menopause and your pelvic health
Menopause is a natural phase in every woman's life, but it often brings along a host of changes that can affect your body in unexpected ways. ‘Officially’ menopause is one year after your last period. The five to ten year lead up to menopause can be described as peri menopause, and for many women the fluctuating hormone levels can cause a host of symptoms.
Menopause can impact the whole body, but what we often notice the most is how our pelvic floor is affected. The decline in estrogen levels during this time can lead to uncomfortable and sometimes challenging symptoms such as urinary leakage, bladder urgency, and painful intercourse. Understanding how menopause affects your pelvic floor is key to managing these symptoms effectively.
The Impact of Menopause on Your Pelvic Floor
As you go through menopause, the drop in estrogen levels can cause your pelvic floor muscles and the supportive tissues around your bladder and urethra to weaken. This weakening can result in stress urinary incontinence (SUI), which means you might experience involuntary leakage during activities like coughing, laughing, or even exercising. The reduced estrogen also impacts the tone and thickness of the urethral lining, making it less effective at staying closed, which can further contribute to leakage.
In addition, you might experience urinary urgency. This is when you experience an increase in how often you need to urinate, or feel an urgent need to go, even if your bladder isn't full. This is partly because the tissues in your urinary tract lose some of their elasticity and strength, making your bladder and urethra more sensitive.
Vaginal atrophy is another common condition during menopause. It involves the thinning and drying of your vaginal tissues, which not only affects comfort during sex but can also lead to bladder issues like increased frequency and urgency. Pain during intercourse, known as dyspareunia, is also common as a result of these changes.
Managing Pelvic Floor Issues During Menopause
If you start experiencing pelvic floor issues during menopause, there are several treatment options to consider. There are some symptoms and issues that may require further investigation and should be discussed with your GP. Some women may benefit from the use of hormone replacement therapy (HRT) or topical vaginal oestrogen. This is a discussion that should take place with your GP.
Aside from hormonal treatments, pelvic floor physiotherapy can be effective in managing symptoms. Physiotherapy can assist with the following;
Manage vaginal dryness: Using vaginal lubricants and moisturisers can help keep your tissues hydrated and reduce discomfort during sex.
Address vaginal narrowing: If vaginal narrowing is affecting your bladder, bowel, or sexual function, dilator therapy might be suggested to help keep the vaginal canal open and flexible. If this is required, then your physiotherapist can provide advice on the correct size and type of dilator.
Control bladder urgency and frequency: Bladder retraining techniques, which involve gradually increasing the time between bathroom visits and using strategies to delay the urge to urinate, can be very helpful.
Strengthen your pelvic floor muscles: Exercises like ‘Kegels’, or using vaginal weights, can help improve the strength of your pelvic floor muscles, giving better support to your bladder and bowel. It is important to have had a full assessment of your pelvic floor muscles prior to using weights or home trainers, to ensure you are using the correct muscles and that the device you are using it the right choice.
Treat prolapse and vaginal heaviness: If you're experiencing a sensation of vaginal bulging or heaviness, which may indicate a prolapse, pelvic floor therapy and devices like support pessaries can help manage these symptoms.
Final Thoughts
Menopause can bring about significant changes to your pelvic floor health, but understanding the connection between declining estrogen levels and these symptoms is the first step toward effective management. There is a wide range of treatment options available. The best way to cope with menopause is to ensure that you are taking steps towards optimal health in the years preceding it. There may be some very simple changes that you can make to your lifestyle to assist with managing the changes that take place.
Always consult with your healthcare provider to determine the best approach for your specific needs.
