At Milestone, these services are thoughtfully integrated into your care—so your experience is coordinated, not fragmented. While all services are optional, if recommended by your physician, they are strongly encouraged to support optimal outcomes.
Physiotherapy Team: Susan Saretsky / Rama Swami
Designed to support:
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Genito Urinary Syndrome of Menopause
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Urinary leakage, urgency, or frequency
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Pelvic pressure or prolapse symptoms
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Pain with intercourse or vaginal dryness Recurrent UTIs
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Bowel urgency or leakage
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Safe return to exercise
Structure:
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3 sessions typically spaced one month apart
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Includes internal and external pelvic floor assessment (with consent)
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Investment: $225 initial session, $200 for follow-up sessions (Receipts provided for extended health/HSA)
Your pelvic health care is fully integrated with the Milestone team ensuring more coordinated and effective outcomes.
Pelvic Health Physiotherapy
1. Do I need a referral to see the pelvic health physiotherapist?
2. Why does Milestone offer Pelvic Health Physiotherapy as part of comprehensive menopause care?
3. How does the Pelvic Health Physiotherapist work with my Milestone Care Model?
4. What symptoms does Pelvic Health Physiotherapy help with?
5. Can Pelvic Health Physiotherapy help with pain during intimacy?
6. What happens at my first appointment?
7. Is the internal examination mandatory?
8. I feel nervous about an internal examination. Is that normal?
9. What if I have a history of trauma or feel uncomfortable with internal assessment?
10. I have my period or I'm experiencing some vaginal bleeding. Should I cancel my appointment?
11. How many sessions will I need?
12. Will my appointments always be with the same physiotherapist?
13. How much do appointments cost?
14. Is pelvic physiotherapy covered by Alberta Health Services (AHS) or provincial insurance?
15. Do you provide receipts for insurance or HSA claims?
16. What is GSM, and why is it relevant to pelvic physiotherapy?
17. My doctor has already prescribed vaginal estrogen. Do I still need Pelvic Health Physiotherapy?
18. I've been told I can't use estrogen because of my medical history. Can Pelvic Health Physiotherapy still help me?
19. I want to get back into exercise, but I leak when I run or jump. What should I do?
FREQUENTLY ASKED QUESTIONS
No, you do not need a referral to see a Pelvic Health Physical therapist. However, our Pelvic Health physiotherapy program is part of the Milestone Pelvic Health Care Pathway, which means it will typically be recommended when appropriate as part of your comprehensive assessment. This ensures your pelvic health care is fully integrated with your broader menopause care plan, not happening in isolation from it.
Because the pelvic floor doesn't exist in a vacuum. Estrogen, which declines during perimenopause and menopause, directly affects the muscles, tissues, and organs of the pelvis. Symptoms like bladder leakage, pelvic pressure, vaginal dryness, and pain with intimacy are not coincidental to menopause; they are often a direct consequence of it.
Having a Pelvic Health physiotherapist as part of your Milestone care team means these symptoms are addressed alongside your hormonal, bone, cardiovascular, and breast health, not treated as an afterthought.
Your physiotherapist communicates directly with your Milestone care team. If your physician has recommended hormonal therapy, your pelvic health physiotherapist will take that into account and build on it. If you are working with the exercise specialist on a strength program, your pelvic health physiotherapy is part of that conversation too. If you are working with one of the counsellors, then your pelvic health physiotherapist will develop a collaborative plan to address psychological aspects of treatment into the care plan. This is genuinely coordinated care.
Our Pelvic Health program is designed to support a wide range of common symptoms that are commonly under-addressed in perimenopause and menopause.
This is not a complete list of ALL symptoms, just the common ones:
● Bladder leakage with coughing, sneezing, laughing, exercise, or lifting
● Sudden urgency to reach the bathroom, and not always making it in time
● Needing to urinate frequently during the day or waking at night to void
● A feeling of heaviness, pressure, or something bulging in the pelvis
● Pain during or after intercourse
● Vaginal dryness, burning, or irritation
● Recurrent urinary tract infections
● Difficulty fully emptying the bladder or bowel
● Bowel urgency, straining, or accidental leakage
● Pelvic, tailbone, or low back pain
● Hip pain, particularly on the outer side
● Shoulder tendonitis or other musculoskeletal aches and pains.
● Wanting to return to exercise but unsure how to do so safely
Yes, and this is an area we take very seriously. Pain during intimacy, whether from vaginal dryness, tissue sensitivity, or pelvic floor muscle tension, is one of the most under-reported symptoms of menopause. It is also one of the most treatable. Your physiotherapist will assess the muscular, tissue, and neuromuscular contributors to painful intercourse and build a program that addresses them directly in a trauma- informed, private, and completely non-judgmental environment. This work is often most effective when coordinated with your Milestone Physician, who may also discuss local hormonal options to support tissue health.
Your initial session is 60 minutes and is both a conversation and an assessment. We begin by listening to your symptoms, your history, your goals, and how your pelvic health has been affecting your day-to-day life. From there, your physiotherapist will conduct an external assessment (posture, movement, breathing, and soft tissue) and, with your consent, an internal pelvic floor examination. You will leave with a clear understanding of your findings and the beginning of a personalized treatment plan.
No, never. The internal examination is always offered, fully explained beforehand, and always subject to your complete consent. You can decline it, pause it at any point, or ask for it to be modified. Your care will not be compromised if you choose not to proceed with an internal assessment. We will always work within your comfort level, and your boundaries are respected unconditionally.
Completely normal, and we hear this often. Many women have had uncomfortable or invalidating experiences with internal examinations in medical settings. Our approach is different. Your physiotherapist will walk you through every step before it happens, answer any questions you have, and check in throughout. Nothing proceeds without your explicit agreement.
At Milestone, we provide trauma-informed care as a foundational part of how we work, not an add-on. Your Physiotherapist is explicitly trained to adapt the assessment and treatment to your comfort and your history.
There is always a meaningful amount we can assess and treat without any internal component.
No need to cancel. You are absolutely welcome to come in.
Pelvic Health Physiotherapists work with the body in all of its natural states, and that includes menstruation and any light vaginal bleeding you may be experiencing. This is a completely routine part of our practice. We are not surprised, not inconvenienced, and not concerned. We see this regularly, and it will not affect the quality of your care or the comfort of your session.
If you are experiencing unexpected or heavier-than-usual bleeding that is causing you personal discomfort or concern, you are always welcome to call us ahead of time, and we can talk through the best plan together. But please know, you will never be turned away, and you will never feel out of place here.
Most patients complete between 3 and 6 sessions, typically spaced approximately one month apart. Some patients find meaningful improvement in fewer sessions; others with more complex presentations may benefit from additional follow-up. Your physiotherapist will outline a realistic plan at your first appointment based on your assessment findings and goals.
Yes. Continuity of care matters to us, and you will see the same physiotherapist throughout your program. All appointments take place in a private, enclosed treatment room, never in an open clinic space.
The initial assessment session is $225. Follow-up sessions are $200 each.
Pelvic Health Physiotherapy at Milestone is not covered by Alberta Health Services as a publicly funded service. However, many extended health benefit plans do cover physiotherapy, and pelvic physiotherapy qualifies. We recommend checking your plan's coverage for physiotherapy services before your appointment.
Yes. Official receipts are provided for all appointments and can be submitted to your extended health benefit plan or Health Spending Account (HSA). Your physiotherapist is a registered physiotherapist, so receipts are issued accordingly.
GSM stands for Genitourinary Syndrome of Menopause. It is the clinical term for the collection of changes that occur to the vulva, vagina, bladder, and urethra when estrogen declines during menopause. These changes include vaginal dryness, tissue thinning, reduced elasticity, increased sensitivity to friction, bladder urgency, and recurrent UTIs. GSM affects up to 80% of menopausal women, and it does not improve without treatment. Pelvic Health Physiotherapy addresses the muscular and circulatory components of GSM that medical treatment alone cannot fully resolve.
Vaginal estrogen and pelvic physiotherapy work through different but complementary mechanisms. Estrogen improves the hormonal and tissue environment of the genitourinary tract. Pelvic Physiotherapy improves blood flow to those tissues, addresses pelvic floor muscle function, reduces guarding and tension, and retrains bladder and bowel behaviour. For many women, the combination produces better outcomes than either treatment alone. If you are already using vaginal estrogen and still experiencing symptoms, Pelvic PT is a well-evidenced missing step that you can include.
Yes, and this is an important point. Pelvic physiotherapy has no hormonal contraindications. It is a recommended treatment option even for women who cannot use local or systemic estrogen.
Across every category: bladder, bowel, sexual health and pain, cancer survivors report worse symptoms. Pelvic Physiotherapy is one of the few evidence-based pelvic health interventions that carries no oncological contraindications. It works independently of hormonal status and can be delivered safely at any stage of survivorship.
This is one of the most common reasons women come to see us, and one of the most rewarding to treat. Leaking with impact activity is not a sign that you need to stop exercising; it's a sign that your pelvic floor needs support to meet the demands you're placing on it. Your physiotherapist will assess how your pelvic floor is managing load and
impact, and build a graduated program that helps you return to the activities you love safely and confidently.