Navigating the Changes: Understanding Pelvic Health During Perimenopause and Menopause
Welcome to the second part of our blog series! This series explores two significant life stages for women and people who menstruate: firstly, pregnancy and postpartum, and now, menopause and beyond.
As you enter the perimenopause stage or find yourself in the midst of menopause, you might notice some unexpected changes in your body. These changes can be both physical and emotional, affecting various aspects of your health, including your pelvic floor. Let's dive into how these hormonal shifts can impact your pelvic health, what symptoms you might experience, and most importantly, what you can do to maintain your well-being during this stage in your life.
Incontinence: It's Not What You Might Expect
Many people assume that stress urinary incontinence – the kind where you leak when you sneeze, cough, or laugh – is the primary bladder issue that worsens during menopause. In reality, urge urinary incontinence often emerges as the most troublesome and disruptive form of incontinence associated with menopausal changes. This shift in bladder function can manifest in several ways, and you may find yourself dealing with:
Sudden, intense urges to urinate (overactive bladder)
Difficulty making it to the bathroom in time
Nighttime bladder urgency
These bladder-related issues can be particularly frustrating when combined with other menopausal symptoms. Hot flashes might jolt you awake, leaving you overheated and uncomfortable, while insomnia can make falling asleep—or staying asleep—a challenge. The trifecta of urinary urgency, hot flashes, and insomnia creates a perfect storm for poor sleep. As a result, you might find yourself exhausted, trudging through your days in a haze or mental fog.
Vaginal and Vulvar Changes
As estrogen levels decrease during menopause, you may experience significant changes in your vaginal and vulvar tissues. These changes can be both physical and functional, affecting various aspects of your daily life and intimate relationships. Some of the common symptoms you might encounter include:
Vaginal dryness: The decrease in estrogen can lead to reduced vaginal lubrication, causing discomfort and potentially making intercourse painful.
Increased sensitivity of vulvar tissues: You may notice that your vulvar area becomes more sensitive or irritated, sometimes to the extent that wearing certain types of underwear or clothing becomes uncomfortable.
Dyspareunia: This is the medical term for pain during intercourse, which can occur due to the changes in vaginal tissues and lubrication.
Recurrent urinary tract infections (UTIs): Estrogen loss weakens the muscles of your urethra, making it easier for bacteria to enter and travel to your bladder. Also, low estrogen levels also mean you have fewer healthy bacteria to help prevent infections.
Vaginal atrophy: This condition involves the thinning, drying, and inflammation of the vaginal walls due to decreased estrogen production.
These symptoms can significantly impact your quality of life, affecting everything from your daily comfort to your sexual health and intimacy. However, it's important to remember that these changes, while common, are not an inevitable part of menopause that you must simply endure. There are various treatments and management strategies available to help alleviate these symptoms and improve your overall comfort and well-being during this transitional period.
Muscle Changes and Associated Risks During Menopause
The decline in estrogen levels during menopause doesn't solely impact your reproductive organs. It can trigger significant changes in your overall muscle structure and bone density, leading to various health considerations:
Decreased muscle mass and strength: As estrogen levels drop, you may notice a reduction in muscle bulk and strength, potentially affecting your overall physical capability and metabolism.
Pelvic floor muscle function: As overall muscle mass decreases, the pelvic floor muscles often compensate by increasing tension. However, when muscles remain tense for extended periods, they actually weaken and become less able to withstand force or pressure from above. This makes these muscles less functional for everyday tasks such as lifting grandchildren or heavy groceries.
Increased likelihood of pelvic organ prolapse: Changes to the pelvic floor muscles and supporting tissues can lead to the descent of pelvic organs—such as the bladder, uterus, or rectum—into the vaginal canal. This may cause a sense of vaginal pressure or a bulge, especially in later stages. It's crucial to note that prolapse itself does not typically cause pain. If you experience pain along with vaginal pressure or a bulge, further assessment is necessary to identify the source of your discomfort.
Elevated risk of osteoporosis: The hormonal changes can accelerate bone loss, making your bones more fragile and increasing the risk of fractures, particularly in the hips, spine, and wrists.
Interestingly, recent scientific investigations have uncovered a potential link between menopausal changes and frozen shoulder syndrome. This condition, characterized by pain and stiffness in the shoulder joint, appears to have a higher prevalence among women during the menopausal transition. While the exact mechanism is still being studied, it's thought that hormonal fluctuations might influence joint and tissue health beyond the pelvic region.
What Can You Do?
While these changes associated with perimenopause and menopause can seem overwhelming, it's important to remember that there are numerous effective strategies to manage them. By taking a proactive approach to your health during this transition, you can improve many of the symptoms and maintain your overall well-being. Here are some key steps you can take:
Consult with a pelvic health physiotherapist: They can provide you personalized advice, tailored pelvic floor and strengthening exercises, teach you relaxation techniques, and offer strategies to manage incontinence or pelvic pain.
Explore hormone therapy (HT) options: Discuss the potential benefits and risks of HT with your primary healthcare provider. For some women, HT can significantly alleviate menopausal symptoms, including those affecting pelvic health. Your primary healthcare provider can help determine if this is a suitable option for you based on your individual health profile and symptoms.
Maintain an active lifestyle: Regular physical activity is crucial for supporting overall muscle and bone health. Engage in weight-bearing exercises to maintain bone density, and incorporate strength training to preserve muscle mass. Activities like walking, swimming, or yoga can also help manage stress and improve sleep quality.
Address vaginal dryness: Use appropriate lubricants or moisturizers designed for vaginal use to alleviate discomfort. Some women may benefit from topical estrogen preparations, which your healthcare provider can prescribe if suitable.
Prioritize good sleep: To minimize nighttime disruptions, establish a consistent sleep schedule, create a relaxing bedtime routine, and ensure your sleeping environment is cool and comfortable. This can help manage sleep disturbances often associated with menopause.
Remember, every woman's experience with perimenopause and menopause is unique, and what works for one person may not be as effective for another. It's crucial to be patient with yourself and your body during this transition. Don't hesitate to reach out to healthcare professionals if you're experiencing discomfort or have concerns about any aspect of your pelvic health or overall well-being. With the right support, information, and self-care practices, you can maintain your quality of life and even embrace this new chapter as an opportunity for personal growth and renewed focus on your health and well-being.
Have questions? Book a complimentary 15-minute meet and greet with our Bright pelvic floor physiotherapist to learn more!
WRITTEN BY: Grecia Alaniz, PT, PHD (C)
Disclaimer
This blog primarily focuses on the menopausal experience of cis-women. While menopause remains vastly under-researched, the effects of menopause on trans-men are even less studied. This blog will be updated as more research becomes available for both cis-women and trans-men.
The advice provided in this article is for information purposes only. It is meant to augment and not replace consultation with a licensed healthcare provider. Consultation with a physiotherapist or other primary care provider is recommended for anyone suffering from a health problem.