Physical therapists are musculoskeletal experts and should see menopause as an opportunity to use their skills to help women ease this life transition.

Menopause is a normal part of aging and is defined as the point in time 12 months after a woman’s last menstrual cycle. It generally occurs between the ages of 45 to 55 and can last for seven to 14 years. It can also be caused by a hysterectomy or surgical removal of the ovaries. Menopause can result in hot flashes, trouble sleeping, pain with sexual intercourse, incontinence, moodiness, and depression.

As a pelvic health therapist, I often treat women who are menopausal for urinary incontinence, constipation, pain with sex, pelvic organ prolapse, and pelvic pain. These women generally have pelvic floor dysfunction, which occurs when the pelvic floor muscles are not working optimally. Pelvic floor muscles function like a sling between the pelvic bones and provide support for the pelvic organs, stability for the lower back, and sphincter control for the bladder.

Let’s look at each of these concerns associated with menopause to determine how pelvic health physical therapy can you achieve your desired goals and return to daily tasks without limitations.

Urinary Incontinence

Urinary incontinence is not caused by menopause. As a woman ages, if her pelvic floor muscles are weak it can result in urinary incontinence. Many women experience leakage of urine with a sneeze, cough, laugh, while lifting, or with exercise which is called stress urinary incontinence. If urinary leakage occurs with an urgent event on the way to the toilet it is defined as urge urinary incontinence.

When a patient has both stress urinary continence and urge urinary incontinence it is called mixed urinary incontinence. Many women may also state that they have difficulty emptying their bladder, which can be related to increased tension in the pelvic floor muscles.

Pelvic floor muscle training can be an effective way to eliminate urinary incontinence and allow a patient to resume all desired activities. Typically, a patient can see improvement in one month and with consistent performance the results can be long-lasting. A pelvic health physical therapist can evaluate you to determine if you need to relax or strengthen your pelvic floor muscles to regain bladder control.

Constipation

There can be many causes of constipation. It is common to experience constipation during menopause due to shifts in hormones, but it can also be related to side effects of medications, lack of physical activity secondary to fatigue and arthritis, fluid intake, and diet. Over time with excessive strain people can develop tension in their pelvic floor muscles making having a bowel movement more difficult. With excessive strain you can also put more pressure on the pelvic organs. If the pelvic floor muscles are weak, this can lead to prolapse. Seeing a pelvic health therapist can help you determine if your muscles are tightening versus relaxing with a bowel movement to reduce strain and prevent additional concerns.

Pain with Sex

With a decrease in estrogen, women can experience vaginal dryness, irritation, and pain with sexual intercourse. The use of vaginal lubricants (which are available without a prescription) can decrease friction and increase your tolerance. The use of vaginal moisturizers can help improve or maintain vaginal moisture, especially in women who have vaginal atrophy or thinning of the tissues.

Pain with sex can also be caused by low back and hip pain secondary to limitations in range of motion for positioning. A pelvic health physical therapist can perform manual therapy to ease tension and pain, prescribe exercises to increase range of motion and flexibility, and educate you on self-care techniques for desensitization to improve your tolerance.

Pelvic Organ Prolapse

With the loss of estrogen during menopause, there is a weakening of both pelvic floor muscles and vaginal tissue leading to a sensation of heaviness. This weakening can result in a prolapse of the colon, uterus, or bladder into the pelvic canal resulting in pressure and pain.

Women who have had at least one vaginal birth are 50% more likely to experience a prolapse which may or may not be symptomatic. A pelvic health physical therapist can evaluate you for pelvic organ prolapse and also determine if you have pelvic floor muscle weakness to assist you in gaining strength to further support your prolapse and prevent worsening of your symptoms.

Weight gain can also contribute to pelvic organ prolapse. Weight gain is common during menopause as the loss of estrogen results in redistribution of weight to your abdomen. Exercise can become uncomfortable leading to lack of physical activity. A pelvic health physical therapist can also assist you in creating an exercise routine focusing on gaining not only pelvic floor strength but core and hip strength to assist with an improved tolerance for both daily tasks and exercise.

Pelvic Pain

There are many causes of pelvic pain. It can be related to inflammation, infection, or trauma. It is generally caused by a combination of things. A pelvic health physical therapist will evaluate your pain for your pelvic region externally but possibly internally if consent is given to determine the cause.

Again, with menopause there is a depletion of estrogen causing the tissues to thin and get more easily irritated. Pelvic organ prolapse can also lead to sacroiliac joint pain which is pain located in your lower back to buttocks. A pelvic health physical therapist can assist you in eliminating this pain with manual therapy, exercise to strengthen the pelvic floor, core and hips for stability and stretching as needed to reduce tension. They can also educate you on proper body mechanics to reduce strain with your daily tasks including those for your home, work, sports or with exercise.

It is never too late to seek out a pelvic health physical therapist to assist you with these concerns. They can create a plan of care designed especially for you to achieve your goals during this transition. They will help you to determine which type of exercise will allow you to achieve your best outcome. Exercise has been shown to improve a person’s quality of life and help them to achieve an ideal weight which can lead to both a decrease in the severity and length of their menopausal symptoms.

 

Amy Hauerstein is a Physical Therapist who specializes in Pelvic Health in the outpatient clinic setting.  She has extensive experience and combines her passion for wellness with physical therapy, addressing the physical and emotional limitations of men and women.  Over the past 20 years, Amy has lived all around the US working as a physical therapist in a variety of healthcare settings. Three years ago, she changed the focus of her practice to pelvic health. She started taking courses with the APTA’s Academy of Pelvic Health and received her CAPP-Pelvic in July of 2021.  She enjoys working in this specialty and seeing first-hand how much Pelvic Health can improve someone’s quality of life.