How Menopause Impacts Pelvic Health: Understanding Symptoms & Solutions for Bladder, Sexual, and Pelvic Floor Health
Did you know that perimenopause, which refers to the period of time leading up to the natural transition to menopause, can begin in your mid-30s and that the average age of menopause in the United States is 45-55 years old? As a pelvic floor physical therapist, I’ve seen the impacts of menopause on the bladder health, sexual health and pelvic health of my patients for years. While menopause is a natural, unavoidable process, there is so much you can do to support your pelvic health as you age in order to stay healthier, longer.
In this blog post, we’re going to dive into how your pelvic floor, vulva and vagina are impacted by menopause, common pelvic floor symptoms associated with menopause, why menopause causes pelvic floor dysfunction and how you can stay healthy as you age.
What’s the pelvic floor?
The term pelvic floor refers to a bundle of muscles that sits at the bottom of your pelvis. This region houses nerves and connective tissue that work alongside your muscles to help your pelvic floor do its job. The pelvic floor has a few key roles, including controlling your bladder and bowels, contributing to sexual sensation, and orgasm.
When you have to pee and you’re holding it - it’s your pelvic floor that’s keeping you from leaking. When you intentionally relax your bottom while sitting on the toilet, those are your pelvic floor muscles relaxing. When you orgasm, those are your pelvic floor muscles rhythmically contracting.
Why does vulvar and vaginal health change through menopause?
Just like with all other parts of your body, your vulva and vagina will change as you age. The onset of menstruation, during pregnancy, postpartum recovery, and menopause are key times in life when changes in vulvovaginal tissue are expected. The reason for these changes is hormonal fluctuation. Vulvar and vaginal tissues are sensitive to changes in estrogen and testosterone levels, two hormones that fluctuate during various points in the reproductive lifespan.
Perimenopause is marked by changes to the menstrual cycle such as flow, length of periods, and frequency of periods. This stage can last for up to 10 years, although the average time is closer to 3-4 years. Menopause is considered to officially begin 12 months following the date of your last period. During this time your body experiences a drop in estrogen, which reduces estrogen’s availability use by vulvar and vaginal tissue - tissues that are highly reliant on estrogen to stay healthy and happy. These hormonal changes can lead to vaginal dryness, thinning of vulvar tissue, sensitivity at the vaginal opening, and exacerbate or create a host of common pelvic floor symptoms.
What are common pelvic floor symptoms during menopause?
The hormonal changes that occur during menopause can lead to a bundle of symptoms now known as genitourinary symptoms of menopause (GSM). These symptoms include:
Vaginal dryness and burning
Genital itching and irritation
Burning with urination and penetration
Urinary urgency and frequency
Urinary leakage
Recurrent UTIs and UTI-like symptoms without infection
Pain with penetration
Learn more about how your sexual health is impacted by menopause and perimenopause here.
What causes pelvic health symptoms during menopause?
The hormonal changes described above create a sensitive environment for the pelvic floor. Because of these hormonal changes, folks may experience new pelvic floor symptoms or an exacerbation of old symptoms. This happens for a few reasons.
The hormonal changes themselves create sensitivity in the skin of the vulva and vagina. This sensitivity can lead to discomfort during urination and sexual activity and even UTI-like symptoms. Vaginal dryness resulting from these changes can also contribute to genital itching, irritation and burning.
Further exacerbation comes from the pelvic floor muscles responding to the sensitivity described. When your body senses discomfort, surrounding muscles tend to tense in a protective response. This protective response can be helpful in certain situations, such as bracing for impact when you trip and fall. In the case of genitourinary symptoms of menopause, this response can serve to further irritate an already vulnerable system.
This tensing in response to chronic tissue changes can lead to tightness in the pelvic floor muscles. Chronic tightness in these muscles causes a further exacerbation of all the genitourinary symptoms created by hormonal changes. Let’s take pain with sex, for example. If the skin around the vaginal opening is sensitive and thin, penetrative sex can cause discomfort. If the surrounding muscles tense in expectation of this discomfort, the pain can become amplified.
Fortunately, there are ways we can treat both tissue and muscular changes during menopause.
How can pelvic health be improved during menopause?
The first place to begin is speaking with your medical provider. They can talk to you potential treatments like vaginal moisturizers and topical estrogen. Topical estrogen has been found to be a safe, effective treatment for many of those experiencing genitourinary symptoms. Vaginal estrogen has also been shown to treat recurrent UTIs associated with menopause. If you’re hesitant to consider topical hormones, discuss your concerns with your medical provider. While many folks are hesitant at the mention of topical hormones, evidence supports the use of topical estrogen as a safe and effective treatment option for many.
If you’re hesitant to consider topical hormones, hyaluronic acid is another evidence based treatment option. Hyaluronic acid functions as a vaginal moisturizer and serves to improve vaginal dryness, reducing irritability of the vulvovaginal tissue.
While treating tissue changes is often a must for folks experiencing genitourinary symptoms of menopause, pelvic floor physical therapy may be a necessary next step. Pairing pelvic floor PT with topical treatments helps to address both tissue and muscular changes, offering your body greater resilience heading in to the rest of your life.
By addressing muscular impairments, we can help patients achieve better bladder control and sexual function so they can continue to participate in the activities they love with the people they love for longer. Menopause doesn’t need to be the end of your athletic career or sexual relationships. We can help.
When should I seek help for pelvic floor symptoms?
The sooner you seek help for pelvic floor symptoms, the better. It’s common for us to see folks in menopause experiencing an exacerbation of symptoms that initially began before or during pregnancy. If you’re experiencing urinary leakage, pain during sexual activity or any of the other symptoms listed in the blog piece, pelvic floor PT can help.
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.