Menopause and your pelvic floor

Menopause is defined as the last menstrual period a woman has, which is confirmed after there has been 12 months without any period (or when ovaries are removed in surgery). 

In those who have not had surgery or damage to their ovaries, Menopause usually occurs between the ages of 40 and 58 years. 

Perimenopause is the transition time leading up to the last period, and is characterised by fluctuations in hormone levels and symptoms. This phase can last up to 6 years years before true menopause has occurred. 

What changes occur during menopause?

The changes experienced in menopause and perimenopause are due to the fluctuating and eventual decline in the hormones; particularly estrogen. 

Estrogen is responsible for: 

  • Stimulating growth of breast tissue
  • Maintaining vaginal blood flow and lubrication
  • Causing lining of the uterus to thicken during the menstrual cycle
  • Keeping vaginal lining elastic
  • Many other functions, including preserving bone density

During perimenopause, levels of estrogen fluctuate and become unpredictable. Eventually, production falls to a very low level. This may cause some women to experience symptoms such as hot flashes, night sweats, palpitations, headaches, insomnia, fatigue, bone loss, depression and muscle aches. It can also be a time of change to sexual function such as vaginal dryness and low libido. Remember, not everyone will experience all of these symptoms, and some people have minimal concerns during this phase of life. 

How does this affect my pelvic floor?

Estrogen plays an important role in keeping the tissues of our vulva, vagina, bladder and pelvic floor muscles strong and flexible. As estrogen levels decline with menopause, the tissues of the vulva, vagina and urethra can become thinner and lose their elasticity, there is a reduction in lubrication of the vagina and the pelvic floor muscles also become thinner and less flexible

Around 50% of those who experience menopause report bothersome pelvic symptoms such as: 

Vaginal/Vulval symptoms:

  • Dryness
  • Burning/itching
  • Vaginal shortening and narrowing

Bladder symptoms:

  • Urinary Urge (need to go more often or trouble holding)
  • Urinary Incontinence (leaking)
  • Bladder infections
  • Recurrent urinary tract infections (UTIs)
  • Stress Urinary Incontinence (leaking when coughing, sneezing or exercise)
  • Pain with urination (Dysuria)

Sexual symptoms:

  • Pain or discomfort with sexual intercourse (Dyspareunia)
  • Loss of libido

Heaviness: 

  • Pelvic organ prolapse 

How can I look after my pelvic floor through menopause?

Evidence shows that pelvic floor muscle training can reduce the pelvic symptoms associated with menopause. 

Regular pelvic floor muscle training - through Kegels or the use of a pelvic floor trainer, can reduce the loss of muscle tone or strength that occurs with the hormonal changes of menopause. Strong and healthy pelvic floor muscles sit like a hammock beneath the pelvic organs and provide and lift and support - reducing heaviness or bulging in the vagina (prolapse). These muscles also provide closure support to the urethra and reduce urinary incontinence. 

A loss of sexual function is commonly reported by those going through menopause. To reduce these effects, maintaining a strong pelvic floor with pelvic floor muscle training can increase sexual sensation and orgasm for both partners. For those experiencing vaginal dryness, topical estrogen creams can be applied in the vagina to reduce dryness, itching and burning, and increase pleasure during sex. 

Other healthy living tips for Menopause 

Keeping generally fit and active during menopause is important for overall well-being and reducing menopause symptoms. Strength training with resistance (like weight training) maintains muscle tone and mass which is often lost with hormonal changes of menopause. 

Weight-bearing exercise like walking or running is also important, as this helps to maintain bone density and strength. This is extra important during and after menopause as women during this phase are at increased risk of osteoporosis and fractures. 

Keeping active and eating well also helps maintain a healthy weight and reduces risk of conditions such as cardiovascular disease and depression, which also affect women more commonly after menopause. 

Speak to your health care provider if you are experiencing any symptoms of concern relating to menopausal changes, as they can help support your health and hormones through this somewhat turbulent time.

Article written by
Laura Justin
Qualified and Registered Australian Physiotherapist
Women's and Children's Health
@thefamilyphysio 

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