How Menopause Affects Your Body and Pelvic Floor

Menopause is a term that marks an official turning point in the lives of those with a uterus. Once your ovaries have stopped producing hormones and your menstrual bleeding has stopped for twelve consecutive months, you have officially hit menopause. The period of time following menopause is referred to as post-menopause. This turning point is not a sudden shift—it actually happens slowly over time.

Many people experience menopause sometime in their 40s or 50s, but it occurs most commonly during their early 50s. The period of time leading up to menopause is known as perimenopause, and this is when a person may begin experiencing a variety of symptoms as a result of reduced hormone production. Perimenopause can last anywhere from several months to several years, and differs greatly from person to person.

While menopause occurs naturally with age, some individuals will enter menopause due to other reasons. Factors such as oophorectomy surgery or chemotherapy treatments such as radiation can cause menopause. Oophorectomy is the removal of the ovaries, which produce the hormones necessary for menstruation. Chemotherapy treatments can damage the ovaries and prevent menstruation.

In some cases, those who undergo chemotherapy may only have temporary menopause, meaning they may experience periods again after some time. However, in many cases these individuals will experience menopause at an earlier age as a result.

Individuals in perimenopause and post-menopause can cause a very wide variety of symptoms. Every person’s experience with menopause is different, and symptoms can range in severity. Your medical history can also affect the symptoms you experience during this time. Some examples of symptoms caused by menopause can include the following:

Pelvic floor dysfunction

• Pelvic floor muscle weakness
• Pelvic floor muscle tension
• Disrupted pelvic floor coordination
• Risk of pelvic organ prolapse

Urinary conditions

• Urinary urgency
• Urinary frequency
• Urinary incontinence
• Nocturia
• UTIs

Bowel conditions

• Constipation
• Fecal incontinence

Body pains

• Pelvic pain
• Low back pain
• Hip pain

Vaginal struggles

• Dryness
• Atrophy
• Painful sex
• Low elasticity

Higher fall risk due to

• Core weakness
• Balance deficits
• Decreased bone density
• Decreased coordination
• Low proprioception

Musculoskeletal changes

• Postural changes
• Myofascial restrictions
• Joint stiffness

Other

• Sleep disturbances
• Hot flashes
• Dysregulated nervous system
• Reduced endurance

Many of these symptoms are directly connected to pelvic floor dysfunction. If you’re not sure what that means, keep reading!

The pelvic floor is an incredibly important group of muscles found in the pelvis. These muscles are essential for normal urinary, bowel, and sexual function! Unfortunately, menopause can significantly contribute to pelvic floor dysfunction, which can look like muscle tension, weakness, incoordination, and more. 

Pelvic floor dysfunction can present as many different symptoms, such as constipation, incontinence, urinary urgency, painful sex, pelvic organ prolapse, and much more.

How the Pelvic Floor Is Affected

So, how is the pelvic floor affected by menopause? Hormones play a major role in muscle health and strength—without these hormones, you will have to give your muscles extra attention and care. 

The pelvic floor is a group of twenty-six different muscles, and these muscles will become weaker as your hormone supply lowers with perimenopause and menopause. Your lowered hormone supply directly and indirectly causes all of the symptoms discussed earlier.

It’s important to note that those symptoms don’t just suddenly hit one day. As you enter perimenopause, your periods may become irregular, and symptoms such as the ones above may slowly begin to appear (remember, perimenopause can last several years). As your hormone production slows and eventually ceases, more of these symptoms can appear or become worse. 

Therefore, if you are just starting perimenopause, it’s important to have any pre-existing pelvic floor dysfunctions addressed as early as possible! This will give you a head start on any possible symptoms you could experience during post-menopause. 

It’s just as important to care for your pelvic floor after you have reached menopause, too. Caring for your pelvic floor properly will help you better manage or prevent many of the symptoms described earlier, and support a better quality of life as you enter this new stage.

A pelvic floor physical therapist will be able to help you during this process, and teach you all about this part of your body. With their expertise, you’ll be able to manage your symptoms much better, experience pain-free sex again, and embrace this next step in your life journey.

No matter if you are just entering perimenopause or have already experienced menopause long ago, everyone can benefit from pelvic floor physical therapy!

Pelvic floor physical therapists aren’t restricted to just working with your pelvic floor, either. They are trained in the entire body just like a regular physical therapist, but with some extra education and additional training for the pelvic floor. What this means is your pelvic floor therapist can help address other symptoms of menopause, too.

Symptoms such as core weakness, low balance, reduced endurance, hip pain, or low back pain are all things that your physical therapist can help address in addition to your pelvic floor dysfunction. We’ll discuss the ways a pelvic floor physical therapist can provide treatment for these symptoms of menopause below!

Pelvic floor physical therapy is a very effective way to manage your symptoms of menopause. Many of the symptoms associated with menopause are directly related to musculoskeletal health and the pelvic floor, so this form of treatment can be very beneficial as you enter this new stage of life.

When working with me, you can expect a comprehensive and holistic treatment approach—meaning I look at the big picture when it comes to your symptoms and lifestyle!

You’ll start with an evaluation, which will allow me to better understand your unique needs and menopause symptoms. This can include a look at your medical history, past surgeries, injuries, or factors like childbirth. I may ask some questions about your daily amount of exercise, sleep, diet, and other lifestyle factors that play a significant role in managing menopause.

With a better understanding of your individual needs, I’ll create a physical therapy treatment plan that best suits those needs. I may suggest coordinating with other providers and specialists for the best results and optimization of your health, as managing menopause can often require a multi-disciplinary approach!

In terms of physical therapy treatment, your care plan will aim to improve your tissue integrity, muscle strength, and your understanding of the bodily changes associated with perimenopause and menopause. 

Education during this time is essential, as there’s tons of myths and misinformation about menopause out there. I’ll help clear the confusion and educate you on what’s actually happening in your body, and how to deal with these changes. I can also recommend some resources that will help you know what to expect.

Don’t hesitate to ask questions during your treatment—in fact, questions are totally welcome! I want you to feel confident about both your health and pelvic floor treatment.

So, what can your plan of care look like with pelvic floor physical therapy? Below, we’ll explain some common treatment methods utilized for perimenopause and menopause.

Pelvic Floor Training

As we discussed before, the pelvic floor is significantly affected by the loss of hormone production that occurs with menopause. In order to prevent and manage symptoms like incontinence, urinary urgency, prolapse, constipation, painful sex, and more, you’ll need to improve your pelvic floor health. By reducing tension, restoring coordination, and improving the strength of your pelvic floor, you’ll be less prone to these unideal symptoms. 

Throughout your care plan, I will lead you through a variety of exercises, activities, and treatment techniques to get your pelvic floor back in good shape! This can involve manual therapies to reduce tension, exercises to build strength, and activities that help with coordination.

Treatments such as neuromuscular re-education and biofeedback are very helpful for restoring coordination to the pelvic floor. They allow you to understand how the pelvic floor contracts and relaxes in order to perform a variety of functions. 

Although you can manually perform these movements, the pelvic floor must also be able to do them on its own (like a reflex) in order to work together with other structures in the body. When your muscles are coordinated, they will time these reflexes correctly to allow for different bodily functions!

Strengthening

Strengthening will be essential during menopause; not just for your pelvic floor, but also your whole body. Menopause has a significant effect on bone density, making your risk of osteoporosis higher and things like injuries or falls more dangerous. The good news is that physical activity can help slow down this bone loss and can help maintain strong bones in the future.

Rest assured that physical therapists are experts of the body, meaning I’ll be able to curate an exercise plan for your body’s needs and motivate you towards optimal health. This exercise plan can be practiced in the clinic, as your form and execution are very important, but you should expect to continue these exercises at home, too. 

Your exercise plan is not limited to strengthening exercises. It may also involve other aspects like stretching, yoga, balance training, and stability practice. All of these factors work together to provide a better range of motion and a lowered risk of injury as you live with menopause.

Pain Management

Menopause can lead to pain in many ways. For example, if someone has already experienced some level of bone loss, their lower back and hips may struggle to support their body’s weight and movements. 

Therefore, I will work to strengthen many areas of the body to improve things like function and weight-bearing support. A body with more balanced muscle tone and strong joints will support a better menopause experience. In addition to strengthening treatments that get to the root of your pain, I can also provide more immediate pain management treatments!

Pain management can vary based on your needs, and may include manual therapies such as massage, cupping, tissue scraping, or dry needling. I may use other treatments like temperature therapies or electric stimulation as needed, too. If you have pain from misalignment or joint stiffness, I may suggest additional treatments like joint mobilization or spinal manipulation.

Another important aspect of pain management is behavioral modification, which we’ll discuss next!

Behavioral Modifications

Behavioral modifications are exactly what they sound like—modifications to your behaviors, specifically those that may be causing pain or worsening your pelvic floor health. 

To identify these behaviors, I may examine your posture while you walk, sit, stand, lift items, and do other activities. Then, I will make corrections as needed to reduce strain on your pelvic floor, hips, abdominals, or lower back. These changes can include modifications to your restroom habits too, as these can put strain on the pelvic floor (such as holding urine for too long, sitting on the toilet for a long time, straining during bowel movements, and more). 

At Home Care

As mentioned earlier, you can expect to be given an exercise routine to practice at home. Exercising regularly is essential for protecting your bone health during menopause! Along with exercise, I may suggest a variety of other at-home strategies, too: Relaxation techniques, massage techniques, pelvic floor exercises, vaginal dilation, and more.

Depending on your individual situation, I can recommend many different tools and products that can further support your health and comfort at home. This can include dilation tools, menopause books, sexual aids, vaginal moisturizers, and much more. While at-home strategies for menopause can be very beneficial, it’s important to know that pelvic floor physical therapy is the only way to truly understand your pelvic floor’s health and needs.

Working alongside a professional is the best way to know that the strategies you’re using at home align with your pelvic floor needs. There is a lot of advice out there that tells you to try certain exercises or products, but the reality is that not all exercises are beneficial for all types of pelvic floor dysfunction.

Not to mention, working with a pelvic floor physical therapist can help you maintain good health in the long run—with regular visits to address new symptoms or struggles as you experience the changes associated with menopause.

If you’re looking to better manage your menopause symptoms or prepare your body during perimenopause, you can get started with me! I accept patients of all ages and gender identities. Go ahead and make an appointment, or check out the discovery call if you have further questions!