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Margaret crossed her legs before she sat down on my exam table. She didn't notice she did it.
It was the same tiny gesture I have watched a thousand women make in my New York City pelvic floor clinic over the last 21 years.
Three seconds of unconscious self-protection.
Margaret was 56. She came in thinking she had a bladder issue. Her doctor ruled out infection. Her gynecologist called it normal aging.
She had been doing kegels for two years. They were sort of working.
I asked her one question that changed everything.
"Did anyone ever tell you that your pelvic floor is built out of collagen, and that you have been losing 1% of your collagen every year since you turned 20?"
She looked at me like I had just handed her a key to a door she did not know was locked.
This is the article I wish someone had handed me at 40.
Here is what dermatology has known for fifty years. Nobody has been telling women.
After age 20, women begin losing collagen at approximately 1% per year. That figure comes from Dr. Sam Shuster's foundational 1975 study in the British Journal of Dermatology. Decades of research since have confirmed it.
It sounds small. It is not small.
By the time you turn 40, you have already lost roughly 20% of your collagen.
That is the cliff. You are already over it.
And here is what nobody tells you next. The loss does not pause. It keeps going, quietly, every single year.
So by the time you reach 50, you are not at the edge of the cliff anymore. You are standing in the steepest part of the drop.
Because that is when menopause arrives, and the rate accelerates. Dr. Mark Brincat's 1987 research in Obstetrics and Gynecology showed that women lose 30% of their skin collagen in the first five years of menopause.
The decline continues across all the postmenopausal years after that.
So if you are in your fifties or beyond, this is not a someday problem.
This is the exact window where the loss is moving fastest, and where feeding it back matters most.
Here is the part nobody mentions in the supplement aisle.
Skin collagen is the outside measure. Your face is the outside measure.
Your bones, your joints, your bladder, your pelvic floor, and the fascial scaffold that holds your organs in place are losing collagen on the same timeline.
You see the outside loss in the mirror. You feel the inside loss in your body.
That is what Margaret was actually experiencing.
It was not a bladder issue. It was a collagen issue showing up in her bladder first.
Most women think collagen is a beauty supplement. Something you take for hair, skin, and nails. That is not wrong. It is just so much smaller than the real story.
Collagen is the most abundant protein in your body. It is the building material your body uses to make fascia.
Fascia is the continuous web of connective tissue that wraps and holds every muscle, every organ, every joint, every bone, every blood vessel, and every nerve in your body.
Fascia is the scaffold. The structural architecture. The thing that holds you up from the inside.
Fascia is 70 to 80% collagen by dry weight, mostly Type I and Type III, with Type V playing a critical role in the pelvic floor specifically.
Here is the part nobody told you in plain English.
As your collagen levels drop, your fascia weakens. When your fascia weakens, your scaffold loses tension.
Your pelvic floor and your face are falling on the same timeline because they are built from the same material. The material is collagen. And the material is running out.
In my practice, I see women every week who tell me their pelvic floor feels weak AND their skin is sagging AND their joints ache AND their bladder is acting up.
These are not four separate problems.
This is one problem with four visible signs.
Find out how Total Fem Collagen can support you
These are the five signs I see most often among the women in my community, and in my online programs. Most women have been taught to blame each one on a separate cause. Most women never connect the dots. Once you see the pattern, you cannot unsee it.
Bathroom Trips at Night You Blame on Drinking Too Much Water.
Your bladder is held in place by a connective tissue web that is heavily dependent on collagen. When the scaffold weakens, the bladder loses support. You wake up two, three, four times a night and tell yourself you drank too much before bed. It is not the water. It is the scaffold.
Pressure or Heaviness Down There You Blame on the Weather.
Your bladder is held in place by a connective tissue web that is heavily dependent on collagen. When the scaffold weakens, the bladder loses support. You wake up two, three, four times a night and tell yourself you drank too much before bed. It is not the water. It is the scaffold.
Leaking When You Laugh, Cough, or Sneeze: You Blame It on Having Babies 20 Years Ago.
The birth was 20 years ago. The leaking is now. What changed in between? Collagen. Research on women with pelvic floor dysfunction has consistently shown lower collagen content and impaired collagen synthesis in pelvic floor tissues. The birth started the story. The cliff finished it.
The Mirror Showing You a Face You Don't Recognize.
Jowls. Neck cords. The skin on your hands looking like your mother's. This is the part of the scaffold collapse you can see. Your face is held up by the same fascia that holds your pelvic floor up. If you are doing creams for the face and nothing for the inside, you are watering the leaves while the roots dry out.
Lower-Back Ache and Abdominal Pressure You Blame on Shoes and Posture.
The connective tissue supporting your organs is the same fascial network running through your lower back, abdomen, hips, and pelvic floor. When the scaffold weakens in one place, it pulls and strains in another. The scaffold is asking for help in a language most doctors have not been trained to translate.
There is a new wrinkle in this story. If you are on a GLP-1 medication for weight loss, you are losing weight fast. Faster than your body can structurally keep up with.
Body composition data from the STEP-1 clinical trial and recent systematic reviews show that roughly 25-40% of the weight loss on GLP-1 is lean mass, not fat (Wilding et al., 2021).
Lean mass means MUSCLE.
It means connective tissue.
It means your collagen scaffold.
Your pelvic floor is lean mass.
Your fascia is lean mass.
The scaffold underneath your face is lean mass.
The GLP-1 compresses what menopause does over a decade into a matter of months. Different path. Same destination.
I am not telling you to stop a GLP-1.
I am telling you that if you are on one, the rebuild has to happen alongside the weight loss.
Otherwise the body you keep is structurally weaker than the body you arrived with.
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Here is the good news. The female body is one of the most regenerative systems on the planet. With the right inputs, your scaffold rebuilds.
Your fascia thickens. Your pelvic floor regains tone. Your skin firms from the inside.
There are three pieces to the rebuild. Only one of them is a supplement.
Piece one is protein at every meal, not just dinner.
Women 40 and over need more protein per meal than younger women to trigger muscle and fascia synthesis due to something researchers call anabolic resistance.
A good target is around 30 grams of complete protein at each meal. The easiest place to come up short is breakfast and lunch, so that is where to focus first.
Piece two is learning to lengthen and release your pelvic floor, not just clench it.
The pelvic floor is not strong when it is gripped. It is strong when it knows how to lengthen, release, and respond.
Most women have been over-clenching for decades and have lost the ability to release the floor at all.
This is the most underrated skill in women's wellness, and it is what I teach in my clinical practice.
Piece three is feeding the scaffold the actual material it needs to rebuild.
Your body cannot rebuild fascia from kale and almonds. It needs a complete protein with all nine essential amino acids, all five collagen types, because each one targets a different tissue, and peptides small enough to actually be absorbed.
This is the piece most women get wrong: most collagen supplements contain only Type I collagen and leave out tryptophan, which makes them incomplete proteins. Your body cannot assemble new fascia from incomplete material.
That is why I built Total Fem Collagen.
It is a complete protein, with 11 grams in a single scoop, containing all 9 essential amino acids, including tryptophan, the one most collagen brands quietly leave out.
Tryptophan also feeds serotonin, so your mood and sleep are supported at the same time as your fascia.
It has all five collagen types, not just the Type I most brands stop at, because your scaffold needs more than one.
Total Fem Collagen includes Naticol marine collagen, the wild-caught Type I peptide clinically studied by Weishardt for skin firmness, hydration, and elasticity.
→ Use code REBUILD to get 15% off Total Fem Collagen
They measured skin because skin is what you can measure from the outside.
Your pelvic floor fascia is built from that same Type I, so the peptides go wherever your body needs to rebuild it, the scaffold under your pelvic floor included.
I take it every morning in my coffee.
My patients take it in tea, in smoothies, stirred into oatmeal.
It is flavorless and dissolves clean. It does the work most women have been trying to do with five different products and a lot of guessing.
You are not getting older the way you have been told you are. You are losing structural material on a timeline nobody warned you about.
The pelvic floor. The bladder. The face. The joints. The lower back. The gut wall. The bones.
They are all built from collagen.
You have been losing it since you were 20. The cliff happens at 40.
By 50, you are in the steepest part. Menopause speeds it up. But the body rebuilds when you feed it.
Margaret took Total Fem Collagen for the next six months alongside the pelvic floor work we did together.
The bladder trips at night settled.
The pressure she had felt for two years quieted.
She told me at her last visit she had stopped crossing her legs before she sat down.
She had not even noticed she had stopped.
That is what rebuilding the scaffold actually looks like.
If you are 40 or over and you have been waiting for someone to hand you the real answer, this is it.
Feed Your Scaffold: Total Fem Collagen →
Support your wellness journey with Total Fem Collagen
Big LOve,
Isa
Isa Herrera, MSPT CSCS, is a pelvic floor physical therapist with 21 years of clinical practice and more than 22,000 Queens served. She is the founder of Pelvic Pain Relief and Rootganic, the creator of Total Fem Collagen, and the author of five books on pelvic floor health, including Ending Female Pain and Female Pelvic Alchemy. She lives and practices in the New York City area. Her work has been featured on NBC, ABC, and major women's health publications.
Shuster, S., Black, M. M., & McVitie, E. "Influence of Age and Sex on Skin Thickness, Skin Collagen and Density." British Journal of Dermatology, 1975. https://pubmed.ncbi.nlm.nih.gov/1220811/
Brincat, M., et al. "A Study of the Decrease of Skin Collagen Content, Skin Thickness, and Bone Mass in the Postmenopausal Woman." Obstetrics and Gynecology, 1987. https://pubmed.ncbi.nlm.nih.gov/3658265/
Wu, J. M., et al. "Prevalence and Trends of Symptomatic Pelvic Floor Disorders in U.S. Women." Obstetrics and Gynecology, 2014. https://pubmed.ncbi.nlm.nih.gov/24463674/
Soderberg, M. W., et al. "Collagen Synthesis and Matrix Composition in Pelvic Floor Tissues of Women with Pelvic Organ Prolapse." Acta Obstetricia et Gynecologica Scandinavica, 2009. https://pubmed.ncbi.nlm.nih.gov/19337900/
Wilding, J. P. H., et al. "Once-Weekly Semaglutide in Adults with Overweight or Obesity" (STEP-1 body composition data). New England Journal of Medicine, 2021. https://pubmed.ncbi.nlm.nih.gov/33567185/
Locatelli et al. "Sarcopenia in Women Through Menopause and Beyond." 2024. PMC12223412.
Isa Herrera, MSPT, CSCS is a New York City-based holistic women's pelvic floor specialist, author of 5 books on pelvic health, including the international best seller Female Pelvic Alchemy, and the ground-breaking self-help book, Ending Female Pain, A Woman's Manual. She has dedicated her career to advancing awareness of pelvic floor conditions so that more people can find relief from this silent epidemic that affects over 30 million people in the US alone. Ms. Herrera holds a BA in Psychology and Biology from Fordham University and also a Masters in Physical Therapy from Hunter College.
