What is the Link Between Perimenopause/Menopause, Pelvic Pain, and My Pelvic Floor?
What is the Link Between Perimenopause/Menopause, Pelvic Pain, and My Pelvic Floor?
Did you know that perimenopause and menopause can significantly impact your pelvic floor? Hormonal changes during this time can lead to symptoms like pelvic pain, vaginal dryness, urinary incontinence, and even prolapse. The good news is that there are strategies to help manage these symptoms and improve your pelvic health!
When do Perimenopause, Menopause, and Postmenopause Occur?
Perimenopause typically occurs in the mid-40s but can start as early as the late 30s. The average duration of the perimenopause stage is 7 years, but it can last up to 10 years! Menopause is defined as the period of 12 consecutive months without a menstrual cycle. The average age at the time of Menopause is 51. The Postmenopause stage starts after menopause occurs.
How do Hormonal Changes affect My Pelvic Floor?
During perimenopause and menopause, estrogen levels decline, affecting the pelvic floor muscles and tissues. This reduction in estrogen contributes to the following:
Inconsistent cycles, less frequent menstrual cycles, and cessation of menstruation.
Thinning of vaginal tissue and atrophy/ weakening of pelvic floor muscles.
Reduced blood flow and lubrication in the pelvic region
Changes in pelvic floor muscle strength and function
What are Common Symptoms of Perimenopause & Menopause Affecting the Pelvic Floor?
Some of the most common symptoms include:
Vaginal dryness
Decreased sexual arousal, desire, lubrication, and painful intercourse
Urinary Urgency
Incontinence (urinary and bowel leaks)
Sleep disturbances with increased bathroom trips
Increased pelvic, hip, sacroiliac, and lower back pain.
Other common symptoms of perimenopause and menopause:
Midnight awakenings/ racing thoughts
Breast tenderness
Weight gain
Heart palpitations
Hair thinning
Mood swings and irritability
Anxiety and depression
How does Estrogen Affect my Pelvic Floor?
As estrogen levels drop, the tissues in the vulva and vagina become thinner and drier, which can lead to:
Reduced vaginal lubrication, vaginal dryness, and thinning of vaginal tissue
Reduced pelvic floor muscle tone and strength resulting in reduced arousal/ orgasm
Reduced arousal and painful intercourse may reduce sexual desire
Increased vulnerability to vaginal irritation and infections
How do I manage Pelvic Pain During Perimenopause & Menopause?
Painful sex, reduced arousal, and pelvic discomfort can make intimacy seem less appealing, but there are ways to address these symptoms:
Moisturize: Natural, hormone-free moisturizers like organic vulvar balms (Vmagic), hyaluronic acid balms (Revaree), and coconut/olive oil, can help reduce dryness and soothe sensitive tissues. Apply these products to the labia, vaginal opening, and inside the vaginal canal.
Use Lubricants: Water-based lubricants are ideal for reducing friction and enhancing comfort during intercourse. Silicone lubricants last longer during intimacy.
Stay Active: Consistent physical activity, including pelvic floor exercises for full range of motion and pelvic floor muscle training, helps maintain healthy tissue and improve blood flow.
Consider a safe Very Low Dose Topical Vaginal Estrogen: Speak with your PCP or gynecologist about the option of a safe, low dose of topical vaginal estrogen that can directly address vaginal dryness and discomfort.
What is the Link between Urinary Urgency, Leakage, & Pelvic Floor Weakness or Tightness?
Many people experience urinary incontinence during perimenopause and menopause due to weakened pelvic floor muscles. To manage urinary urgency and leakage:
Consult a Pelvic Health Physical Therapist: Urinary urgency and leakage are fixable! Your pelvic floor may be weak, too tight, or both! A Pelvic Floor Physical Therapist will evaluate and will provide you with a tailored plan of care to resolve these symptoms.
Practice Urge Suppression: retrain your bladder to extend void intervals every 2-4 hours.
Practice Kegels: Doing Kegel exercises helps strengthen a weak pelvic floor and may reduce incontinence. If your pelvic floor is tight do not start with kegel strengthening! It may make your urgency and leakage worse. You must begin with pelvic floor lengthening.
Practice Pelvic Floor relaxation and Lengthening techniques: Learn how to lengthen your pelvic floor with deep inhalation. This will improve your pelvic floor activation, and relaxation, and reduce pelvic pain and urgency. Certain pelvic floor lengthening tools can aide as well.
Reduce fluid intake several hours before bed to minimize nighttime bathroom trips.
Drink more water earlier in the day to avoid excessive intake in the evening.
Avoid bladder irritants: Cut back on caffeine, alcohol, carbonated drinks, citric juices which irritate the bladder and can increase urinary urgency and frequency.
How do I Enhance My Sexual Function During Perimenopause & Menopause?
Decreased estrogen and testosterone levels, combined with sleep disruptions and stress, can reduce sexual desire. However, there are ways to maintain a fulfilling sexual life:
Plan your time: Set aside time for intimacy before fatigue sets in, or try experimenting with new positions or sex toys to enhance pleasure.
Use Lubricants: Water-based lubricants can reduce pain and improve comfort during sex. Silicone lubricants last longer during intimacy.
Consult MD for use of vaginal estrogen: Topical safe, low-dose vaginal estrogen can help restore vaginal tissue and reduce pain during sex. Your doctor may also suggest systemic hormone replacement for broader effects on your body.
What are My Treatment Options for Pelvic Floor Symptoms during Perimenopause & Menopause?
Recognizing that perimenopausal and menopausal symptoms are linked to hormonal changes can empower you to take proactive steps. Here are some ways to manage symptoms effectively:
Exercise regularly: Physical activity, such as cardio vascular training, walking, pilates resistive strength training, helps alleviate stress and improves pelvic health.
Practice stress-relieving activities: Techniques like deep breathing, meditation, and pilates can reduce stress and improve sleep quality.
Consult with a doctor that specializes in perimenopause and menopause: To address specific symptoms with a doctor that specializes managing your hormones medically and holistically.
Pelvic Floor Physical Therapy: A pelvic floor therapist can offer personalized guidance to address pelvic pain, hip and back pain, pelvic floor weakness or tightness, urgency, and incontinence. Our signature physical therapy program, The RX, takes a holistic look at your pelvic health.
What Types of Pelvic Floor Exercises would Improve My Symptoms?
Pelvic floor exercises, particularly Kegels, are often recommended to strengthen a weak pelvic floor for leakage and certain types of prolapses. However, it's essential to get personalized advice from a pelvic floor physical therapist to ensure you're doing the right exercises for your needs. You may need to lengthen your pelvic floor before strengthening if it is too tight, otherwise your symptoms may get worse.
Here are a few tips to relieve urinary urgency, urinary and bowel leakage, pelvic heaviness, and hip, groin and pelvic pain during perimenopause through postmenopause stages:
Improve your diaphragmatic breathing: Deep belly breathing with inhalation through the nose and exhalation through pursed lips restores pelvic floor movement, reduces pelvic floor tightness, and reduces urinary urgency.
Lengthen your pelvic floor and hip musculature: deep diaphragmatic breathing into the pelvic bowl and with hip stretching improves pelvic floor length and reduces pelvic floor and hip pain.
Strengthen pelvic floor muscles: Consistent specific pelvic floor contraction exercises can help improve pelvic floor strength, decrease bladder and bowel incontinence, and decrease pelvic floor prolapse and heaviness.
Train your bladder: Practice urge suppression techniques and urinary void intervals to 2-4 hours to manage urinary urgency and incontinence.
Avoid bladder irritants: Reduce caffeine, alcohol, carbonated drinks, and citrus drinks to reduce urinary frequency and urgency.
Incorporate strength training 3 times a week: Building muscle mass throughout your body, including your pelvic floor, can improve your metabolism, reduce leaking, and eliminate lowback, hip, and pelvic pain.
Should I see a Pelvic Floor Physcial Therapist?
Pelvic floor physical therapy is an excellent option for addressing perimenopausal and menopausal symptoms. A pelvic floor physical therapist specializes in:
Strengthening pelvic floor muscles to eliminate bladder and bowel leaking, rescue prolapse vaginal heaviness, and eliminate lowback, hip, and pelvic pain
Lengthening pelvic floor muscles to reduce pelvic and hip pain
Improving vaginal elasticity to eliminate pain during intercourse
Eliminate urinary urgency, bladder or bowel leaks, and managing incontinence.
Provide a specialized pelvic and hip strengthening and lengthening home, pilates, or gym program to perform independently with confidence.
You're not alone in dealing with these challenges. It’s important to understand that these symptoms are often manageable. Pelvic floor physical therapy can help restore pelvic health, pelvic strength, alleviate pain, and help you return to normal activities. If you're experiencing any symptoms, it's essential to reach out for support by talking doctor specializing in perimenopause and menopause or pelvic floor physical therapist if you're experiencing any of these symptoms. Remember, it's never too late to take action and explore solutions that work for you! If you’d like to learn more about our signature pelvic health program, The RX please book a free consultation with us here.
