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  • Jennifer Kruger, PhD

How menopause affects the pelvic floor

Menopause is an inevitable, natural phase in a woman's life, but it’s not all hot flashes and mood swings—it brings about various changes, including in the pelvic floor.


You see, your pelvic floor muscles, those unsung heroes that support your bladder, vagina, and more, are sensitive to hormonal changes. When menopause arrives and estrogen levels drop, these muscles can start acting up, causing problems like leaks, discomfort, and even organs shifting out of place.


However, there are simple and effective interventions that can make a significant difference in managing these symptoms.


Defining menopause


Menopause is effectively the end of menstruation, or monthly periods. It’s a natural occurrence marking the end of reproductive years, almost like how the first period during puberty marked a new beginning.


You will know that menopause has taken place if you have not had any menstrual bleeding for a continuous 12 months. This transition typically occurs for most women between the ages of 45 and 55, with the average age being around 51.


The impact of menopause on pelvic floor muscles


The pelvic floor muscles are similar to other muscles in the body, and as we age, there is a natural decrease in muscle mass (sarcopenia), and loss of elasticity due to reduced collagen levels. Additionally, the drop in estrogen levels during menopause can contribute to various symptoms, such as weight gain, vaginal dryness, and an increased prevalence of chronic conditions like diabetes.


The good news is that there are evidence-based interventions that can help manage and alleviate these symptoms during menopause.

Weight management and healthy lifestyle


Maintaining a healthy weight through balanced nutrition, regular physical activity, and quitting smoking can have a positive impact on urinary incontinence, pelvic organ prolapse, and constipation. Making these lifestyle changes can significantly improve pelvic floor health and overall well-being.


Pelvic floor muscle training (PFMT)

PFMT is a well-established exercise program that targets the pelvic floor muscles. It aims to increase muscle strength, endurance, power, flexibility, and relaxation. Numerous clinical trials, including those with post-menopausal women, have shown that PFMT is an effective treatment and preventative measure for urinary incontinence.


Prevention of urinary incontinence: A study example


A recent study involving 359 women without symptoms of urinary incontinence found that after 12 months of participating in a PFMT program, these women showed significant improvements compared to the control group, which only received advice on PFMT. The improvements included better continence, increased pelvic floor muscle strength, and reduced frequency of bathroom visits.


Treatment of urinary incontinence


Effective PFMT can also treat the symptoms of urinary incontinence by strengthening the pelvic floor muscles to better support the bladder, improving muscle coordination to activate before activities like sneezing or coughing, and training the muscles to both tighten and relax as needed.


Managing pelvic organ prolapse


For women experiencing symptoms of pelvic organ prolapse, PFMT has shown promising results. A study on women who had their first baby at least 12 years ago and had prolapse symptoms found that after participating in a 16-week PFMT program, they experienced fewer symptoms, requiring less additional treatment such as surgery or the use of a pessary.


Relieving vaginal dryness and discomfort


In addition to helping with incontinence and prolapse, PFMT has shown promise in alleviating symptoms of vaginal dryness, painful intercourse, and discomfort, providing relief during menopause.


Menopause brings significant changes to a woman's body, including the pelvic floor muscles. As estrogen levels drop, the muscles may weaken and lead to various symptoms like urinary incontinence and pelvic organ prolapse. However, simple interventions, such as weight management, healthy lifestyle choices, and pelvic floor muscle training, offer effective ways to manage and alleviate these symptoms. By prioritising pelvic floor health, women can maintain an active and healthy lifestyle during menopause and beyond. Consulting with healthcare professionals can help develop personalised plans to address individual needs and ensure a smooth transition through this transformative phase of life.


Pelvic floor muscle training as a treatment for genitourinary syndrome of menopause: A single-arm feasibility study. J. Mercier, M. Morin, D. Zaki, B. Reichetzer, M.-C. Lemieux, S. Khalifé, et al. Maturitas 2019 Vol. 125 Pages 57-62.


Keeping the pelvic floor healthy. C. Dumoulin, L. Pazzoto Cacciari and J. Mercier. Climacteric 2019 Vol. 22 Issue 3 Pages 257-262

DOI: 10.1080/13697137.2018.1552934


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