1. Everyone is Affected by Menopause
Some of the best years of a person’s life happen when a person is over forty, and for those with a uterus, that includes perimenopausal and menopausal years (Psychology Today). In fact, one-third of a woman’s life occurs after menopause, and approximately 37% of women are affected by pelvic floor disorders (PFDs), while huge gaps in women’s health research and treatment persist (Alperin et al., 2019). So how do we explore the rich possibilities of this period of life while also exploring the challenges of menopause and treatment?
Historically, menopause has been viewed as a physiological process that women simply put up with, while women have consequently suffered in silence. But menopause is a profound endocrinological event; it has widespread impacts on bodily systems and the health of the individual (Hillard, 2019). This is because endocrine receptors are located throughout the body, with estrogen and estrogen deficiencies affecting the cardiovascular system, the breast, the skeleton, the brain, and other organs (Hillard, 2019). Clinical research has established the larger impact of estrogen reductions on health while its effects on pelvic floor dysfunction remain underappreciated and understudied (Hillard, 2019).
The lack of awareness of the possibilities and challenges related to menopause extends to family members who live with individuals experiencing menopause. Family members may recognize their family member’s symptoms, and talking openly about menopause allows family members to respond with more empathy and understanding (Kenney, 2023). Changes in sleep, emotional fluctuations, and physical symptoms can shift daily routines and impact individual and familial well-being, so normalizing discussion about menopause is crucial in supporting loved ones through menopause (Kenney, 2023). Partners may be confused or hurt by changes in libido or in shifting familial roles, making it important for partners and children to have honest conversations that support the family as they navigate new territory together (Kenney, 2023).
2. Learn to Recognize Pelvic Floor Dysfunction
Awareness about pelvic floor dysfunction and the ways we can treat it can give menopausal individuals the tools to function normally and experience pleasure at menopause and beyond. Menopause-related shifts in the genitourinary system and pelvic floor have negative impacts on well-being, including common conditions of pelvic floor disorders (PFDs), genitourinary syndrome of menopause, and recurrent urinary tract infections (Alperin et al., 2019). PFDs significantly decrease the quality of life, increase depression, social isolation, caregiver burden, and economic costs to both the individual and society (Alperin et al., 2019).
The symptoms associated with pelvic floor dysfunction are not solely related to sexual health and pleasure; pelvic floor dysfunction includes irritative lower urinary tract symptoms, overactive bladder dry, urinary incontinence, pelvic organ prolapse, sexual dysfunction, and anal incontinence, all of which have enormous implications on the individual’s ability to function normally (Alperin et al., 2019). These conditions can range from experiencing weakness or discomfort to more complex issues that affect one’s daily activities of life and require specialty interventions (Hillard, 2019). Yet, many individuals express a lack of trust in the abilities of their medical providers to understand and treat their symptoms. According to a 2021 survey, 73% of women aged 40-65 were not currently seeking treatment for their menopause symptoms (Elflein, 2021).
While menopause encompasses many symptoms, here are a few signs that you are experiencing pelvic floor dysfunction at any age or stage:
Painful urination
Frequently needing to use the restroom
Constipation or straining pain during bowel movement
Trouble releasing a bowel movement
Incomplete bowel movements
Urine or stool that leaks
Pain during sex
Pain in the lower back with no other cause
Ongoing pain in the pelvic region, genitals, or rectum
3. We Have the Power to Support Our Communities
One protective factor for premenopausal individuals is in the hands of medical providers; women’s health clinicians should prepare patients for menopausal changes to the pelvic floor, encourage them to keep the pelvic floor muscles active and healthy and provide support through recommendations to specialists (Hillard, 2019). However, many providers are underprepared to provide treatment and support the holistic impacts of menopause. But some individuals simply aren’t seeking care for their symptoms, and access to information is responsible for the lack of treatment. In fact, inadequate knowledge of pelvic floor dysfunction is the largest barrier to seeking care (Neels et al., 2016). In a study done to assess barriers to pelvic floor care, 68% of postmenopausal women felt uninformed about pelvic floor dysfunction and most women expressed they would be interested in learning more (Neels et al., 2016).
While clinicians have work to do in menopause research and education, we currently have the power to advocate for ourselves and our communities rather than live with treatable symptoms. Educating ourselves and our communities about protective factors like pelvic floor muscle training (PFMT) allows us to take control of our own bodies and minds. PFMT has been shown to improve blood flow in vulvovaginal tissues, pelvic floor muscle relaxation, and vulvovaginal tissue elasticity in postmenopausal women with genitourinary syndrome of menopause and urinary incontinence (Mercier et al., 2020). In a study comparing the effectiveness of PFMT in treating urinary incontinence, 74% of women reported a cure or improvement in their symptoms (Dumoulin et al., 2018). It’s also important to note that many women do not require treatment for menopause, which reflects another gap in clinical research as we are unsure why some women experience no symptoms while others experience a wide array of symptoms. If you are experiencing symptoms that make you uncomfortable physically, mentally, or emotionally, talk to your doctor to discuss symptoms and treatment.
4. There Are Benefits for Well-being
Many people approaching menopause are prepared to experience unwanted symptoms like hot flashes and vaginal dryness, but they might not expect the benefits that also come with menopause. For those with heavy periods and menstrual migraines, menopause marks the beginning of a period-free life without cramping, anemia, and PMS symptoms altogether (Upham et al.). The PMS symptoms that can affect daily life such as fatigue, depression, anxiety, and irritability lessen as hormones even out and the body adjusts to its new normal (Upham et al.).
Menopause provides more benefits than lessening menstrual and contraceptive symptoms; many individuals 50 and above experience a newfound sense of self and confidence in the menopausal years (Upham et al.). Women report feeling secure in their identities and womanhood, although some say these are understandings we gain as we age (Upham et al.). These physiological and socioemotional benefits of menopause are often overshadowed by the possible negative symptoms of menopause, but there are solutions available to decrease symptoms and increase the quality of life for menopausal people.
5. The Sex Gets Better
The last reason to learn more about menopause: the sex gets better. One of the major benefits of menopause expressed by post-menopausal individuals is the ability to have sex without contraception and with no worries of pregnancy, which can enhance sexual satisfaction and decrease external anxieties (Upham et al.). The newfound freedom from contraception also frees individuals from the common side effects of some hormonal birth control methods such as acne, high blood pressure, dizziness, insomnia, nausea, and weight gain (Gotter, 2018).
Menopause-related effects on libido may allow individuals and their partners to rediscover what libido and sexual intimacy mean to them (MD, 2020). Exploring new avenues of intimacy can be a fun and exciting aspect of menopause where changes can be brought to the bedroom (MD, 2020). For instance, changing sexual routines, focusing on foreplay, and incorporating sex toys can all be exciting tools to enhance your sex life even when your libido may be lower than usual (MD, 2020). Think of the transformative period during menopause as a time to think about sexual intimacy and reimagine the possibilities for yourself and your partner.
Join us for a Pelvic Floor Health and Wellbeing Workshop on Sunday, November 19th from 9 am-12 pm to take control of your pelvic health and pleasure at all ages and stages! Visit our website to sign up here: https://app.ubindi.com/Revolution.Therapy.and.Yoga
References
Alperin, M., Burnett, L., Lukacz, E., & Brubaker, L. (2019). The mysteries of menopause and Urogynecologic Health: Clinical and Scientific Gaps. Menopause, 26(1), 103–111. https://doi.org/10.1097/gme.0000000000001209
Devlin, H. (2019, August 26). The menopause: Why so little research on the middle-aged ovary?. The Guardian. https://www.theguardian.com/society/2019/aug/26/the-menopause-why-so-little-research-on-the-middle-aged-ovary
Dumoulin, C., Cacciari, L. P., & Hay-Smith, E. J. (2018). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews, 2018(10). https://doi.org/10.1002/14651858.cd005654.pub4
Elflein, J. (2021, August 5). Treatment of menopause symptoms among older women U.S. 2021. Statista. https://www.statista.com/statistics/1255552/treatment-of-menopause-symptoms-among-older-us-women/
Gotter, A. (2018, August 3). Birth control side effects: Risks and long-term safety of the pill. Healthline. https://www.healthline.com/health/birth-control-side-effects#risks
Happiness over the lifespan | psychology Today. (n.d.). https://www.psychologytoday.com/us/basics/happiness/happiness-over-the-lifespan
Hillard, T. C. (2019). Pelvic floor function around the menopause and how to improve it. Climacteric, 22(3), 213–214. https://doi.org/10.1080/13697137.2019.1583827
Kenney, A. (2023, June 20). The impact of Menopause on families. wearemorethanmeno. https://www.wearemorethanmenopause.com/post/the-impact-of-menopause-on-families
MD, J. S. (2020, February 3). An OB-GYN’s 3 strategies for making sex better after Menopause. Healthline. https://www.healthline.com/health/menopause/sex-after-menopause#2.-Bring-in-the-cavalry-for-symptoms-support
Mercier, J., Morin, M., Tang, A., Reichetzer, B., Lemieux, M.-C., Samir, K., Zaki, D., Gougeon, F., & Dumoulin, C. (2020). Pelvic floor muscle training: Mechanisms of action for the improvement of genitourinary syndrome of Menopause. Climacteric, 23(5), 468–473. https://doi.org/10.1080/13697137.2020.1724942
Neels, H., Tjalma, W. A., Wyndaele, J.-J., De Wachter, S., Wyndaele, M., & Vermandel, A. (2016). Knowledge of the pelvic floor in menopausal women and in peripartum women. Journal of Physical Therapy Science, 28(11), 3020–3029. https://doi.org/10.1589/jpts.28.3020
professional, C. C. medical. (n.d.). Pelvic floor dysfunction: Symptoms, causes & treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/14459-pelvic-floor-dysfunction
U.S. Department of Health and Human Services. (2022). Research Explores the Impact of Menopause on Women’s Health and Aging. National Institute on Aging. https://www.nia.nih.gov/news/research-explores-impact-menopause-womens-health-and-aging
Upham, W. B., Upham, B., Landau, M. D., Sullivan, K., Upham, B., Orenstein, B. W., Rauf, D., & Rapaport, L. (n.d.). 10 reasons to look forward to menopause - menopause center. EverydayHealth.com. https://www.everydayhealth.com/menopause-pictures/positives-of-menopause.aspx