Dr. Susie Gronski
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Don’t Let Menopause Keep You from Rockin’ That Pelvis!

Who says sex has to stop after you hit menopause? Well, according to an international survey of 4,100 women, up to 50% said that sex was painful.1 Ouch! 50%?! That’s a whole lotta deprived vaginas.

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Top 5 symptoms you might complain of in your golden years:

  • A vagina dryer than the sahara desert

  • Getting “hot” and not it a good way

  • Waking up to a pool of sweat in your bed sheets

  • Insomnia

  • That annoying belly fat that won't go away no matter what diet or exercise fad you try

So What Gives?

I’m not gonna bore you with the medical jargon so let’s keep it simple eh? Basically, after you hit 30yo your hormones gradually start to drop. Dr. Irwin Goldstein, sexual medicine doc, recently stated at this years International Pelvic Pain Society conference in Chicago that during menopause “biologically your tissue will become like the pre-pubescent days.” Remember those days? Bald vagina and small “lips”?

Your vaginal tissue health is dependent on a nice balance of testosterone and estrogen among other reproductive and stress hormones. Believe it or not the amount of estrogen you have is dependent on testosterone. Yup, it’s not only dudes that have to worry about low T. You’re heart, brain, skin, and “privates” need it too!

Your Bladder on Menopause

Your bladder, urethra (tube that empties the bladder), vaginal tissue, pelvic ligaments, pelvic floor muscles and connective tissue all depend on estrogen to keep things running smoothly. During menopause, it’s been reported that 50% of women complain of urinary symptoms that worsen over time and 9-39% over 60yo report urinary leakage. 2,3  Vaginal dryness and pelvic floor muscle degeneration is common in menopause. Besides leaking everytime you a-choo! you’re also at risk for POP. No, I’m talking about a carbonated beverage here. I’m talking about pelvic organ prolapse, POP for short.

POP is a condition where the pelvic organs start to creep down towards the vaginal opening. Some women complain of lower abdominal and pelvic pressure or feelings of something “falling out” of the vagina. Don’t get me wrong, menopause isn’t the only thing that can put you at risk for POP. Other risk factors include “hulking it” to poop, childbirth, previous abdominal or pelvic surgeries, chronic coughing, and lifting heavy weights just to name a few.

The plumbing “down below” relies on hormones to function properly and since testosterone and estrogen both decline in menopause, it’s no wonder why symptoms like leakage, low libido, vaginal dryness, and pain with intercourse just spring up outta nowhere.

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Menopause Doesn’t Have to Suck

Ok, by now you’re probably thinking that a life after menopause looks depressing. It doesn’t have to be! There’s lots of options out there to help keep your hoo-ha vibrant. I’m sure you’ve heard about bioidentical hormone replacement therapy and maybe even about laser vaginal therapy.4,5  Although there’s conflicting research about these hot topics there seems to be benefits to both. Whoa! Hold on. I’m not promoting any of those treatment methods but I’d like you to be aware of your options, especially about the most important option which is pelvic floor muscle training!

Work It Girl!

Want something that works without any side effects? Then pelvic floor muscle training is for you! Pelvic floor muscle training has been shown to help decrease urinary urgency, urinary incontinence, stress urinary incontinence, decrease risk of POP, decrease anxiety, and potentially improve sexual function. In fact the International Continence Society recommends that pelvic floor muscle training be the first line of defense for urinary leakage.

In one study, researchers found that the more sexually active you were, the better your pelvic floor strength.6 Woo-hoo! But sadly, more research needs to be done to determine if pelvic floor muscle tone impacts sexual satisfaction and activity. But common sense tells me that if you’ve got vaginal dryness and experience pain during sex, it isn’t going to feel good, putting a damper on your sex life and intimacy.

Top 5 Tips to Improve Your Pelvic Health During Menopause:

  1. Lube it up! Vaginal dryness is the leading cause for discomfort during sex in menopause. Invest in an organic oil based or water based lubricant that matches the pH of your vagina (3.5-4.5). Some of my patients enjoy using olive, coconut, or vitamin e oil but I can’t say with 100% confidence about their effect on the vaginal tissues. Very little research on their use in the vagina. So use cautiously.

  2. Exercise! Exercise has been proven to diminish effects of menopause such as poor memory, cardiovascular disease, osteoporosis, mood swings, and declining hormone levels. Exercise has also been shown to improve sexual function and satisfaction through the release of happy hormones and chemical messengers in the body that affect hormone production.8 Exercise makes you feel good about yourself and when you feel good about yourself that love resonates throughout your entire body.

  3. Squat to drop. Avoid constipation! To help relax your pelvic floor muscles while pooping, use a foot stool to prop up your knees. Creating something similar to a squat. Use gentle belly breathing and make sure to avoid holding your breath if you have to push. And remember, it’s ok to sit on the toilet for 10-15 min. So don’t rush!

  4. Drink plenty of H20 to help decrease constipation and bladder irritation. Hydrate your tissues!

  5. Use it or lose it. Just like any other muscle in your body, your pelvic floor muscles need a workout too! They need to be stretched, relaxed, and strengthened to efficiently do their job of keeping you dry, holding up your organs, and experiencing an orgasm. An exercise program specifically targeting the pelvic floor muscles is helpful in reducing urinary incontinence.7 So don’t underestimate their importance, they’re small but mighty!

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Here’s my disclaimer: If you’re experiencing pelvic pain, doing kegels and pelvic floor strengthening might make things worse. A pelvic health specialist should evaluate you to see if you have tight pelvic floor muscles because tight muscles can also be weak causing a lot of the same symptoms like leakage and pain with sex. So when in doubt, have it checked out!

Don’t let the menopause blues keep you down. You don’t have to keep wearing pads for those embarrassing moments. Pelvic floor muscle training and exercise can help. So let’s cheers to the golden years!

 

  1. Minkin, M.J., Reiter, S., & Maamari, R. (2015). Prevalence of postmenopausal symptoms in North America and Europe. Menopause: The Journal of The North American Menopause Society. 22(11), 1231-1238. DOI: 10.1097/GME.0000000000000464

  2. Manella, P., Palla, G., Bellini, M., & Simoncini, T. (2103). The female pelvic floor through midlife and aging. Maturitas. 76, 230-234. DOI: http://dx.doi.org/10.1016/j.maturitas.2013.08.008

  3. Pereira, V.S., Vieira, M., Correia, G.N., & Driusso, P. (2012). Long-Term Effects of Pelvic Floor Muscle Training With Vaginal Cone in Post-Menopausal Women With Urinary Incontinence: A Randomized Controlled Trial. Neurourol. Urodynam. 32(1), 48-52. Doi: 10.1002/nau.22271

  4. Kingsberg, S.A., Simon, J.A., & Goldstein, I. (2008). The Current Outlook for Testosterone in the Management of Hypoactive Sexual Desire Disorder in Postmenopausal Women. J Sex Med. 5(suppl 4), 182-193.

  5. Croft, S. (2105, November 15). Mona Lisa Touch Therapy- What is it? [Web log post] Retreived from: https://suecroftphysiotherapistblog.wordpress.com/2015/11/15/mona-lisa-touch-therapy-what-is-it/

  6. Kanter, G., Rogers, R.G., Pauls, R.N., Kammerer-Doak, D., & Thakar, R. (2015). A strong pelvic floor is associated with higher rates of sexual activity in women with pelvic floor disorders. Int Urogynecol J. 26(7), 991-996. Doi: 10.1007/s00192-014-2583-7

  7. Bø K., Herbert R.D,. (2013). There is not yet strong evidence that exercises regimens other than pelvic floor muscle training can reduce stress urinary incontinence in women: a systematic review. J Physiother. 59(3):159–68.

Gerber, J.R., Johnson, J.V., Bunn, J.Y., & O’Brien, S.L. (2005). A longitudinal study of the effects of free testosterone and other psychosocial variables on sexual function during the natural traverse of menopause. Fertil Steril. 83(3), 643-8.