Celebrities like Davina McCall and Mariella Frostrup have recently raised the profile of all things ‘menopause’. It’s no longer a word you need to whisper under your breath to your friends, and it’s okay to admit you’re ‘going through it.’ It’s even starting to become something you can talk to your manager about if you’re having issues at work.
Many of us are familiar with the more obvious symptoms that women may experience during this time of life, such as hot flushes, mood swings, insomnia, night sweats, and weight changes.
However there are a group of pelvic symptoms of menopause that are less well known, yet affect over 50% of women and can cause great discomfort and anxiety.
Below, Jo Dafforn, Clinical Lead for Pelvic Health Physiotherapy at Nuffield Health, explains the lesser-known pelvic symptoms of menopause and how to ease them.
5 common pelvic symptoms of menopause
Bladder issues – including urinary urgency (finding it hard to hold on when you need the loo), incontinence related to this (leaking before you ‘get there’) or stress-related urinary incontinence (leakage when you cough, laugh, sneeze, or trampoline with your grandkids!).
Vaginal dryness/irritation – women may experience vulval or vaginal soreness or dryness (particularly during foreplay and sex) or irritation around the vulva and urethra.
Frequent urinary or vaginal infections such as thrush and bacterial vaginosis – urinary tract infections are relatively common and often aren’t picked up on a midstream urine test, meaning you can go some time without receiving the correct treatment.
Pelvic pain – this can be felt in the vulva, vagina, or deeper in the pelvis during sex, urination, or at other times.
Pelvic organ prolapse – this is a condition whereby the pelvic organs move down with gravity and cause a vaginal lump or heavy feeling.
Why do these symptoms develop?
All of these symptoms are caused by a reduction in oestrogen levels around the genital area as you reach perimenopause (the time when you start to make your transition towards menopause).
The vulvovaginal tissues love oestrogen and just aren’t happy when they don’t get enough – becoming thinner, irritated, and more easily inflamed (it’s like your garden pots going without water all summer!). This results in the urethra not being sealed in the same way, increasing the risk of infection.
The reduction in oestrogen also changes the pH of the vagina, which can also increase the risk of vaginal infections. The result of a dry, irritated genital region is often pain or discomfort – but it’s not something women always feel comfortable talking about.
Pelvic organ prolapse can become obvious with low oestrogen levels alongside a reduction in muscle mass of the pelvic floor muscles. Many women also suffer from constipation during menopause – and straining on the toilet to empty your bowels can often worsen any existing prolapse.
5 ways to reduce pelvic symptoms of menopause
The good news is there are some quick and easy things you can do to help if you’re experiencing any of the symptoms above.
1. Have a chat with your GP about topical oestrogen and hormone replacement therapy (HRT)
Your GP can prescribe local oestrogen cream/pessaries for the vulvovaginal region, which can improve the elasticity and health of the tissues in the region.
This can often reduce irritation and urinary tract infections but may take up to six weeks to become effective. You may also like to talk to your GP about other HRT options.
2. Consider using a vaginal lubricant
There are a number of vaginal moisturisers and lubricants on the market that can offer short-term relief from vulvovaginal discomfort and improve comfort during sex. Regular use of silicone or hyaluronic lubricant can help to reduce any dryness.
3. Explore ways to reduce irritation
Following good vulvar skincare can help to reduce irritation. This can include using skin cleansers (not soap), and a vulvar moisturiser with non-perfumed ingredients. If it irritates you in any way, then it’s best not to use it.
Here are a few more ways to reduce irritation:
Avoid removing pubic hair
Avoid using intimate wipes
Check that your toilet paper and sanitary products don’t have added perfume or chemicals
If you’re using a pad for leakage, use an incontinence pad rather than a sanitary pad
Make sure your washing powders/liquids and fabric conditioners are non-irritating
Avoid wearing tight clothing and thongs, and wear breathable materials for athletic activities
4. Give up smoking
Smoking affects your blood circulation and may lessen the flow of blood and oxygen to the vagina and other nearby areas. Smoking also reduces the effects of naturally occurring oestrogens in your body.
If you need help and support to give up smoking, then it’s best to make an appointment with your GP.
5. Try pelvic floor muscle exercises
Your pelvic floor is a group of muscles that form a ‘sling’ underneath your pelvis and are responsible for controlling your bladder and bowels. They’re also involved in sexual pleasure and offer support to your entire pelvis. After the age of 40, we start to lose muscle bulk throughout our body, including from the pelvic floor.
The old adage ‘use it or lose it’ has some truth to it here – because improving the strength and function of these muscles can reduce urinary symptoms, improve circulation to the genital region, reduce irritation, and may help or prevent symptoms of pelvic organ prolapse.
If you want to strengthen your pelvic floor muscles, then check out the video below to see examples of some pelvic floor exercises you can try. It’s never too late to start – and contrary to popular belief, these exercises are useful for women of all ages – not just for women of childbearing age.
Exercise classes such as yoga and Pilates can also help to strengthen the pelvic floor. Gyms offer a wide range of these classes, as well as personal training if you’d like a personalised programme for pelvic floor strengthening.
Need more support?
If you’re struggling with any of these symptoms and would like some more guidance, you might want to speak to one of Nuffield Health’s pelvic health specialist physiotherapists. They can help and support you with a range of pelvic conditions, as well as teach you to perform pelvic floor muscle exercises correctly.
Alternatively, you could make an appointment with your GP (and request a female doctor if this makes you feel more comfortable).
Or, if you’re having difficulty coping with the symptoms emotionally, then it’s important not to suffer in silence. You could try speaking to a trusted friend, family member, your GP – or to a mental health specialist, who can offer you tailored support.