Support Your Pelvic Health in Menopause
If fortunate enough to live long enough, 100% of women will experience menopause and spend about 37% of their entire life in this natural phase. Menopause can accompany some uncomfortable pelvic health symptoms, like leakage and painful intercourse, but there are plenty of things you can do to feel your best in this stage of life.
Premenopause can last up to 10 years with a wild fluctuation of hormones, causing symptoms long before the body ultimately stops producing estrogen. Although there are several types of estrogen produced in different parts of the body (fat cells, adrenal glands, etc.), I”m going to distill this complex endocrinology down into what we need to know for your pelvic health. It’s also important to know that estrogen works in a complex orchestra with other hormones (testosterone, androgens, progesterone, etc.).
For our purposes, just know that estrogen is a hormone that’s made in the follicles (egg container) in our ovaries. Humans are born with a finite number of eggs, so when the body stops kicking out eggs, we stop making estrogen.
How does this relate to Pelvic Health? Glad you asked :)
Estrogen plays a huge role in many body systems: muscle, bone, urinary tract, blood vessels, metabolism, inflammation, vulva/vagina, and brain to name a few. It’s kind of a big deal. So when estrogen declines during premenopause, these systems lose important protection and function, and we experience new and exciting symptoms, such as:
urinary leakage,
urgency/frequency,
urinary tract infections (UTI’s),
joint pain,
prolapse/vaginal pressure,
belly fat (adipose tissue around organs),
osteoporosis/osteopenia,
heart palpitations,
sleep disruption,
insulin resistance,
muscle loss,
brain fog,
vaginal dryness/itching, and
painful intercourse.
Like I said, it's a big deal.
It’s incredibly and unfortunately common to hear symptoms like leaking, back pain, and belly fat dismissed as things that “just happen at a certain age.” While these issues do more often surface around menopause, it’s important to understand why and know that there are things we can do about it!
What Causes Menopause?
Over time, the ovaries slow and then stop producing estrogen, but the process causes one hell of a rollercoaster on its way out! Estrogen doesn’t simply decrease in a nice, steady slope. It fluctuates, causing many other hormonal systems in the body to flare up and down in response to try and find balance. Think of an orchestra that was once playing beautifully together, now playing totally out of rhythm and pitch. This last ditch effort to regulate hormones is in part what causes distressing symptoms like heart palpitations, hot flashes (vasomotor symptoms), mood changes, and sleep disruptions. Sweet.
On average, this process typically begins in the mid/late 40's (premenopause), and “ends” in the early/mid 50's (menopause). Technically, menopause is a moment in time after you have not had a menstrual cycle in 12 consecutive months. This means that you can have 3, 5, or 10 months without a cycle, but the clock starts all over because the ovaries happen to pop off another egg. Thus, the process can take 8-10 years to complete. On the other hand, some women experience the cessation of cycles all of a sudden. It’s here one month, and gone forever! Both of these experiences are called “natural menopause.”
Not all women experience menopause the same way. Women who experience “medical menopause,” usually have an increased number and severity of symptoms. Rather than a natural, gradual, decline in estrogen, the cycles cease suddenly in medical menopause due to a surgical procedure, such as a total hysterectomy or oophorectomy (removal of one/both ovaries). Current research also points to the relationship between race and ethnicity and the severity of menopause symptoms. Lifestyle factors such as stress, activity, smoking, education, and comorbidities can impact the experience.
Now that we know the what and why, let’s dive into the pelvic health elements of menopause to figure out how we can help bothersome symptoms.
If you have problems such as bladder issues, pelvic pain, prolapse, vaginal itching/burning, decreased orgasms, or painful sex, you may be experiencing what is called the Genitourinary Syndrome of Menopause (GSM). This was formerly known as “vaginal atrophy,” but we’re thankfully finding more helpful terminology.
The bladder and urethra depend on estrogen for elasticity and thickness/bulk. When the body has less estrogen, we have decreased urethral closure and increased urinary symptoms/leakage. Thinning of these tissues and an increase in vaginal pH also makes it easier for bacteria to take hold and cause more frequent UTIs.
Here are some ways to help support the body’s pelvic health functions during menopause:
Focus on hydration to keep the bladder and bowels happy. Aim for about half of your body weight in fluid ounces daily, mostly plain water.
Avoid bladder irritants. Acidic drinks can irritate the bladder, causing urgency, frequency, and leakage. Top irritants are: coffee (decaf or regular), tea (any kind), carbonated beverages (water, soda, etc.), alcohol, OJ, etc. Every bladder is different, so it takes some detective work to sort out.
Strengthen the pelvic floor. The pelvic floor is a group of muscles, and we lose muscle mass without estrogen, thus an increase in leakage, prolapse, etc. There are 14 different pelvic floor muscles, so it’s important to know which ones you need to target.
Learn urge-suppression techniques to retrain the bladder if it gets a mind of its own.
Keep the vulvovagina environment happy. Clean the area with only warm water, wear cotton underwear, and change damp clothing/pads frequently.
Optimal nutrition and supporting the microbiome of this area also matter!
Keep the bowels moving! Constipation puts pressure on the bladder, contributing to leakage. Straining to eliminate also puts excessive pressure through the pelvic floor.
Ask your PCP or GYN if a topical and/or systemic prescription or OTC medication can help replace the protection that estrogen once provided.
Old and poorly done research about risks of HRT is being replaced with more robust and accurate information. While HRT is not the best choice for some, it is absolutely appropriate for others. If you’ve been dealing with menopause-related symptoms, but have been told “everything looks fine” or “you’re just getting older,” keep looking and find a provider who has additional training in menopause care.
If you’re experiencing pesky pelvic health symptoms like sexual health issues, bladder problems, constipation, core weakness, or hip/back pain, we are here to help. This is 100% our speciality area! Let us help connect the dots to find out exactly why you are experiencing symptoms and get you on the road to feeling your best!
Got questions? We’re here to help! Give us a call to talk with one of our knowledgeable and friendly patient care coordination or schedule a free consultation appointment here. (336) 443-0202
