Why We Should All Be Talking About Perimenopause and The Pelvic Floor
Dr. Jenn Gelfand, Pelvic floor PT, educating a patient about perimenopause at Root To Rise Physical Therapy & Pelvic Health in Scarborough, Maine.
As pelvic floor physical therapists, we often see our patients that are in their thirties, forties and fifties beginning to notice pelvic floor symptoms that weren’t there before. Symptoms such as leaking, urgency, pain with intercourse, vaginal dryness. Often, it seems there’s no explanation for why these things are happening now. And it can be frustrating and confusing as to what to do about it. Perimenopause impacts the pelvic floor and understanding why can make a big difference in how we approach care.
Hormonal Impact on the Pelvic Floor in Perimenopause
Perimenopause is the transition into menopause and can begin years earlier than people expect. During this phase, estrogen fluctuates and gradually declines. Estrogen plays a big role in keeping vaginal and urinary tissue healthy and well lubricated and supports the connective tissue that helps support our organs. When estrogen declines, the tissue can become more sensitive, drier and thinner. This cluster of symptoms is referred to by the medical field as Genitourinary Syndrome of Menopause (GSM)
During Perimenopause, we often see our patients experiencing:
Vaginal dryness, irritation or burning
New or worsening urinary urgency, frequency or leaking
Pain or new discomfort with intercourse
Pelvic heaviness or pressure
New or worsening GI issues such as constipation
New or more frequent urinary tract infections
Symptoms of GSM do not usually just go away once we go through the transition into menopause (unlike hot flashes) and often, they continuously get worse. This is why it’s important to address them rather than push through or try to wait it out.
The pelvic floor muscles, urethra, bladder and all the connective tissue surrounding and supporting them contain lots of estrogen receptors that help them utilize this hormone for resilience, blood flow and lubrication. When estrogen declines, these tissues lose some of these characteristics which impact their function including how they manage pressure and stretch, how hydrated the tissues are and how well the muscles can contract and relax. Estrogen also impacts the overall function of the bladder.
How Can Pelvic Floor PT Support You in Perimenopause
While Physical and Occupational Therapists do not prescribe hormonal treatments, we work closely and alongside your physician or nurse practitioner who may recommend topical vaginal estrogen and or other pharmaceutical therapies. Non-hormonal vaginal moisturizers can also be helpful in improving comfort and function. As pelvic floor therapists we focus on:
Improving pelvic floor muscle coordination and strength
Restoring tissue mobility and resilience
Addressing bladder urgency and leaking symptoms
Lifestyle and behavior strategy coaching to help improve function and quality of life
Programming for whole body strength and resilience to fit your specific needs and goals
Pelvic floor therapy should always be individualized and focused on addressing the root cause of your symptoms and taking a full body whole person approach to helping you achieve your goals.
Perimenopause is a normal phase and transition but this doesn’t mean you need to just live with symptoms and an impacted comfort and quality of life. You deserve to feel good in your body at every phase of life and not just have to push through or deal with it. If you have questions about whether a wand or dilator might be right for you, we're always happy to talk it through at your next visit.
If you're looking for support in managing pain with intercourse, urinary urgency, incontinence, or just looking to optimize your pelvic health during perimenopause, our team at Root To Rise Physical Therapy & Pelvic Health in Scarborough, Maine is here to help.