I recently had a patient who came to me for a pelvic floor evaluation. She is 50 years old, has 2 grown adult children and is recently retired. Anna* was enjoying her freedom that retirement had allowed her and loved to hike and run, until she started to notice some increasingly bothersome pelvic floor symptoms she had never experienced before. She thought that she was in the clear for leaking because she had never experienced any incontinence after either of her two vaginal deliveries around 20 years earlier. She also was enjoying an increased libido now that she did not have children in the house except that sex seemed to be more and more painful. After some other confusing symptoms that made her frustrated, Anna consulted with her PCP, and they concluded that Anna was probably in perimenopause.
Perimenopause, or the menopausal transition, is the time leading up to menopause which often begins in the mid-40s, and is associated with lots of bothersome symptoms such as hot flushes and mood swings. Menopause is defined as 12 months after the last period, and the average age of menopause in the US in 51 years old. It can be difficult to know if you are in menopause and not just experiencing irregular periods in the perimenopausal phase. The postmenopausal period is any time after menopause.
Menopause is NOT a disease or a disorder and is a natural biological process. However, the changes that occur are very real and can be extremely frustrating especially because (as usual) menopause is hardly discussed as a society, symptoms are often “normalized” and people do not know that treatment and help even exist!
During menopause estrogen levels begin to decrease which may lead to the following common signs and symptoms:
• Changes in periods
• Hot flushes (flashes)
• Incontinence and leaking
• Insomnia and trouble sleeping
• Vaginal dryness
• Pain with intercourse
• Changes in mood
• Weight gain
• Joint and muscles aches and pains
Several of these symptoms are grouped together and termed “genitourinary syndrome of menopause” (aka GSM) which include what Anna was experiencing: painful sex, vaginal dryness and decreased lubrication, urinary frequency and urgency, urinary leaking, post-coital bleeding, recurrent UTIs and prolapse. GSM is a very commonly under diagnosed condition despite 50-70% of the postmenopausal population reporting at least one symptom of GSM, and up to 70% of postmenopausal women displaying pelvic floor dysfunction. Although the menopause phase is most typically associated with hot flashes, GSM symptoms have a higher negative impact on quality of life and unfortunately do not typically spontaneously resolve and can get worse if left untreated.
If you’ve read any of my other blogs, you know that PT can help with several of the symptoms listed above! Pelvic floor physical therapy has great success rates treating urinary urgency and frequency, pain with intercourse, as well as addressing leaking.
PT cannot help improve or decrease vaginal dryness however ensuring you are using enough lubrication (preferably water-based) can be extremely helpful to minimize pain and post-coital bleeding caused by increased friction. A vaginal moisturizer can help to decrease the uncomfortable sensation of a dry vulva.
A pelvic floor physical therapist can also help devise a strengthening and cardiovascular program. Both are essential components of successful aging and minimizing the negative effects of changing hormones. These hormonal changes make weight gain easier, bones more brittle and building muscle mass harder. It is imperative to continue to strength train to sustain and build your muscle mass as well as improve bone density. Strength training does not have to be intimidating, and gym selfies are not required, but think about all of the activities that we do on a daily basis that require leg and arm strength – getting up and down from a chair or off of the floor, climbing stairs, carrying groceries and holding grandchildren.
Cardiovascular exercise is also extremely important due to the increased risk of cardiovascular disease women experience (and not to get too morbid here, just trying to shock you into action – heart disease is the leading cause of death in US women). Both cardiovascular exercise, strength training and a good diet can help manage weight gain.
Anna decided to take both a pharmacological and conservative approach to manage her symptoms and was pleased to tell me the last time I saw her that she is once again enjoying being intimate with her boyfriend! Let us be a part of your team and help guide you to and through menopause so that you feel empowered and equipped to deal with these significant life changes.
* Anna: name changed for patient confidentiality
This blog was written by our very own Pelvic/Women’s Specialist, Dr. Sam Greig.
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