How Menopause Affects the Pelvic Floor

By Dr. Christine Martirez PT, DPT on 11/6/2024

Menopause brings profound changes to the body, especially to the pelvic floor muscles, which are greatly influenced by hormonal shifts. During menopause, the decrease in estrogen levels can lead to muscle atrophy, weakness, dryness, and decreased pliability in pelvic floor tissues, all of which can impact comfort and function. However, combining pelvic floor therapy with gynecological care can significantly ease this transition, supporting pelvic health and overall well-being.

Hormonal Changes During Menopause and Their Impact

Menopause is marked by a reduction in estrogen and progesterone, two essential hormones that influence various bodily systems, including the pelvic floor. Estrogen in particular plays a major role in maintaining the strength, elasticity, and hydration of pelvic floor muscles and tissues. The decline in these hormones during menopause impacts the body in several ways:

• Muscle Atrophy

  : Estrogen helps maintain the strength and mass of pelvic floor muscles, so when levels drop, these muscles may begin to atrophy. This weakening can lead to decreased pelvic support, making individuals more prone to issues like prolapse, where pelvic organs shift downward.

• Tissue Dryness

  : Estrogen supports hydration within the vaginal walls and other pelvic tissues. With its decline, dryness becomes common, leading to discomfort, itching, and pain, particularly during sex.

• Decreased Pliability

  : Estrogen helps tissues remain flexible and resilient. Reduced estrogen during menopause makes the pelvic tissues stiffer and less responsive, which can contribute to pain during movement or exercise and hinder the natural flexibility of the pelvic floor.

How Menopause Affects Pelvic Floor Function

The decline in estrogen and resulting changes in pelvic muscle tone and elasticity can lead to various symptoms that affect quality of life, including:

• Urinary Incontinence

  : Weakness in the pelvic floor muscles often results in stress urinary incontinence, where leaks may occur during activities like coughing, sneezing, or lifting.

• Pelvic Organ Prolapse

  : Due to decreased muscle tone and tissue support, pelvic organs may start to drop, which can cause feelings of heaviness, discomfort, and pressure in the pelvic area.

• Sexual Discomfort

  : Reduced hydration and tissue elasticity can lead to vaginal dryness and pain during intercourse, making sex less comfortable or enjoyable.

• Constipation and Bowel Strain

  : The decreased muscle tone of pelvic floor muscles can impact bowel function, leading to constipation or difficulty fully emptying the bowels.

How Pelvic Floor Therapy Can Help During Menopause

Pelvic floor therapy can play an important role in addressing these issues, working alongside other gynecological interventions to support muscle health, tissue elasticity, and overall pelvic function. Here’s how pelvic floor therapy helps during menopause:

1. Strengthening Exercises

   : Pelvic floor therapists guide patients through tailored exercises to strengthen pelvic muscles and other surrounding musculature including the core, lower back, and glutes. This can improve support for the bladder, bowel, and uterus, reducing symptoms of prolapse and stress incontinence. Consistent strengthening exercises help keep the pelvic floor resilient against changes.

2. Manual Therapy

   : To enhance tissue pliability, therapists may use manual techniques to release tension in surrounding musculature, gently mobilize pelvic tissues, and improve flexibility. This can relieve tightness, enhance blood flow, and help with tissue elasticity.

3. Pain Management and Relaxation Techniques

   : Therapists teach techniques to manage and reduce discomfort, such as breathing exercises and biofeedback to enhance pelvic floor control. This helps those experiencing muscle spasms or tightness find relief and improve their muscle relaxation.

4. Guidance for Sexual Health

   : Therapists can help address vaginal dryness and pain, offering advice on relaxation techniques, dilator use, and guidance to support comfortable intimacy. Working with a gynecologist for estrogen therapy (topical or systemic) can also provide significant benefits in supporting tissue hydration and elasticity.

5. Bladder and Bowel Retraining

   : Pelvic floor therapy can address urinary and bowel symptoms by retraining the muscles involved in these functions. Therapists can help with strategies to control urgency and reduce constipation by teaching proper toileting positions, relaxation techniques, and timing strategies for more comfortable elimination.

6. Education and Holistic Support

   : Menopause affects more than just the pelvic floor; it influences overall well-being. Pelvic floor therapists educate patients on lifestyle adjustments, such as posture, movement patterns, and stress management, to support their pelvic health and empower them during this transition.

Combining Pelvic Floor Therapy with Gynecological Care

In addition to pelvic floor therapy, working with a gynecologist can further enhance menopausal support. Many find relief with hormone replacement therapy (HRT), especially topical estrogen applications, which can specifically address vaginal dryness, tissue atrophy, and other pelvic symptoms. When used alongside pelvic floor therapy, HRT can help improve tissue hydration and elasticity, creating a more effective foundation for long-term pelvic health. Consult your gynecologist for further information regarding these interventions.

Navigating Menopause with Support

While menopause brings many changes, a proactive approach can make all the difference in preserving pelvic health and quality of life. With pelvic floor therapy, those going through menopause can regain strength, address discomfort, and reduce the impact of menopausal symptoms on their day-to-day lives. Combining pelvic floor therapy with the right gynecological interventions offers a holistic, effective way to support the body during this important transition.

Looking for guidance with the bodily changes that occur with peri-menopause, menopause, and post-menopause? 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 receptionmadison@pelvichealthnj.com.

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