By The Team @ Indigo Physiotherapy
Some people might be dreading menopause as an inevitable experience they can’t escape. While we agree that it’s unavoidable, it’s time to challenge the stubborn stigma that somehow has come to signal a period of decline.
Instead, we’re celebrating menopause as the start of a new chapter while arming you with the proper knowledge to navigate this transition with more ease. Plus, you’ll learn about the various ways physical therapy can help you navigate perimenopause and menopause with confidence.
But before we dive in – we want to acknowledge that, yes, your body will go through changes, and to some people, it might be more noticeable than others. However, our bodies are always in a constant state of flux, and while this transition might come with challenges, it also brings about positive changes.
Ultimately, this new phase of life deserves to be celebrated instead of feared. It’s a chapter of change, so approach it with the mindset of embracing new possibilities and perspectives. It’s a moment to check in on your health, fine-tune where needed, and celebrate the end of one phase while looking forward to the other side.
How Your Hormones Change From Puberty To Menopause
What are Perimenopause and Menopause?
Menopause marks the official end of your menstrual cycle, and it’s diagnosed after you’ve gone 12 consecutive months without a period. This is a natural biological process that signifies the end of fertility.
While we may typically associate menopause with the aging process, some people may go through menopause for reasons other than aging. Someone might go through medical menopause through hormone suppression for specific medical diagnoses. Or menopause could be triggered by the removal of ovaries for various reasons, like treating a particular type of cancer.
Perimenopause is the transitional period leading up to menopause, which may last anything from a few months to over a decade. During this time, your ovaries gradually reduce the production of eggs and hormones, resulting in various symptoms and changes in your body.
“Perimenopause” is a relatively new term, as previously, people’s experiences “around menopause” were often just lumped together as a natural part of aging. Luckily, the recognition of perimenopause as a stage on its own has led to more targeted research, understanding, and treatment options for people going through this transitional phase.
Timeline and Changes of Perimenopause
The onset of perimenopause typically occurs in your 40s, although it can occur as early as your mid-30s. Your estrogen level fluctuates significantly during perimenopause, causing a variety of changes throughout your body.
However, keep in mind that a symptom you might be experiencing that seems like a typical perimenopause or menopause symptom might be due to something else. So, never hesitate to contact your medical care team to verify.
The list of symptoms could feel pretty overwhelming, but it doesn’t mean you’ll experience all of them. Fortunately, so many of these symptoms can be addressed or reduced with the right care. Plus, some positive changes might even surprise you!
Symptoms Of Perimenopause And More...
Irregular periods: Ovulation becomes more unpredictable, and your menstrual cycle may become irregular, shorter, longer, heavier, or lighter. But remember, some disruptions in your menstrual cycle don’t necessarily signal early perimenopause. Many other factors, such as stress, nutritional changes, lifestyle changes, or diet, can influence your cycle.
Hot flashes: Sudden feelings of heat that vary in intensity, length, and frequency. This is a very common symptom during perimenopause.
Sleep problems: Interruptions often occur because of hot flashes or night sweats, but sleep disturbance can occur even without hot flashes.
Mood changes: Mood swings and irritability may occur, as well as an increased risk of depression. These symptoms may be caused by sleep disruption or other factors not related to perimenopause or menopause, so always check in with your care provider if you’re not feeling like yourself.
Vaginal dryness: Low estrogen levels can lead to loss of lubrication and elasticity of the vaginal tissues, creating some discomfort or pain during intercourse. If you’re not doing so already, start experimenting with different kinds of lubes for added comfort. Low estrogen may also make you more vulnerable to urinary or vaginal infections.
Vaginal Burning and Discharge: Changes in the vaginal environment can cause irritation and abnormal discharge.
Genital Itching: Hormonal changes can lead to persistent itching in the genital area.
Urinary Urgency and Frequency: The decline in estrogen during menopause can increase the sensitivity of the bladder, making it more reactive. This hormonal change may also weaken pelvic muscles, affecting bladder support and your ability to retain urine. As a result, you might experience more frequent trips to the bathroom (urinary frequency) or a sudden, intense urge to urinate (urinary urgency).
Urinary Incontinence (Loss of Bladder Control): Urinary incontinence can result from the atrophy of urethral and vaginal tissues or weakened pelvic muscles, both of which can occur with the decline in estrogen during menopause. These changes can compromise bladder control, leading to involuntary leakage of urine.
Burning with Urination: A sensation of burning during urination is common This can be due to hormone changes, but like any of these symptoms, it’s important to note that any of these signs or symptoms could be perimenopause or menopause, and it’s always important to touch base with your health care practitioner.
Decreasing fertility: As ovulation becomes irregular, your ability to conceive decreases. As long as you are still having periods, pregnancy is still possible, so use birth control if you wish to prevent pregnancy.
Changes in libido: Hormonal changes may cause a change in sexual arousal and desire. As hormonal changes also lead to decreased blood flow to your pelvic area, orgasms may feel different or less ‘powerful’.
These changes are common during this timeframe in your changing physiology but can be addressed. Give yourself (and your partner) the time and space to (re)explore what you need and what you enjoy. See this as an invitation to try new methods of foreplay to increase blood flow and lubrication to the area and experiment with new kinds of lubricant.
Many people find that once they’ve completely stopped ovulating and they can stop using birth control or don’t have to worry about pregnancy anymore, they can enjoy sex even more.
Loss of bone density: One of the most significant effects of declining estrogen levels during menopause is the reduction in bone density. Estrogen plays a crucial role in maintaining bone strength; as its levels drop, bones become more brittle and fragile. This condition, known as osteoporosis, increases the risk of fractures, even from minor falls or injuries.
Changes in cholesterol levels: Cholesterol changes can occur due to decreased estrogen, increased “bad” cholesterol (aka low-density lipoprotein), and decreased “good” cholesterol (aka high-density lipoprotein). Both put you at a greater risk for cardiovascular disease.
Relief from menstrual symptoms: Hormonal changes that govern your menstrual cycle can cause symptoms ranging from bothersome to severe. When you start menopause, estrogen and progesterone levels decline permanently, ending your monthly periods and the accompanying symptoms. So, it could finally be time to wave goodbye to those pesky premenstrual migraines!
Uterine fibroids may shrink: Uterine fibroids are noncancerous growths influenced by estrogen and progesterone. They often shrink and become less noticeable during and after menopause. This natural reduction can alleviate severe symptoms like pain, heavy menstrual bleeding, and pressure on the bladder.
The Effects on Your Pelvic Floor
As estrogen levels drop, it may have significant effects on your pelvic floor muscles, which may lead to some uncomfortable symptoms.
Atrophy, or thinning of muscles, can be caused by disuse, declining hormones, or declining blood flow (which provide nutrients to the tissues) in perimenopause or menopause.
Since this is a bit of a flywheel (all three things impact each other), sometimes this thinning of muscle – which leads to weakness as well – can lead to increased incidence of pelvic organ prolapse, leaking, urinary frequency, or pain with penetration for intercourse or a medical exam.
But weakness does not mean your muscles are necessarily “loose”. It could be that the varying effects of perimenopause make the muscles shorter or tighter. So before you do 100’s of kegels, see a pelvic PT to find specific recommendations for your needs.
How Pelvic Floor Therapy Can Help During Perimenopause and Menopause
Pelvic Floor Physical Therapy (PFPT) can be an incredible tool for managing the various symptoms and changes associated with perimenopause and menopause.
Your therapists can provide crucial education about hormonal changes and the impacts of those changes on vaginal tissues. Plus, they can provide information about the appropriate movement, exercises or stretches to impact bone health, maintain muscle strength, promote blood flow, libido, and prevent pain or dryness.
From various exercises and stretches, to suggestions on lubes or toys, to other self care techniques, pelvic physical therapy can arm you with a curated, evidence based arsenal of knowledge to fit your needs.
However, it’s important to reiterate that issues like leaking and weakness isn’t always directly correlated to kegels (or pelvic floor muscle contractions). Many people need more help with breath, core control and coordination, intrinsic core and hip strength, movement patterns/posture, and lengthening/stretching. Your therapist will be able to guide you through all of these different elements.
What to Expect from Pelvic Floor Physical Therapy (PFPT)
Here’s what you can expect from working with your therapist:Customized Assessments: The pelvic floor evaluation is tailored to each person’s comfort level and specific needs and includes the following elements:
Functional Movement Screen: This involves assessing how your body moves and identifying any limitations or compensations in movement patterns.
Breathing Mechanics: Evaluating your breathing patterns to ensure optimal oxygen flow and core support.
Scar Tissue Assessment: Examining any scar tissue from previous surgeries that might affect pelvic floor function.
Hip Range of Motion (ROM) and Strength: Checking the mobility and strength of your hip joints, which are integral to pelvic stability.
Lumbar Spine Mobility: Assessing the flexibility and movement of your lower back to understand its impact on pelvic health.
Deep Core Activation: Evaluating the engagement and strength of your deep core muscles, which play a crucial role in overall functional movement.
External Assessment: A therapist may perform an external evaluation with your consent. This evaluation will include palpation of the urogenital triangle to assess muscle tone, pain points, or symptom reproduction.
Internal Assessment: If necessary and with your comfort in mind, a therapist may conduct an internal assessment to evaluate pelvic floor function related to common diagnoses such as urinary incontinence, prolapse, vaginal atrophy, or pain (including discomfort during intercourse or perineal pain).
Treatment Techniques
Treatment techniques are always individualized and will vary from person to person. You can always expect to gain knowledge from your therapists about perimenopause and menopause and the associated symptoms that you may be experiencing.
Other Components of Care for Managing Perimenopause and Menopause Symptoms
In addition to PFPT, several other components of care can help manage symptoms. These include nutritional support, enough sleep, medical management, topical support and regular exercise.
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Dr McCaul Practices Physical Therapy at Indigo Physiotherapy.
Indigo Physiotherapy is an innovative, evidence based boutique practice, offering exceptional physical therapy services and licensed massage therapy in Maryland and northern Virginia. Whether it's incontinence, sexual dysfunction, bowel issues, endometriosis, pregnancy related concerns, or general pelvic health and wellness, our highly trained physical therapists are expertly trained to provide exceptional care to help you feel your best and get you back to doing what you love.
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