Menopause and Pelvic Floor Symptoms

Menopause is the time in a women’s life when they have their final period. It marks the end of their reproductive life. Ovulation no longer occurs, resulting in a decline in oestrogen and progesterone, which will show in various symptoms. Most women in Australia will be menopausal by the age of 51 and perimenopause can last for many years prior to this.

 

There are three main phases to menopause:

1. Perimenopause: the time prior to menopause where a person may notice a change in her periods (shorter, longer, or more irregular) as well as other symptoms like hot flushes, brain fog and weight gain
2. Menopause: The last menstrual bleed
3. Post menopause: starts when a person has had no menstrual bleed for 12 months.

There are many different effects that can occur on the body (and it’s not limited to just the vagina and pelvic floor). There are oestrogen receptors in many different parts of the body and because of this, a decline in oestrogen can result in impacts on the skeletal system, cardiovascular system and brain, as well as the vagina and pelvic floor.

Symptoms of perimenopause and menopause may include:

• Hot flushes
• Night sweats
• Brain fog
• Fatigue
• Mood changes and irritability
• Sleep disturbances
• Decreasing libido and painful intercourse
• Weight gain
• Body aches.

As well as general body symptoms there is often symptoms and changes that occur to the vagina and pelvic organs. Vulvovaginal atrophy (also called Genitourinary Syndrome of Menopause – GSM) refers to symptoms that occur in the vaginal canal, primarily due to a decrease in oestrogen. These symptoms include:

• Vaginal dryness
• Vaginal irritation
• Vaginal soreness and vaginal splitting
• Pain with intercourse.

You can read more about Vulvovaginal Atrophy and its impacts on sexual function here.

As well as localised effects on the vaginal tissue, the decline in oestrogen can also have an impact on the pelvic floor, bladder, and bowels. This may result in a worsening or increase in:

• Urinary frequency
• Urinary urgency
• Incontinence
• Constipation
• Obstructed defecation
• Fecal incontinence (inability to control farts)
• Pelvic organ prolapse and vaginal heaviness.

Menopause and post-menopause is a common time for pelvic floor symptoms to worsen with up to 40% of post-menopausal women reporting urinary incontinence and up to 31% reporting symptoms of pelvic organ prolapse, with most symptoms being reported around age 60-65 years old. Oestrogen assists with keeping muscles and tissues strong and flexible which is why there can be such profound symptoms occurring in the pelvic floor and vaginal tissue.

Treatment Options:

There are several options available to you to assist with vaginal and pelvic floor symptoms during this period:

• Topical vaginal oestrogen or hormonal replacement therapy (HRT):your doctor may recommend topical vaginal oestrogen or HRT if you experiencing symptoms related to Genitourinary Syndrome of Menopause including vaginal dryness and painful sex. This is not suitable for everyone and is always prescribed by your medical professional.
• Using a good quality water based gel/lubricant to assist with vaginal dryness during intercourse. You can read about other causes of vaginal dryness and its impact on intercourse here.
• Pelvic Floor Physiotherapy: there is a huge role for pelvic floor physiotherapy during this time, especially in relation to sexual function, vaginal, bladder and bowel symptoms.

A pelvic floor physio can work on:

• Increasing pelvic floor strength, endurance, and co-ordination to assist with urinary incontinence, wind incontinence and pelvic heaviness
• Increasing pelvic floor support through things such as pessaries
• Stretching and helping to relax the pelvic floor with things such as dilators
• Working on your bladder function and re-training the bladder in the case of frequency and urgency
• Addressing bowel mechanics and looking at mechanisms for obstructed defecation and constipation
• Addressing full body flexibility and strength to ensure good muscle and bone health into the future (which is also protective for the pelvic floor!). You can find free pelvic floor yoga and mobility here.

References:

• Versi E, Harvey MA, Cardozo LD, et al. Urogenital atrophy and prolapse at menopause: a prevalence study. Int Urogynecol J2001;12:107–10
• Handa VL, Garrett E, Hendrix S, et al. Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women. Am J Obstet Gynecol2004;190:27–32
• DeLancey, J. O. L., Kane Low, L., Miller, J. M., Patel, D. A., & Tumbarello, J. A. (2008). Graphic integration of causal factors of pelvic floor disorders: an integrated life span model. American Journal of Obstetrics and Gynecology, 199(6), 610.e1–610.e5.doi:10.1016/j.ajog.2008.04.001