Menopause, Pelvic Floor Training, and Kegels
Menopause has held a particular ominous reputation in society. For women heading into midlife, it is a natural part of the cycle of life.
Photo by E.Moran at Unsplash
On average, most women reach Menopause at age 51 but some may reach it earlier or later. It is not that uncommon for women to reach menopause surgically when they have a hysterectomy. Over 600,000 hysterectomies are performed in the United States each year and little to no information is provided to these women about the influence of the procedure on their hormones or their pelvic floor. Regardless of how or when you reach menopause, it is important to get informed and be be prepared for the changes our bodies may go through. Some ways to get informed are to talk to your mother, read books, and find a NAMS (North American Menopause Society) practitioner.
Before we look at how to prepare for this time in your life, let's discuss some of the more common symptoms.
Manifestations of Menopause
Weak Pelvic Floor Muscles - When the body is no longer producing estrogen, the tissues and muscles in the pelvic floor become thinner and weaken. This can lead to -
Bladder Control Issues – Do you ever find yourself searching for bathrooms everywhere you go or that you have overwhelming urges that feel like you may not make it to the toilet in time? Maybe you have little bits of leaking out throughout the day and find yourself putting a pad on just in case. These are all signs of urinary incontinence.
Pelvic Organ Prolapse – You may feel like you have something in your vagina or a sense of pressure or heaviness in the pelvis. A prolapse occurs when the bladder, rectum and/or uterus (if you still have one) shift out of their optimal position and bulge into or descend into the vagina. Of note here, hysterectomy can increase your chances or experiencing organ prolapse.
Hot Flashes – It’s the middle of winter, and suddenly you are ripping your clothes off, turning red and feeling like you’re burning up – or you wake up drenched from sweating and only had a thin blanket on. Welcome to hot flashes! Remember the commercial where the woman goes out in the snow to clean off the air conditioner? Menopause contributes to major changes in our hormones and our hormones have a direct impact on our brain and all that it governs.
Decreased Libido - A decreased libido in women can be from various things, and it’s not uncommon for a woman to experience low libido at some point in her life caused by changes in hormones, stress, psychological attributes, troubling relationships, and vaginal dryness. However, if you are experiencing a low desire for sex, you aren’t alone. Several solutions may be able to help!
Painful Sex (Dyspareunia) - Dyspareunia means pain with sex and can result in sharp or intense pain while having sex. It may happen while having intercourse and possibly before or after. It can be a result of overactive or hypertonic pelvic floor muscles and/or from vaginal dryness. With less estrogen the walls of the vagina thin and become dry and irritated which contributes to discomfort during sex and even with daily activities.
There are many ways women can manage and overcome these common menopause symptoms and get to the other side with ease.
Pelvic Floor Strengthening Exercises
A study published in 2018 reviewed the value of pelvic floor exercises in the treatment of incontinence. It positively impacted the quality of life for women incorporating pelvic floor training, which includes Kegels when done correctly. “Systematic muscle activity causes muscles to lose four times less of their mass than staying inactive.”
Part of the solution for bladder control and pelvic organ prolapse is to strengthen your pelvic floor muscles. You can do this with Kegel exercises. They are one form of pelvic floor exercise. It is advisable to seek help and treatment from a pelvic floor physical therapist. They, in my opinion, are the gold standard in terms of learning how to do Kegels, but they are also the best people to see to have your pelvic floor evaluated so that you know what types of pelvic floor exercises are best for you. When your muscles are strong, supple, and responsive, they can better control those urges and protect you from those leaks that sometimes happen.
It is Never too Late!
Many women believe that because they have had this problem for years that there is no hope. With consistent attention to bladder retraining and a pelvic floor exercise program, you CAN make a change no matter your age or stage.
Hormone Therapy for Decreased Libido & Hot Flashes
One reason for your low sex drive could be vaginal atrophy, which causes drying and narrowing of the vagina. Sex may be incredibly uncomfortable and, therefore, contribute to your lack of desire. Luckily, local vaginal estrogen can help relieve these symptoms reduce the pain. It may also help with those nasty hot flashes. Estrogen has a bit of a bad wrap but the book Estrogen Fix is a fantastic and important read for all women, ideally before they reach menopause.
When it comes to low sexual desire, there is not a one-size-fits-all type of treatment plan. What works well for a friend, may not necessarily work for you, so assess your overall wellness and sex life first. Have some peace of mind that there are options, and this isn’t a forever thing. Working with a naturopathic doctor or functional medicine practitioner is beneficial to have your hormone levels evaluated and also your thyroid function.
Many women with painful sex do not require medical treatment. If sex hurts to the point that you avoid it or want to stop, then it’s time to find a pelvic floor physical therapist and get help.
Photo by Baptista Ime James
Pelvic Physical Therapy
Pelvic Physical Therapy is beneficial for painful sex and bladder problems. It is a process by which you can get to the root of your concerns. So many women think that just doing kegels will solve everything and that if they experience discomfort it is from lack of tension when the inverse might be true. Too much tension can be equally challenging and can also cause discomfort.
Seeing a pelvic floor physical therapist can help you figure out what’s really going on and give you a plan to address the underlying issues. These are professionals who have extensive experience and education and a commitment to women’s wellness. They can explain what is going on with your body in an accessible way so you can participate in your recovery.
We are here to help!
Most people have questions about menopause and their pelvic health. Fill out the form below/in the sidebar to speak with one of our Pelvic Floor Professionals and get clarity on all the options available to you