As estrogen levels fluctuate and eventually decline, changes to the vaginal and urinary tissues can contribute to symptoms such as urinary leaking, urgency, recurrent UTIs, vaginal dryness, painful sex and changes related to pelvic organ support.
These symptoms are common, but they are not something you simply have to live with.
How does declining estrogen affect the pelvic floor?
Estrogen plays an important role in maintaining the health and function of the vaginal, urethral and surrounding pelvic tissues. As estrogen levels change during perimenopause and decline after menopause, these tissues can become thinner, drier and less elastic.
This can contribute to what is often called genitourinary syndrome of menopause (GSM), which may include:
- Vaginal dryness or irritation
- Burning or discomfort
- Pain with penetration
- Increased urinary urgency or frequency
- Urinary leakage
- Recurrent urinary tract infections
- Changes in sexual function
At the same time, changes in muscle strength, coordination and connective tissue can affect how well the pelvic floor supports the bladder, bowel and pelvic organs.
Where does pelvic floor physical therapy fit in?
Pelvic floor physical therapy can address the muscular and movement-related components of these changes.
Depending on your symptoms and evaluation, treatment may include pelvic floor strengthening, relaxation and coordination training, bladder retraining, breathing and pressure management, hip and core mobility, or hands-on treatment for areas of muscle tension and pain.
For example, someone experiencing urinary leakage may benefit from learning how to coordinate the pelvic floor with coughing, sneezing, lifting or exercise. Someone experiencing painful sex may need a very different approach, particularly if the pelvic floor muscles have become overactive or guarded.
Pelvic floor PT is not simply about doing more Kegels. The goal is to determine what your pelvic floor is actually doing and develop a treatment plan based on your symptoms.
What about vaginal estrogen?
For some women, their doctor may recommend vaginal estrogen or another local treatment to address changes associated with declining estrogen.
Vaginal estrogen can help improve the health of estrogen-sensitive tissues and may be recommended for symptoms such as vaginal dryness, irritation or certain urinary symptoms. It is a medical treatment, so whether it is appropriate for you should be discussed with your physician or other qualified healthcare provider.
Pelvic floor PT and medical treatment can work alongside one another.
For example, improving tissue health with treatment prescribed by your doctor may make vaginal or pelvic floor symptoms more manageable, while physical therapy can address muscle tension, coordination, strength, mobility and functional habits that may also be contributing to your symptoms.
Depending on your situation, your care team may also discuss other options, including vaginal moisturizers or lubricants, medications, behavioral strategies or additional gynecologic or urologic treatment.
When should you consider pelvic floor PT?
Consider talking with your doctor or a pelvic floor physical therapist if you are experiencing:
- Leaking with exercise, coughing, sneezing or lifting
- A sudden or frequent need to urinate
- Difficulty making it to the bathroom
- Recurrent UTIs or urinary symptoms
- Vaginal or pelvic discomfort
- Pain with penetration
- Pelvic pressure or a feeling of heaviness
- A sensation of vaginal bulging
- Constipation or difficulty emptying your bowels
- Changes in pelvic symptoms that are interfering with exercise, sleep, intimacy or daily activities
You do not need to wait until symptoms become severe.
Your symptoms are treatable
Perimenopause and menopause can affect the pelvic floor in several different ways, and there is rarely one solution that works for everyone. Your treatment may involve your gynecologist, urogynecologist, urologist, pelvic floor physical therapist or other healthcare providers depending on your symptoms.
The important thing is that you have options.
Menopause doesn’t mean accepting symptoms.
Looking to optimize your well being with pelvic floor physical therapy? Reach out to us at Pelvic Health Center in Madison, NJ to set up an evaluation and treatment! Feel free to call us at 908-443-9880 or email us at [email protected]. We are in-network with several insurance plans and can help you confirm your benefits before your evaluation.