So you’ve made it the last 4 to 5 decades relatively unscathed as far as pelvic health is concerned. Maybe you had babies, maybe you didn’t... but as far as you can remember, you never experienced leakage, prolapse or painful sex. (By the way if this is you - you are in a very lucky minority of ladies!) Then… BOOM! One day you wake up and notice something isn’t right down there. “Is this normal? Is this just part of being a woman? I wonder if my friends are experiencing the same thing.”
“I feel like something is falling out of my vagina."
“I’m peeing myself on my runs.”
“My tissue feels sensitive and dry.”
“Sex has become uncomfortable. I don’t even want it.”
What this sounds like is the often misunderstood and nonlinear segue into perimenopause and menopause. Menopause literally translates to “the end of menstruating.” It is considered official if you haven’t had a period for 12 consecutive months. Telltale signs and symptoms include:
Change in sex drive (most often, ladies experience a decrease in desire but on rare occasion it can be quite the opposite!)
Bloating and food sensitivities
Well, this is off to a fun start! But really it’s no secret, ladies... hormones can be a B*TCH! Three hormones in particular that we are referring to are Estrogen, Progesterone and Testosterone (yes ladies, we have that one too!). Knowing how the shift in these hormones affects our musculoskeletal system is important to stay healthy and active during this time.
Estrogen is the main player in the menopause game and has a ton of wonderful roles including regulating the menstrual cycle, skin, hair, breast, bone, brain and heart health. As it relates to pelvic floor physical therapy, Estrogen is this beautiful hormone that lubricates us and promotes tissue elasticity and blood flow. It increases our anabolic (building) response to exercise. Estrogen also gives us that “glow” - think of times Estrogen is riding high like pregnancy and ovulation. As we age and approach menopause, Estrogen gets depleted. Times when Estrogen is riding low (postpartum, breastfeeding and menopause), it is very common to experience vaginal dryness. This can lead to discomfort with clothing, skin fragility and pain with penetration (sex, speculum exam, etc). A pelvic floor specialist can help you find the right balance of vaginal moisturizers and lubricants to decrease friction and pain. If deemed beneficial and low risk, your doctor may consider a topical estrogen cream.
Progesterone “promotes gestation” and is in full swing during pregnancy to protect the growing baby and nourish your uterus. It also counteracts the stress hormone, Cortisol, in order to reduce anxiety, mood swings and help us sleep. Progesterone, like Estrogen, offers benefits to breath, cardiovascular, bone and nervous system health. As we exit the childbearing years, our bodies decide it can’t make much use of Progesterone and it gets a one way ticket along with Estrogen.
Ladies, we all have Testosterone - just in lower amounts compared to the fellas. It aides in giving us energy, sex drive and building lean muscle. It promotes cognitive health and helps Estrogen and Progesterone to give us strong bones. As Estrogen and Progesterone decrease, there is a relatively higher amount of Testosterone in the system that can lead to ovarian cysts in perimenopause. You may also notice a change in fat distribution from pear shaped (butt and thighs) to apple shaped (belly).
Now that we have a better idea of key hormones and the roles they play during Menopause, let’s dive into some common signs and symptoms of pelvic floor dysfunction that can occur as a result.
As we mentioned, decrease in Estrogen levels can cause decreased soft tissue elasticity and strength. The pelvic floor muscles have to have both endurance and the ability to turn on quickly to stay dry with walking, lifting, sneezing, coughing, laughing and any of life’s activities. BOTTOM LINE: leaking during any phase or stage of life is not normal and can be treated with specialized pelvic floor therapy.
The pelvic floor muscles act as a trampoline that stretches and contracts with activity to support our organs (bladder, uterus and rectum). With decreased collagen and soft tissue elasticity, this trampoline can lose some tension and these organs can drop. Telltale symptoms of pelvic organ prolapse, also known as POP, include feelings of pelvic pressure, heaviness, like something is falling out or the need to splint in order to empty the bladder or bowels. Splinting is pushing the perineum (spongy tissue between the openings of vagina and rectum). Many patients innately find themselves doing this already.
3) Vaginal Dryness
Decreased estrogen means decreased lubrication. That is why vaginal dryness is extremely likely to happen in the postpartum period, while breastfeeding and… you guessed it… during menopause. This can lead to decreased tissue integrity and pain with intercourse. Lube has always been and remains to be our BEST FRIEND to decrease friction and improve pleasure. A pelvic floor therapist can also recommend a vaginal moisturizer routine and refer to your gynecologist if you could benefit from a topical Estrogen cream (assuming no contraindications).