As a woman nearing the age of 40, I realize that it may be as soon as a year or as far out as a decade when I start experiencing the transition into menopause.
Menopause definitively starts when 12 consecutive months have passed since your menstrual cycle. Most women experience menopause between the ages of 40-60, but changes during the transitional phase into menopause, called perimenopause, can start years earlier.
During perimenopause, an individual will experience a change in hormones, menstrual cycles, sleep, mood, hair loss, weight gain and, of course, pelvic health. Decreased estrogen levels during perimenopause cause menstrual cycles to become inconsistent and more spaced out. In addition, dramatic mood swings, difficulty sleeping, depression and anxiety can affect your psychological and emotional well-being.
Many individuals experience these symptoms and do not realize they are related to perimenopause. Being aware that these symptoms are due to hormonal fluctuations can help you take proactive steps to ease the transition. Regular exercise and relaxation exercises, including meditation and yoga, help decrease stress and improve sleep. Working with your medical provider on ways to balance or manage your hormones can also help.
Pelvic health changes related to menopause includes changes in pelvic floor muscle strength, vaginal dryness, and a decrease in sexual desire.
Decreased estrogen levels during perimenopause and menopause contributes to decreased lubrication, less vaginal discharge, and dryness of vulvar and vaginal tissues. This dryness may contribute to painful sexual intercourse, bleeding during intercourse, itching or irritation of vulvo-vaginal tissues, and increased bacterial infections.
My number one tip for women is to moisturize. Using an all-natural, and hormone free moisturizer, such as Coconut oil, Vitamin E oil, or all-natural balms, can help manage these symptoms related to dryness. These all-natural moisturizers can be used inside your labia, at your vaginal opening, and inside the vaginal canal to help with dryness. Using this nightly prior to sleep (or as often as your like) can help soothe sensitive tissues.
Pelvic Floor Muscle Weakness
Decreasing estrogen levels also contribute to thinning and weakness of your pelvic floor muscles and vaginal tissues. Your pelvic floor muscles help support your pelvic organs (your uterus, bladder, and rectum) and help keep the sphincters closed that hold in pee and poop. As perimenopause progresses, you may experience increased leaks of urine with coughing, sneezing, laughing or exercise.
Weakness of your pelvic floor muscles can also contribute to pelvic organ prolapse, when your pelvic floor muscles and ligaments are not supporting your organs well. Your bladder, uterus, or rectum may drop down or press into the walls of the vagina. This can feel like pressure or heaviness in your pelvis that is worse with standing or at the end of the day, the sensation of something “falling out” of your vagina, a bulge at the vaginal opening, rubbing on the inside of your vaginal canal or even incomplete emptying when you pee or poop. Working with a pelvic floor physical therapist is key to managing prolapse to learn how to minimize straining, strengthen your pelvic floor muscles, and modify exercise and activity. A medical provider, such as a urogynecologist, can recommend supportive devices like a pessary or perform surgery if needed.
Hormonal changes can also affect your sexual desire and health. Decreased estrogen levels, along with increased stress and lack of sleep, can decrease one’s sexual desire. In addition, low estrogen levels can cause vaginal tissues to be thin and dry, leading to pain, a raw sensation or even mild bleeding with intercourse.
Water-soluble lubricants are recommended for sexual activity and intercourse to minimize friction and improve pleasure. Your medical provider may also recommend a topical hormone replacement to “plump” up the vaginal tissues to improve moisture and comfort. Sexual activity or intercourse should not be painful and if you experience pain with sex, work with a pelvic floor physical therapist or your medical provider for help. Increased pleasure may also help increase sexual desire.
Pelvic Floor Physical Therapy
Pelvic floor physical therapists specialize in treating the muscles and tissue in the pelvic region, which affect bowel, bladder, and sexual health. We also specialize in treating women experiencing the symptoms of perimenopause or menopause by working to strengthen the pelvic floor muscles, improve the elasticity of the vagina to minimize pain and tearing with intercourse, and help prevent those little bladder leaks that increase with aging.
If you are already experiencing any of these symptoms, it’s never too late to talk with your medical provider and work with a pelvic floor physical therapist for help. We often do not discuss these very intimate changes we experience. Know you are not alone, and there is help and hope available!
Sara Reardon PT, DPT, WCS is the owner of NOLA Pelvic Health and founder of The Vagina Whisperer, a resource for online pelvic health education and therapy to help women worldwide with pelvic health conditions. She is a board certified women’s health physical therapist with a special interest in treating pelvic pain and pregnancy and postpartum conditions. She is a mom, wife, Saints fan and wanna be yogi.
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