain Series

[05:15] – Physical Pain and Career Change

[06:15] – Financial Struggles and Career Change

[06:57] – Facing Rejection and Building Resilience

[09:42] – Support and Gratitude for Others

[10:24] – Unexpected Challenges in 2020-2021 and Opportunities

[11:10] – Writing the Book 'Piss Off'

[12:07] – Unexpected Health Challenges

[13:08] – Physical Injuries and Business Adaptation

[15:31] – Developing Online Education Programs

[18:59] – Embracing Pain and Offering Support

🎧 Connect & Share:

Have questions or want to connect?

👉 Subscribe on YouTube:

The Pelvic Connection with Laura McKaig PT

https://www.youtube.com/channel/UCE7zyN28inZxCovuMqInzSA

👉 Follow on Facebook:

https://www.facebook.com/lauramckaigpt/

👉 Follow on Instagram:

https://www.instagram.com/lauramckaigpt/

👉 Visit for programs, resources, or in-person support:

https://www.pelvicconnection.com/

👩‍⚕️ Find a pelvic floor therapist near you:

https://pelvicglobal.com/directory/

🎵 Music Credits:

Original composition “Down There” by Forest Stewart

***DISCLAIMER***The content of this video, description, links, and comments, is intended for educational and informational purposes. It is not intended as medical advice or a personalized treatment plan. Pelvic Connection Physical Therapy & Wellness LLC is not liable for any injuries or damages related to the practice of any exercise or activity shown on this video. Injury risk is possible if you do not follow due diligence and seek qualified professional advice about your medical condition or injury. Please consult your healthcare professional for specific concerns. No guarantees of specific results are expressly made or implied from this content.

What if healing wasn’t just physical but also deeply connected to your mindset?

In this episode of Down There, Pelvic Floor Physical Therapist Laura McKaig is joined by fellow Physical Therapist James Connelly, PT, Owner of Results Rehab, Roswell, GA (Atlanta area), for a deeply human conversation on the psychology of gratitude and how it supports physical healing, pain recovery, and pelvic health.

What started as a casual retreat conversation quickly turned into an inspiring exchange on nervous system regulation, pain neuroscience, and how reframing your inner dialogue can truly change how your body feels and functions.

⏱️ Timestamps:

[00:00] – Reframing Pain

[01:22] – Meet James Connelly

[02:01] – Understanding the Psychology of Gratitude

[03:19] – The Body's Response to Stress and Pain

[05:44] – Chronic Stress and Its Effects

[06:11] – Pelvic Health and Chronic Stress

[07:42] – Practical Tips for Managing Stress

[09:01] – Real-Life Patient Examples

[13:58] – Incorporating Gratitude and Exercise into Daily Life

[16:19] – Introduction to Habit Stacking

[16:55] – Using Pelvic Floor Muscles Properly

[17:29] – Consistency and Grace

[18:24] – Impact of Negative Self-Talk

[19:15] – The Nocebo Effect in Healthcare

[21:01] – Mindful Communication in Medicine

[23:23] – Gratitude in Daily Life

[25:08] – Reframing Pain and Gratitude

[29:30] – Personal Stories of Resilience

[31:09] – Final Thoughts and Gratitude

🎧 Connect & Share:

Have questions or want to connect?

👉 Subscribe on YouTube:

The Pelvic Connection with Laura McKaig PT

https://www.youtube.com/channel/UCE7zyN28inZxCovuMqInzSA

👉 Follow on Facebook:

https://www.facebook.com/lauramckaigpt/

👉 Follow on Instagram:

https://www.instagram.com/lauramckaigpt/

👉 Visit for programs, resources, or in-person support:

https://www.pelvicconnection.com/

👉 Guest Info:

Learn more about James Connelly, PT:

https://www.resultsrehab.org

👩‍⚕️ Find a pelvic floor therapist near you:

https://pelvicglobal.com/directory/

🎵 Music Credits:

Original composition “Down There” by Forest Stewart

***DISCLAIMER***The content of this video, description, links, and comments, is intended for educational and informational purposes. It is not intended as medical advice or a personalized treatment plan. Pelvic Connection Physical Therapy & Wellness LLC is not liable for any injuries or damages related to the practice of any exercise or activity shown on this video. Injury risk is possible if you do not follow due diligence and seek qualified professional advice about your medical condition or injury. Please consult your healthcare professional for specific concerns. No guarantees of specific results are expressly made or implied from this content.

Ready to return to exercise after prostate surgery, but feeling unsure where to start?

In this episode of Down There, Pelvic Floor Physical Therapist Laura McKaig shares 9 clear, supportive tips to help you build strength, improve bladder control, and feel confident getting back to movement. Whether that’s walking, golfing, or hitting the gym again.

You'll also hear the inspiring story of “Joe,” one of Laura’s real patients, who went from post-surgery incontinence to climbing mountains again through smart rehab strategies and consistency.

⏱️ Timestamps:

[00:00] – Overcoming Post-Surgery Exercise Fears

[01:27] – Guidelines for Post-Surgery Exercise

[02:22] – Joe's Story: A Journey Back to Fitness

[03:58] – Common Concerns About Post-Surgery Exercise

[04:24] – The Importance of Movement-Based Therapy

[05:29] – General Exercise Guidelines

[06:05] – Guideline 1: Start Slow and Steady

[08:43] – Guideline 2: The Importance of Breathing

[09:46] – Guideline 3: Quality Over Quantity during exercise

[11:05] – Guideline 4: No Pain, No Gain Myth

[11:42] – Guideline 5: Listen to Your Body

[13:02] – Guideline 6: Managing Pelvic Floor Fatigue

[13:54] – Guideline 7: Modify Activities, Don't Quit

[14:45] – Guideline 8: Lighten Up on the Squeeze

[15:34] – Guideline 9: Be Prepared for Leakage

[16:36] – Strength Training Post-Surgery

[19:31] – Joe's Success Story and Achieving Your Exercise Goals

🎧 Connect & Share:

Have questions or want to connect?

👉 Subscribe on YouTube:

The Pelvic Connection with Laura McKaig PT

https://www.youtube.com/channel/UCE7zyN28inZxCovuMqInzSA

👉 Follow on Facebook:

https://www.facebook.com/lauramckaigpt/

👉 Follow on Instagram:

https://www.instagram.com/lauramckaigpt/

👉 Visit for programs, resources, or in-person support:

https://www.pelvicconnection.com/

👩‍⚕️ Find a pelvic floor therapist near you:

https://pelvicglobal.com/directory/

🎵 Music Credits:

Original composition “Down There” by Forest Stewart

***DISCLAIMER***The content of this video, description, links, and comments, is intended for educational and informational purposes. It is not intended as medical advice or a personalized treatment plan. Pelvic Connection Physical Therapy & Wellness LLC is not liable for any injuries or damages related to the practice of any exercise or activity shown on this video. Injury risk is possible if you do not follow due diligence and seek qualified professional advice about your medical condition or injury. Please consult your healthcare professional for specific concerns. No guarantees of specific results are expressly made or implied from this content.

They told me menopause meant hot flashes… but no one warned me about this.

Laura McKaig breaks down the real (and often unexpected) ways menopause affects your pelvic floor, bladder, and vaginal health.

Forget the myth that it’s just hot flashes we’re talking about, leaking, dryness, UTIs, and changes no one warns you about. Laura also explains why it happens, hint: it’s all about estrogen and what you can do about it, from movement and pelvic floor therapy to moisturizers and more.

⏱️ Timestamps:

[00:46] – Menopause and Pelvic Health

[01:41] – Menopause: What No One Told You

[02:03] – What Changes Down There After Menopause?

[03:28] – Postmenopausal Changes in the Pelvic Floor

[04:27] – Menopause and Urinary Symptoms

[08:30] – Common Symptoms and Solutions

[08:45] – Changes in Bladder Function After Menopause

[10:48] – Understanding UTIs and the Pelvic Floor

[12:16] – Decreased Lubrication and Vaginal Dryness

[13:20] – Intercourse Discomfort and What You Can Do

[13:41] – Positive Steps to Manage Symptoms

[14:38] – The Importance of Movement and Exercise

[16:05] – Good Bladder Habits

[17:56] – Bladder Irritants to Avoid

[18:46] – Using Vaginal Lubricants and Moisturizers

[20:22] – Topical Vaginal Estrogen Cream

[22:00] – Recap of Menopausal Changes

[23:03] – Resources and Recommendations

[23:37] – Conclusion and Next Steps

Connect & Share:

Have questions or want to connect?

Subscribe to our YouTube channel: The Pelvic Connection with Laura McKaig PT (https://www.youtube.com/channel/UCE7zyN28inZxCovuMqInzSA)

Follow on Facebook: https://www.facebook.com/lauramckaigpt/

Follow on Instagram: https://www.instagram.com/lauramckaigpt/

Visit: https://www.pelvicconnection.com/ for online programs, resources, or to work with Laura in person.

Music Credits:

Musician: Forest Stewart

Original composition “Down There”

***DISCLAIMER***The content of this video, description, links, and comments, is intended for educational and informational purposes. It is not intended as medical advice or a personalized treatment plan. Pelvic Connection Physical Therapy & Wellness LLC is not liable for any injuries or damages related to the practice of any exercise or activity shown on this video. Injury risk is possible if you do not follow due diligence and seek qualified professional advice about your medical condition or injury. Please consult your healthcare professional for specific concerns. No guarantees of specific results are expressly made or implied from this content.

Ever feel bloated, backed up, or just… off? Your gut could be messing with your pelvic floor.

In this episode of Down There, host Laura McKaig explores the powerful connection between gut health, nutrition, and the pelvic floor with special guest Megan Pribyl, PT, CMPT, CMTPT/DN, PCES, a trailblazer in the fields of pelvic rehabilitation and integrative nutrition.

We explore how everyday food choices can fuel or wreck your gut, and how that directly impacts pelvic floor dysfunction, including bloating, constipation, urgency, incontinence, and chronic pelvic pain. You’ll learn why gut-brain-pelvis communication matters, and what your body might be trying to tell you.

Plus: Megan shares simple, empowering tips that clinicians and patients alike can start using today to move toward a happier gut and a healthier pelvis.

Whether you’re a patient or just gut curious, this one is a must-listen.

⏱️ Timestamps:

[00:00] – Intro to today's topic

[02:16] – Meet Megan Pribyl

[04:08] – Megan's Journey: From Nutrition to Pelvic Health

[05:43] – The Importance of Nutrition in Pelvic Health

[10:14] – The Gut-Brain Connection

[12:19] – Dietary Impact on Pelvic Health Conditions

[15:00] – The Impact of Antibiotics on Gut Health

[16:57] – Dietary Patterns and Prostate Cancer Risk

[21:37] – Bladder and Bowel Interconnection

[25:34] – Common Conditions and Dietary Conversations

[26:52] – Patient-Centered Approach to Nutrition

[30:01] – Long-Term Dietary Changes and Patient Experiences

[30:50] – The Impact of Small Changes Over Time

[31:21] – The Importance of Hydration

[31:51] – How Much Water Should You Drink?

[33:49] – Movement and Gut Health

[34:57] – Starting the Nutrition Conversation

[36:35] – Basics of a Healthy Diet

[37:07] – Finding Accurate Nutrition Information

[39:53] – Adjusting Diet for Menopause

[41:05] – Benefits of Fermented Foods

[45:14] – Improving Digestion

[46:29] – Mindfulness and Eating

[48:20] – The Impact of Antacids on Digestion

[49:45] – Holistic Health Considerations

[50:45] – Final Thoughts on Nutrition and Health

Connect & Share:

Have questions or want to connect?

Subscribe to our YouTube channel: The Pelvic Connection with Laura McKaig PT (https://www.youtube.com/channel/UCE7zyN28inZxCovuMqInzSA)

Follow on Facebook: https://www.facebook.com/lauramckaigpt/

Follow on Instagram: https://www.instagram.com/lauramckaigpt/

Visit: https://www.pelvicconnection.com/ for online programs, resources, or to work with Laura in person.

Music Credits:

Musician: Forest Stewart

Original composition “Down There”

***DISCLAIMER***The content of this video, description, links, and comments, is intended for educational and informational purposes. It is not intended as medical advice or a personalized treatment plan. Pelvic Connection Physical Therapy & Wellness LLC is not liable for any injuries or damages related to the practice of any exercise or activity shown on this video. Injury risk is possible if you do not follow due diligence and seek qualified professional advice about your medical condition or injury. Please consult your healthcare professional for specific concerns. No guarantees of specific results are expressly made or implied from this content.

No one warned us this could start in our 30s, but we don't have to deal with it alone.

In this honest and heartfelt episode of Down There, Laura McKaig brings you a candid conversation with two powerhouse physical therapists and business owners: Lianne Rogers, Owner of Balance By Li in Phoenix, AZ, and Lindsay Rush, Owner of Beyond Physical Therapy in Milwaukee, WI. Recorded live at a retreat, the trio delves into what it truly means to be a woman in business, a mom juggling priorities, and a health-conscious woman navigating the realities of perimenopause.

From burnout and boundaries to building a business that reflects their values, these women share the behind-the-scenes moments no one talks about. They also unpack the under-discussed experience of perimenopause mood swings, brain fog, fatigue, and the frustrating journey to find providers who actually listen.

It’s a mix of laughs, raw truths, and inspiring wisdom for anyone building a career while balancing hormones, home life, and high expectations.

⏱️ Timestamps:

[00:00] – Introduction to Today's Podcast

[01:21] – Meet the “The 3 L’s” Laura, Lindsay, Lianne

[02:18] – How did they all Meet

[02:35] – The Importance of Business Skills

[04:42] – Starting Your Own Practice

[04:06] – Lianne's Journey into Business

[04:48] – Lindsay's Path to Entrepreneurship

[05:45] – Balancing Motherhood and Business

[07:00] – Setting Boundaries as a Business Owner

[08:38] – Flexibility and Family Time

[09:22] – Entering the Forties: Self-Care and Priorities

[09:59] – Perimenopause: Early Signs and Self-Advocacy

[10:30] – Experiences with Perimenopause

[12:02] – Navigating Perimenopause and Business

[15:56] – Pelvic Health in Older Adults

[16:16] – Common Pelvic Health Issues

[18:48] – Pelvic Health in Active Women

[21:53] – Referring to Pelvic Floor Specialists

[24:14] – Advice for Aspiring Business Owners

[26:26] – The Importance of Coaching and Mentorship

[29:03] – Conclusion and Final Thoughts

Connect & Share:

Have questions or want to connect?

Subscribe to our YouTube channel: The Pelvic Connection with Laura McKaig PT (https://www.youtube.com/channel/UCE7zyN28inZxCovuMqInzSA)

Follow on Facebook: https://www.facebook.com/lauramckaigpt/

Follow on Instagram: https://www.instagram.com/lauramckaigpt/

Visit: https://www.pelvicconnection.com/ for online programs, resources, or to work with Laura in person.

Music Credits:

Musician: Forest Stewart

Original composition “Down There”

***DISCLAIMER***The content of this video, description, links, and comments, is intended for educational and informational purposes. It is not intended as medical advice or a personalized treatment plan. Pelvic Connection Physical Therapy & Wellness LLC is not liable for any injuries or damages related to the practice of any exercise or activity shown on this video. Injury risk is possible if you do not follow due diligence and seek qualified professional advice about your medical condition or injury. Please consult your healthcare professional for specific concerns. No guarantees of specific results are expressly made or implied from this content.