Like an intricate spider web, a network of muscles, tissues and nerves support pelvic health and function. This includes core stability, bladder and bowel control, and for women – sexual pleasure. Collectively called the pelvic floor, these interconnected structures contain many estrogen receptors. So when hormones shift with perimenopause and menopause, changes often trigger uncomfortable symptoms.
By understanding the impact of menopause on the pelvic area, you can ease discomfort through targeted lifestyle tweaks and treatment. This article explores what’s happening “down below” particularly the intricacies of menopause and the pelvic floor, along with tips to smooth the transition.
Why Menopause Strains the Delicate Pelvic Floor
During the reproductive years, estrogen helps keep pelvic floor muscles strong and flexible. Surrounding tissues stay thick, cushioned and well lubricated. But as estrogen production declines with perimenopause and eventual menopause, these delicate structures gradually weaken and dry out.
Pelvic floor muscles lose tone and the ability to contract effectively. Nearby ligaments become lax, potentially allowing pelvic organs to sag or prolapse. Mucus membranes lining the vagina and urethra also thin and produce less protective fluids. This provokes irritation.
These cumulative changes commonly spark annoyance or embarrassing bladder, bowel, sexual and comfort issues – collectively called genitourinary syndrome of menopause or GSM.
Defining The Change: Genitourinary Syndrome of Menopause
The array of pelvic floor problems arising from menopause used to be termed atrophic vaginitis or vulvovaginal atrophy (VVA). More recently, the preferred medical name became GSM since it better captures the various symptoms women may develop.
Hallmark GSM complaints include:
- Vaginal and Vulval Discomfort
- Dryness and irritation
- Burning or stinging sensations
- Bladder Problems
- Urinary urgency/frequency
- Recurrent infections
- Leaking with exertion
- Sexual Function Issues
- Low arousal/desire
- Painful intercourse
- Delayed or absent orgasm
- Pelvic Organ Prolapse
- Bulging sensation
- Bowel Control Issues
- Gas or occasional fecal incontinence
Research shows over half of menopausal women battle bothersome pelvic floor issues. Yet due embarrassment only around 25% seek medical support, wrongly assuming problems are normal or untreatable. Unlike hot flashes, these issues often worsen without relief.
Menopause and the Pelvic Floor Changes Correlation
To understand why our pelvic floor endures such changes, we need to examine some fundamentals about hormones, aging and muscle composition.
- Hormones 101 – Estrogen and progesterone are crucial sex hormones helping females develop reproductive characteristics during puberty and support pregnancy. These hormones continue being produced mainly by the ovaries during adulthood. Estrogen in particular helps thicken the lining of the uterus month to month preparing for potential pregnancy. This hormone also keeps tissues throughout the pelvic area and breasts lush and healthy.
- Aging and Hormones – As women pass through their 30s and 40s, ovulation becomes less regular and hormone production fluctuates more. This perimenopause transition reflecting the ovaries winding down usually lasts several years. Ultimately ovulation ceases completely marking full menopause – on average around age 51. The ovaries decreasing production of estrogen and progesterone sparks widespread effects.
- Impact on Muscles and Connective Tissue – Pelvic floor muscles contain a particularly high concentration of estrogen receptors. Declining levels allows these tissues to weaken, thin and dry out. Nearby connective tissue similarly changes, growing more lax. This strains the pelvic floor on two fronts: reduced muscular support and strength combines with loosened ligaments potentially allowing pelvic organs to sag and prolapse.
- Bowel and Bladder Control – Changes to muscle coordination and connective tissue laxity puts added pressure on pelvic floor nerves and muscles to maintain bowel and bladder continence. With less muscular strength and stamina combined with thinning tissues, small leaks may start occurring. In some cases organ prolapse causes a feeling of heaviness or visible bulging. These changes spark awkward, frustrating or limiting bladder and bowel symptoms. While rarely life threatening, leaks and accidents cause understandable distress lowering quality of life. Let’s explore some strategies offering relief as you navigate menopausal pelvic floor changes.
Maintaining Pelvic Floor Comfort Through Menopause Changes
Think of pelvic health like a bank account. Making regular “deposits” keeps those intricate muscles toned, tissues cushioned and nerves firing properly. Once declining hormones deplete reserves, targeted lifestyle and treatment “deposits” better maintain comfort and function.
Strengthen Support Muscles – Performing Kegels properly tones pelvic floor muscles supporting healthy bladder and bowel function. Pilates, yoga and core exercise also strengthen interconnected support structures.
Stay Sexually Active – Regular, pain-free intercourse brings blood flow nourishing pelvic tissues and keeps them flexible. Use lubricant to ease dryness provoking pain. Explore non-penetration if discomfort persists.
Improve Bowel Regularity – Constipation worsens irritation since straining also strains muscles and connective tissue already impacted by hormones. Drink enough fluids, add fibre-rich foods, consider probiotic supplements supporting regularity without pushing.
Quit Smoking and Handle Chronic Cough – Smoking tightens pelvic blood vessels, restricting oxygen and nutrients to nourish area tissues. Chronic cough similarly stresses muscles and connective tissue. Ask your provider about supports to quit smoking and manage prolonged cough or asthma flare-ups.
Consider Targeted Therapies – Localized, low-dose estrogen treatments can temporarily replenish atrophying tissues and relieve hallmark symptoms of genitourinary syndrome of menopause. Pelvic floor physical therapy retrains muscle coordination. Discuss options with your care team.
Let’s explore these suggestions further:
Pelvic Floor Exercises
Kegel exercises were developed by physician Arnold Kegel to retrain weakened pelvic muscles after childbirth. They were later shown to effectively treat urinary incontinence and bowel urgency issues sparked by menopause as well.
Kegels use squeeze and release movements to strengthen the intricate web of muscles spanning from pubic bone to tailbone that support pelvic organ function. Over time, regularly performing Kegels boosts muscular tone and stamina so these structures better perform their job.
Learning proper Kegel technique is crucial to avoid straining other areas like hips and abs. A women’s health physical therapist can ensure correct form. Though simple once learned, studies show over 25% of women don’t do these properly. So get professional guidance when starting a Kegel routine.
Continue Benefits of Core Exercise
Many midlife women fondly remember school sit-up requirements building abdominal muscles and low back endurance. These core-focused exercises train muscles providing essential support to organs and stabilizing connective tissue attached to the pelvis.
As estrogen levels fall, keeping core muscles strong through Pilates, yoga, swimming, walking and other gentle activities compensates somewhat for inevitable changes to ligaments and fascia. You’ll also feel stronger and more flexible aiding regular activity. Regularity matters most – not overdoing or straining.
Consider Bioidentical Hormone Therapy
Localized, low-dose estrogen treatment often brings significant relief from dryness and associated discomfort during sex. These therapies deliver hormones directly into vaginal tissues temporarily replenishing estrogen receptors starving from depleted blood levels.
Relieving vaginal dryness and irritation improves lubrication during intercourse and overall comfort. Discuss prescription estrogen creams, tablets or the estradiol vaginal ring with your provider to see if a good option for you. Over-the-counter lubricants and moisturizers provide shorter-term relief.
Moving Smoothly Through Menopause's Pelvic Floor Changes
Perimenopause and menopause sparks a slump in estrogen production, triggering widespread changes throughout a woman’s body – including the intricate network of pelvic floor muscles and tissues. As these important structures gradually weaken and dry out, women experience uncomfortable urinary, bowel, sexual and other pelvic health issues collectively termed genitourinary syndrome of menopause or GSM.
Left unmanaged, problems tend to incrementally worsen over the years impacting health, self-confidence and quality of life. The key is recognizing subtle changes early and taking proactive steps to nourish and rehabilitate the area before extensive changes occur. Combining targeted lifestyle tweaks and therapies tailored to your needs offers the best chance smooth sailing through the menopausal transition.
