As a woman nearing menopausal years it can be a daunting transition, one you feel you may not be ready for. Menopause 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.
Below are some changes you can expect to see in relation to your pelvic health.
HORMONE CHANGES 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. Women may also experience mood swings, insomnia, depression and anxiety which can affect your psychological and emotional wellbeing. Many women experience the above symptoms without even realising they are linked to perimenopause. Being conscious that these symptoms are due to hormonal fluctuations and imbalances can help you take proactive steps to ease the transition. Working with your doctor on ways to balance and manage your hormones can also be beneficial, they may also be able to refer you to professionals who can assist. Pelvic health changes due to menopause includes; changes in pelvic floor muscle strength, vaginal dryness, and a decrease in sexual desire.
VAGINAL DRYNESS During perimenopause and menopause our oestrogen levels start to drop which contributes to decreased lubrication and vaginal discharge, dryness of vulvar and vaginal tissues. This vaginal dryness may cause painful sexual intercourse, bleeding during intercourse, itching or irritation of vulvo-vaginal tissues, and increased risk bacterial infections. By seeing your local GP they may be able to prescribe you a low-grade oestrogen to apply topically or internally by pessary application. Another important element to decreasing the risk of irritation is to reduce or avoid prolonged use of sanitary pads for incontinence. By wearing sanitary pads 'just in case' or soiled pads for too long it can cause increased irritation and redness.
PELVIC FLOOR MUSCLE WEAKNESS Decreasing oestrogen levels also contribute to the thinning and weakness of your pelvic floor muscles and vaginal tissues. Your pelvic floor muscles help support your pelvic organs (uterus, bladder, and rectum) and help keep the sphincters closed that keep your bladder and bowel from leaking. As perimenopause progresses, you may experience increased leaks of urine with coughing, sneezing, laughing, exercise or when your bladder is full.
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 pelvic floor is quite literally the floor of your body, such a crucial and important muscle to prevent prolapse. A prolapse is where your bladder, uterus, or rectum may drop down or press into the walls of the vagina. Symptoms include; 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 or like you are sitting on a small ball, a bulge at the vaginal opening or incomplete emptying of your bladder or bowel. Please be aware that sometimes women don't realise that they have a prolapse, you may have subtle clues or symptoms - this is why its so important that you be checked during your perimenopause and menopause period.
Working with a Physiotherapist is key to conservatively managing prolapse to learn how to minimise straining, strengthen your pelvic floor muscles, and if needed modify your exercise and activity. A Physiotherapist may also be able to fit you with a pessary, which is a medical grade silicon assistive device.
SEXUAL HEALTH Hormonal changes can also affect your sexual desire and health. A decrease in oestrogen levels, along with lack of sleep and increased stress, can decrease a woman's sexual desire. As stated above low oestrogen levels can cause vaginal tissues to be thin and dry, which can lead to pain, a raw sensation or even mild bleeding with intercourse. The use of water-soluble lubricants are recommended for sexual intercourse to reduce friction and improve pleasure. Sexual activity or intercourse should not be painful and if you experience pain with sex, work with a Physiotherapist or your GP for assistance.