Menstrual Health, Kegels, and Your Pelvic Floor
Women accept the menstrual cycle as a natural part of life, however, many have painful periods due to cramping and conditions like endometriosis.
Dysmenorrhea is the medical term used to describe pain before or during menstrual periods. It is more common among those with heavy or irregular periods. Dysmenorrhea is one of the first signs that our hormones and our bodies are not working at peak performance.
While you may not feel like it, you can absolutely do Kegels while on your period and for some it can actually help lessen the discomfort of cramps. Your sense of motivation may be lower and your perception of ‘engaging’ the muscles may also be less but that doesn’t mean the muscles aren’t working. Pelvic floor exercise may feel more or less effective depending on where you are in your cycle and if you are nearing menopause or past it.
Estrogen increases the integrity of soft tissues (muscles and fascia), so your pelvic floor may feel strongest in the first phase of your cycle, when estrogen levels are high.
During menstruation, (the follicular phase) when estrogen is lowest, you may notice your pelvic floor muscles feel more fatigued or weaker.
It is common to feel tired and to even want to withdraw from day to day activities. In our busy world we don’t always have the time to do so but even 15 minutes a day to sit and be still can make a huge difference. It can be a good time to do Kegels (the core breath) but respect your feelings and opt to do nothing if your energy is low.
It is a good time reflect and set intentions so perhaps visualizing the movement of your pelvic floor in relationship to the diaphragm would serve you better than actively contracting and releasing your pelvic floor. That being said, contracting and relaxing the pelvic floor can help reduce cramps in some people.
The cervix sits lower during the bleeding phase and the uterus is heavier as well which could also contribute to the sense of ‘doing’ a Kegel being not as strong. Studies have found that strength training during the follicular phase resulted in greater increases in strength.
During the non-bleeding phase as estrogen and testosterone start to rise, so does your energy, confidence, and sense of power. This is a great time to do Kegels!
An even better time to do Kegels is during ovulation. Bleeding has stopped, estrogen has helped with vagina dryness, testosterone is higher, and you feel more like your happy self again.
In perimenopause, the typical cycle (25-35 days) may start to vary and women may experience months where ovulation does not occur perhaps because there was not enough follicle-stimulating hormone to mature the follicle or perhaps not enough luteinizing hormone to cause the follicle to rupture. The ruptured follicle is a source of progesterone and if a follicle is not developing or is not rupturing then the increase of progesterone may not happen. This can lead to estrogen dominance over time which can contribute to heavier periods and longer periods…which can in turn mean more time not feeling like doing Kegels.
In menopause, ovulation does not occur at all and estrogen levels drop. Progesterone which had been starting to drop in perimenopause continues to drop as well. This can often leave the vagina feeling dry and irritated which can contribute to the development of incontinence or prolapse. There can in turn be a tendency for women to develop clenching or gripping strategies for core control which can have a negative influence on the overall function of the pelvic floor.
Maybe it feels like Kegels don’t work anymore? Local estrogen therapy can help offset the dryness and atrophy, referred to as Genitourinary Syndrome of Menopause. It can also help restore the suppleness of the vaginal tissues and pelvic floor.
Hyaluronic Acid is another great option to help heal and restore dry, irritated tissue in the vagina. A naturopathic doctor or functional medicine physician may help supplement hormones in peri and post-menopause.
Make it a Lifestyle
Kegels work when done correctly, consistently and coordinated with movement. A Kegel-centric lifestyle with pelvic floor exercises done most days either on their own or as part of activities of daily living and workouts is a good plan and a great way to start making Kegels a habit.
Proactive is best but it is never too late, so no matter what phase of life you are in, pay attention to your pelvic floor health and make all the other facets of life easier!
We Want to Help
If you have any questions about menstruation, Kegels, exercise programs, or how physical therapy can help, speak with one of our Pelvic Floor Professionals and get clarity on all the options available to you.