Importance of pelvic floor health during menopause

Reviewed by Mandie Fankhauser

Mandie Fankhauser is the Founder of Amandarin Wellness. As a certified Health & Wellness and Menopause Coach, she works with women navigating the complex journey of perimenopause and menopause; providing compassionate support, practical guidance, and empowering resources to help them thrive through this transformative phase of midlife.

Introduction

In the hierarchy of menopausal concerns, pelvic health often falls near the bottom of the list. We talk about hot flashes, weight gain, and mood swings, but we rarely discuss the structural changes occurring in the pelvic floor. Issues like urinary leakage or pelvic pressure are common but not normal.

Your pelvic health is the literal foundation of your physical comfort and mobility. The muscles and tissues of the pelvic floor are highly responsive to oestrogen. As levels decline, these tissues can become thinner, weaker, and less elastic, leading to a range of symptoms that significantly impact quality of life.

The impact of "vulvovaginal atrophy"

The medical term for the changes in the pelvic region during menopause is Genitourinary Syndrome of Menopause (GSM). Because the bladder, urethra, and vagina all share oestrogen receptors, they are all affected by the hormonal shift:

• Urinary urgency and frequency: You may find yourself needing to run to the bathroom more often or experiencing a sudden, overwhelming urge to go.
• Stress incontinence: This is the involuntary leakage of urine when you cough, sneeze, laugh, or exercise. It is a sign that the pelvic floor muscles and the tissues supporting the urethra have lost their tone.
• Recurrent UTIs: Lower oestrogen levels change the pH of the vaginal and urinary environment, making it easier for "bad" bacteria to thrive, which can lead to frequent urinary tract infections.
• Pelvic organ prolapse: In some cases, the weakening of the support tissues can cause pelvic organs (like the bladder or uterus) to drop from their normal position, creating a feeling of heaviness or pressure.

Breaking the stigma

The cultural stigma surrounding pelvic health is a major barrier to care. Many women feel embarrassed to bring up urinary leakage with their doctors. But ignoring pelvic health can lead to serious health consequences and deterioration of quality of life. It can also lead you to start avoiding exercise, travel, or social events for fear of an accident.

Reclaiming pelvic strength

The good news is that the pelvic floor is a set of muscles that can be rehabilitated, and the tissues can be revitalised.

1. Pelvic floor physiotherapy: A specialised physiotherapist can assess your pelvic floor health and help you learn how to properly contract and relax your pelvic muscles.
2. Localized oestrogen: Localised vaginal oestrogen can be incredibly effective at restoring the health of the urinary and vaginal tissues, reducing urgency and the risk of UTIs.
3. Lifestyle adjustments: Managing constipation (which puts pressure on the pelvic floor), staying hydrated (to prevent bladder irritation), and maintaining a healthy weight can all reduce the load on your pelvic structure.
4. Devices and interventions: For some women, devices like pessaries (which provide internal support) or minor surgical procedures may be recommended to address prolapse or severe incontinence.

Final thoughts

Your pelvic health is a vital component of your independence. By addressing these changes early and seeking specialised care, you can maintain your active lifestyle and physical confidence well into your postmenopausal years. Sow Fertility has a team of physiotherapists to guide you along your unique journey.