Menopause and the Pelvic Floor

Menopause: Pelvic Pain, Incontinence, Prolapse, Urgency, and More: What you need to know menopause and pelvic floor Physical therapy

Are you in your late 30s or early 40s or 50s and experiencing pelvic floor dysfunction such as  vaginal dryness, pain with sex, frequent UTIs, urinary urgency, frequency and urinary incontinence? You may be entering perimenopause or in menopause. 

Perimenopause is defined as the time in a woman's life prior to menopause. This can start as early as the mid 30s but typically in their 40s. 

Perimenopause is characterized by irregular periods that are longer and shorter in duration, and significant fluctuations in estrogen levels. 

Menopause is defined as a lack of menstrual period for 12 consecutive months. The average age a woman experiences menopause is 51, but it can happen anytime between 40-58.  Menopause results in a decrease in the hormone estrogen, which is a very important hormone for sexual health in addition to overall health and well being. Symptoms of menopause include hot flashes, night sweats, vaginal atrophy and dryness, and pain with sex. 

The significant drop in estrogen associated with menopause can contribute to pelvic floor symptoms such as 

• Vaginal dryness

• Pain with sex 

• Frequent UTIs

• Urinary urgency and frequency 

• Urinary incontinence

These symptoms are referred to as the Genitourinary Symptoms of Menopause (GSM). 

If these symptoms sound familiar, it's because they are pelvic floor dysfunctions. 

Your pelvic floor muscles are the base of your core. They make a hammock in your pelvis and run front to back from pubic bone to tailbone and side to side from the hip bones. The pelvic floor muscles provide support for your bladder, uterus and rectum and keep these organs from falling out. The pelvic floor is also responsible for maintaining continence and sexual function. For an in depth information on the pelvic floor check out this article here.

Pelvic floor dysfunction can occur at any age, but it’s most common in women who have given birth. Pelvic floor symptoms that may have resolved after giving birth might show up again during perimenopause/menopause. 

The good news is that all of these pelvic floor symptoms associated with menopause can be treated with Pelvic Floor Physical Therapy, similar to the way they would be treated in pregnancy and childbirth. 

Take a look at how Pelvic Floor Physical Therapy can help some common conditions associated with menopause. 

Pain with sex: Pain with sex can be caused by tightness and overactivity of the pelvic floor muscles. Pelvic Floor PT for pain with sex involves addressing these tight muscles with manual therapy, trigger point release, and learning to relax the pelvic floor muscles with breathing and stretching exercises. Another common cause of pain with sex in menopause is the dryness associated with the drop in estrogen. A topical estrogen cream in conjunction with pelvic floor PT can greatly reduce pain with sex. 

Urinary Urgency and Frequency: Pelvic floor Physical Therapy for urinary urgency and frequency starts with retraining the bladder via behavioral modifications. Strengthening the pelvic floor and surrounding musculature can also be helpful with this. 

Urinary Incontinence: Contrary to popular belief, Kegels are not the most effective way to treat urinary incontinence. In fact, tightness in the pelvic floor muscles can cause incontinence, and Kegels will just make this worse. Instead, your pelvic floor physical therapist will teach you strategies on managing pressure, postural modifications, breathing techniques and strengthening the glutes and hips to reduce incontinence. 

Pelvic Organ Prolapse: Pelvic Organ Prolapse is descent of the pelvic organs into the vagina. It’s more common in women who have given birth vaginally, but can occur in any woman. With menopause, the muscles and ligaments surrounding these structures weaken, which can worsen prolapse. Pelvic floor physical therapy for prolapse involves postural education, pressure management strategies (avoiding bearing down) and strengthening the hips and glutes to better support these organs. 

Frequent UTIs in Menopause 

Urinary Tract Infections, or UTIs, can be more common post menopause. The drop in estrogen that comes with menopause largely plays a role in these frequent UTIs. Lack of estrogen can weaken the urethra and cause dryness and irritation in the urinary tract. As we age, UTIs can prove to be deadly if not treated effectively. The good news is, a topical estrogen cream can prevent UTIs.

 Hormone Replacement Therapy 

In conjunction with pelvic floor physical therapy for menopause, hormone replacement therapy can greatly reduce menopausal symptoms such as vaginal dryness, urinary frequency and urgency, urinary incontinence, pain with sex and UTIs. 

Although estrogen wrongfully gets a bad rep, it’s actually an incredibly important hormone for women’s health and well being. Estrogen plays a role in every single organ in our body. 

Some of the important functions of estrogen include: 

• stimulating neuron growth and increases plasticity of the brain which can reduce risk of Dementia 

• protection against cardiovascular disease. Estrogen is a vasodilator which means it increases the diameter of the blood vessels which can decrease the risk of high blood pressure, which occurs when the blood vessels are constricted. 

• maintains bone structure by slowing down the natural breakdown of bone. This can help reduce the risk of fractures, especially as we age. 

The drop in estrogen that comes with menopause can lead to an increased risk of

• Alzhemiers 

• cardiovascular disease

• osteoporosis and hip fractures

As most menopausal symptoms are caused by a drop in estrogen, Hormone Replacement Therapy (HRT)  can also be very helpful for menopausal symptoms. Contrary to popular belief, HRT is safe for most women. Of course there are some exceptions, so we highly recommend a conversation with your provider to see if you are appropriate for HRT. This is not something a Pelvic Floor Physical Therapist can prescribe.

If you are interested in learning more, we highly recommend reading the book Estrogen Matters. This book debunks the myth that HRT causes breast cancer. We also recommend finding a provider who is supportive of HRT.

Just like pregnancy, menopause is a time of significant change for a woman’s body. And just like pregnancy and postpartum, there is so little information about what we can do during this time to help alleviate pelvic floor symptoms associated with menopause. 

If you are experiencing any pelvic floor symptoms associated with menopause, give Cappuccino Physical Therapy a call today. It’s never too late to get help.