Menopause. Maybe you’ve already gone through it, or maybe you’re going through it right now. Women who are going through menopause quite often complain of a wide variety of symptoms. Hot flashes. Night sweats. Vaginal dryness. Thinning of hair and tissues. Urinary and/or fecal incontinence. Constipation. Pain with sex. Pelvic organ prolapse. While not all of these things are directly caused by menopause itself, many are secondary complications of the aging process.
A woman has reached menopause after going 12 consecutive months without having a menstrual period. This happens because the body’s production of estrogen and progesterone decreases, thus disrupting a woman’s reproductive cycle. Menopause most often occurs in the mid-40s to mid-50s. The good news is that pelvic floor physical therapists (PFPTs) are trained to identify and treat the changes a woman’s pelvic floor undergoes as the result of “The Change” in order to improve your function.
One of the first things I recommend to menopausal or post-menopausal women who are experiencing pelvic floor dysfunction is to speak with their healthcare provider. Whether it be a primary care physician, OB/GYN, urologist, urogynecologist, or another specialist, to see if they need their hormone levels checked. This can be done simply with a thorough history, however many healthcare providers may also opt for a blood test for a detailed hormone panel.
As previously described, menopause is defined as a decrease in the production of estrogen and progesterone. Estrogen is vital in tissue and muscle integrity, and a decrease in estrogen promotes thinning/weakening of your vaginal wall and surrounding tissues, thinning of the lining of your urethra (the tube that allows urine to pass from your bladder) AND weakening of your pelvic floor muscles. This can all lead to incontinence, pelvic organ prolapse, and pain with intercourse. If deemed appropriate by your healthcare provider, an estrogen supplement, such as a topical estrogen cream can be extremely beneficial to tissue health and very quickly affect your symptoms.
A PFPT can then develop a treatment program for you to address all the other impairments contributing to your symptoms, such as pelvic floor tension, posture, other areas of weakness, core strength, breathing patterns, and pressure management strategies.
It is important to know that not all impairments are physical. Sleep, hydration, diet, and stress management are all extremely important in pelvic floor dysfunction, particularly in menopause. Managing these areas well can help with the fatigue, irritability, and weight gain associated with menopause, and requires a collaborative effort. A physical therapist can help direct women to other specialists that are vital to complete care, such as a dietician for nutritional guidance, an endocrinologist for any thyroid issues, or a mental health professional to work through any stress, anxiety, depression, or other mental health needs.
Bottom line: incontinence, prolapse, pain, and many more of these symptoms may be common, but they are NOT normal. Just because we get older, doesn’t mean we need to leak. We don’t have to accept these symptoms as they are, rather we can work together to stay dry, light, and pain-free.