We need to talk more about the menopause and its symptoms. Most women don’t know what to expect other than the possibility of hot flushes and their periods stopping. Did you know that in the years surrounding the menopause there can be implications for your pelvic health? Yes, it’s true the menopause is a major risk factor for the development of pelvic floor dysfunction and the severity of these symptoms can increase after the menopause.
Many of us don’t even think about our pelvic health or pelvic floor muscles unless symptoms develop and we are having problems. Throughout life this tends to be while pregnant or maybe after giving birth. Pelvic floor dysfunction can also become an issue in the years surrounding the menopause. Symptoms arise because of weakening of the pelvic floor muscles and hormonal changes, in particular the depletion of oestrogen levels during the menopause. Symptoms of menopause do vary from one person to another, however paying special attention to our pelvic floor muscles and pelvic health when approaching, during and after the menopause will help maintain or even improve our pelvic floor muscle function. It will also help prevent and manage any pelvic floor symptoms.
Let’s discuss the pelvic floor muscles. These are an important group of muscles at the base of your core running from the pubic bone at the front to the tailbone at the back and fanning out the inside of the pelvis, a bit like a hammock. The pelvic floor muscles have several vital functions including maintenance of our continence - both bladder and bowel, support of our pelvic organs, stability of the pelvis and we also require them for our sexual function. Weakness of these muscles with the onset of the menopause can lead to problems with the bladder and bowel function, incontinence, pelvic organ prolapse and urgency. These symptoms are exacerbated further by falling oestrogen levels resulting in vaginal atrophy which is reduced elasticity and thinning of the tissues, vaginal dryness, burning, urinary tract infections and painful sexual intercourse.
The term used to describe menopause symptoms related to pelvic health is ‘Genitourinary Syndrome of Menopause’ (GSM) and 50% of women will experience this. People of all ages need to have well-functioning pelvic floor muscles to help prevent or reduce pelvic health issues. Research shows a positive impact on GSM, in particular bladder and prolapse symptoms with physiotherapy and pelvic floor muscle training. Pelvic health issues are common because of the structural changes with aging and the hormonal changes that come with the menopause but we should not consider them inevitable or simply put up with them. We can improve and even futureproof our pelvic floor muscle health with my 5 pelvic health tips…
1. Do pelvic floor muscle training daily.
Before the menopause the muscles and tissues tend to be able to cope with some level of weakness but with falling oestrogen levels the weakness can suddenly worsen and result in the onset of symptoms. 50% of women will experience urinary incontinence or prolapse or both. Pelvic floor muscle training helps maintain pelvic floor strength, endurance and tone.
2. Ensure good bladder and bowels habits.
Hydrate, aim for 1.5-2l of fluids daily. Don’t strain and take your time to empty. Avoid constipation. Wipe from front to back. Avoid going to the toilet ‘just in case’.
3. Ensure good vaginal and vulvar care.
Because of changes to the skin and tissues in the area avoid harsh soaps, gels, washes or sprays. Use warm water to clean and pat dry. Wear cotton underwear. Change pads or liners if they get wet as they will irritate the skin. 40% of women experience vaginal atrophy(reduced elasticity and thinning of the tissue) and dryness. This can impact sexual health and relationships. A good lubricant is advisable for intercourse. Speak to your GP about local oestrogen.
4. Get daily physical exercise.
Both physical and mental health issues can be a concern in menopause. Exercise has many well documented physical and psychological benefits. It helps build and maintain muscle strength, bone density and a healthy weight. Exercise also improves energy levels, sleep and mood. Management of any pelvic floor dysfunction is important in maintaining physical activity. Many women stop exercising because of leakage, prolapse or pain. See a pelvic health physiotherapist if your pelvic health issues are holding you back.
5. If you are symptomatic seek out help and support.
We know women wait on average 6.5 years before seeking help for pelvic floor dysfunction. There are many reasons for this. Pelvic health conditions are not life threatening, they can have stigma or shame attached to them and unfortunately some, like incontinence have been normalised. Help is available.
Pelvic health issues are probably not the most obvious symptoms of menopause, however they can affect your physical, social, emotional and sexual wellbeing and may have a significant impact on your quality of life. It is important to be aware of what you can do to improve your pelvic health at this stage in life. You shouldn’t have to live with these symptoms. With the correct education and management they can be alleviated or managed.
We definitely don’t talk about our pelvic health enough but please:
- Don’t suffer in silence:
- Don’t settle.
- Be an advocate for yourself.
- Don’t put up with pain, discomfort, leakage, prolapse symptoms, bladder or bowel issues.
- Don’t accept pelvic health symptoms as your normal.
- Do seek help and support.
- Speak to your GP or your local Pelvic Health Physiotherapist.
Sylvia Farrell BSc(Hons), MISCP, CPWHC, CORU Registered PT026294
Chartered Physiotherapist – Women’s and Men’s Pelvic Health
Evidence Based Therapy Centre