Pelvic Health in Menopause: A Guide to Comfort and Confidence

Menopause is a significant life stage for women, marking the end of reproductive years and the beginning of a new phase in health and wellness.

While many women are aware of the hormonal shifts, hot flushes, and changes in mood that come with menopause, fewer are aware of how this transition can affect pelvic health. As a pelvic health physiotherapist, I work with women who experience a variety of pelvic floor issues related to menopause. In this blog, we’ll explore how the pelvic floor changes during menopause and what can be done to manage and prevent common pelvic floor concerns.

The Role of the Pelvic Floor

The pelvic floor is a group of muscles and connective tissues that stretch like a hammock from the pubic bone to the tailbone. It plays a crucial role in supporting the bladder, uterus, rectum, and small intestine. The pelvic floor muscles are vital for controlling urination, bowel movements and sexual function. These muscles are essential for maintaining core stability, posture and overall pelvic health.

Hormonal Changes and the Pelvic Floor

One of the key changes that women experience during menopause is the decline in oestrogen levels. Oestrogen is a hormone that supports the strength and elasticity of the pelvic floor muscles and tissues. As oestrogen decreases, the pelvic floor muscles can become weaker, less elastic and more prone to atrophy. This decline can contribute to several pelvic health issues, including urinary incontinence, pelvic organ prolapse and vaginal dryness.

Urinary Incontinence

Urinary incontinence is a common concern during menopause, with many women experiencing a weakened pelvic floor that leads to involuntary urine leakage. This is particularly noticeable during activities that increase abdominal pressure, such as coughing, sneezing or laughing. The reduced oestrogen levels affect the pelvic floors ability to support the bladder, making it less effective in preventing leaks. Stress urinary incontinence, which occurs when physical activity puts pressure on the bladder, is often seen in postmenopausal women.

Women may also experience urgency incontinence (sudden, intense urge to urinate) often with little warning. This can be linked to changes in bladder function and pelvic muscle coordination, which may worsen during menopause.

Pelvic Organ Prolapse

Pelvic organ prolapse (POP) is a condition where one or more pelvic organs (bladder, uterus, or rectum) descend from their normal position due to weakened pelvic floor muscles. While prolapse can occur at any age, the risk significantly increases after menopause. The decrease in oestrogen contributes to the weakening of the pelvic tissues, including the ligaments that hold the pelvic organs in the right position. This results in a feeling of heaviness or pressure in the pelvic region, urinary incontinence, and sometimes difficulty with bowel movements.

Prolapse can be classified into stages, with more severe cases requiring medical interventions, such as surgery. However, for many women, pelvic health physiotherapy can help alleviate symptoms by strengthening the pelvic floor muscles and improving organ support.

Read more about Pelvic Organ Prolapse here.

Vaginal Dryness and Painful Intercourse

Another common issue for postmenopausal women is vaginal dryness, which can be exacerbated by lower oestrogen levels. Oestrogen is responsible for maintaining the health of vaginal tissues, keeping them moist, elastic and lubricated. When oestrogen levels drop, vaginal dryness can occur, leading to irritation, discomfort and pain during intercourse. This can contribute to a decline in sexual health and intimacy, which can impact emotional well-being.

Vaginal dryness can also be accompanied by vaginal atrophy, where the vaginal walls become thinner and less elastic, leading to discomfort and pain. As a pelvic health physiotherapist, I can offer treatments to help restore pelvic health, including exercises to improve vaginal tone and suggestions for lubrication or local oestrogen therapy.

Managing Pelvic Floor Health During Menopause

The good news is that pelvic health issues related to menopause can be effectively managed with a combination of lifestyle changes, physiotherapy and medical interventions. Here are some strategies that can help:

1. Pelvic Floor Exercises (Kegels)

Strengthening the pelvic floor muscles through exercises like Kegels is one of the most effective ways to combat urinary incontinence, prolapse and overall pelvic health issues. I can teach you the most effective technique to fully engage your pelvic floor muscles and guide you through a personalised exercise programme.

2. Manual Therapy

I can offer manual therapy techniques to release muscle tension, improve muscle coordination and reduce pain.

3. Lifestyle Changes

Maintaining a healthy weight, staying physically active, avoiding constipation and practicing good bladder habits can help reduce pressure on the pelvic floor and prevent symptoms like incontinence and prolapse.

4. Vaginal Moisturisers and Lubricants

For women experiencing vaginal dryness and discomfort, the use of vaginal moisturisers or lubricants can help alleviate pain during intercourse. In some cases, local oestrogen therapy may also be recommended by a healthcare provider to restore vaginal health.

 Menopause is a natural transition, but it brings about significant changes in pelvic health due to hormonal shifts. With the right support and treatment many pelvic health issues can be managed or even prevented. As a pelvic health physiotherapist, I am dedicated to helping women navigate these changes, providing the tools and techniques needed to maintain a healthy and active life.

If you are experiencing pelvic health concerns related to menopause, consulting with our specialist pelvic health physiotherapist could be the first step toward reclaiming your pelvic health and well-being.

If you or anyone you know, would like to have a Women’s Health Physiotherapy assessment with Evie or Anna at Dorking  or Leatherhead, book online here or contact us here.

Blog post guest written by Evie Spreadbury, Women’s Health Specialist Physiotherapist, member of Pelvic, Obstetric & Gynacological Physiotherapists (POGP),  Dorking, & Leatherhead Clinics.

References

Bø, K., Nygaard, I., & Hunskaar, S. (2017). Pelvic organ prolapse and urinary incontinence in women: An overview of the evidence. European Journal of Obstetrics & Gynecology and Reproductive Biology, 214, 68-72.

Dumoulin, C., & Hay-Smith, E. J. (2010). Pelvic floor muscle training versus no treatment, or inactive control interventions, for urinary incontinence in women. Cochrane Database of Systematic Reviews, 1, CD005654.

Palsson, R., Wiseman, A., & Hsu, A. (2018). Menopause and its impact on pelvic floor health. Maturitas, 108, 42-47.

Perry, S., Burch, L., & Swithinbank, L. (2019). Menopause and its impact on pelvic floor health: The role of pelvic health physiotherapy. Physiotherapy, 105(2), 211-217.