How Menopause and Perimenopause Affect Your Body – And How Pelvic Health Physiotherapy Can Help

October 1, 2024

 

Navigating menopause and perimenopause can be a challenge, but we’re here to help you understand what is going on in your body and suggest some care and treatment options to support you. 

This blog post will give you a brief definition of menopause and perimenopause, and cover some of the symptoms that folks might experience when going through this period of life. We’ll also explore some of the available treatments, including preventative care, and explain how and why pelvic floor physiotherapy can be a helpful tool for dealing with symptoms and supporting your overall health, pelvic and otherwise.

 

Woman smiling while doing physio exercises on a floor mat.

Understanding Menopause and Perimenopause

Menopause is defined as a point in time 12 months after a person born with ovaries has stopped having their period. Generally, menopause begins later in life, with the average age of onset being 52.6 years. However, it can also affect younger individuals whose ovaries have stopped producing estrogen, either from cancer treatment or because they have had their ovaries removed for other reasons. 

Perimenopause describes the transitional years leading up to menopause, during the time when estrogen starts to decline, with the average age of onset being 47.5 years. Folks experiencing perimenopause might start to notice changes in their menstrual cycles (such as irregularity and heavier flows), hot flashes, and symptoms like vulvovaginal dryness, bladder leakage, and painful sex.

 

Woman lying on the couch experiencing a hot flash.

Common Menopause Symptoms

Menopause symptoms fall into two categories:

  • Genitourinary syndrome of menopause (or GSM): Symptoms in this category relate to the genital and urinary organs.
  • Musculoskeletal syndrome of menopause (or MSM): Symptoms in this category relate to the muscles, tendons, joints, ligaments, and bones.

Let’s explore these further and explain what causes them and how to treat them.

 

Genitourinary Syndrome of Menopause (GSM) Symptoms

Historically, this category of symptoms has been referred to as “vulvovaginal atrophy (VVA),” “vaginal atrophy (VA),” or “atrophic vaginitis (AV).” If you ask us, these are unnecessarily scary-sounding, so we tend to refer to it by its factual name, genitourinary syndrome of menopause (GSM).

Symptoms of GSM can include:

  • Genital dryness or burning
  • Irritation of the vulva
  • Decreased vaginal lubrication
  • Discomfort during urination
  • Bladder urgency
  • Urinary incontinence
  • Recurrent urinary tract infections (UTIs)
  • Pain and dryness with sexual activity 

 

Signs of GSM can include:

  • Thinning of the labia
  • Pale vaginal tissues
  • Vaginal tissue dryness
  • Narrowing of the vaginal opening
  • Decreased mobility of the clitoral hood
  • Vaginal tissue bleeding

Folks experiencing GSM might have a few, some, or all of these symptoms and signs, and be affected by them to different degrees. Some may hardly notice them at all, while others can be quite bothered by them. 

GSM happens because estrogen levels start to decline during perimenopause and after menopause. This contributes to decreased hydration and elasticity of the vaginal tissues, which makes them thinner. In terms of onset timing, one study noted that roughly a third of subjects reported noticing GSM during perimenopause, while the remaining two-thirds started to experience it after menopause.

 

GSM Treatment Options

If you’re experiencing any of the symptoms noted above, it’s important to rule out the possibility of other conditions before proceeding with GSM treatments. Conditions like the following can cause some of the same symptoms:

  • Allergic reactions to soaps, washes, creams, or fabrics
  • Yeast infections
  • Vulvovaginal skin conditions (for example, lichens sclerosis)
  • Vulvodynia
  • Pelvic floor hypertonicity

If you’re experiencing urinary symptoms, it’s also important to rule out the possibility of a bladder infection. 

 

In terms of treating GSM, the following can help:

  • Vaginal moisturizers: Use one that’s specifically designed to hydrate the vulva and vagina, not the same one you’d use on your hands or body, as the moisturizer needs to match your vaginal pH.
  • Vaginal estrogen or DHEA: These can both help offset the decline in estrogen associated with GSM by improving tissue hydration and resilience. They can come in the form of a cream or a suppository, and you’ll need a referral from your doctor for this type of treatment.
  • Pelvic floor muscle exercises (PFME): Your pelvic floor physiotherapist can provide exercises to help improve your blood flow, pelvic floor muscle function, and tissue elasticity, which can address the symptoms above. 

Learning about GSM before menopausal changes begin can help you be on the lookout for signs and symptoms, and understand the different treatment options available to you. We also recommend starting preventative care, especially pelvic floor muscle exercises, during perimenopause. 

 

Musculoskeletal Syndrome of Menopause (MSM) Symptoms

Symptoms in this category can affect the muscles, tendons, joints, ligaments, and bones, and can often have a significant negative impact on quality of life. An estimated 70% of all people born with ovaries will experience MSM, and 25% of these will experience severe symptoms.  

To complicate things, for 40% of these folks, there will be no objective findings that can be discovered with testing or imaging. Likely, this is the reason behind all the medical gaslighting that this demographic has historically had to endure.

Signs and symptoms of MSM can include:

  • Musculoskeletal pain
  • Joint pain
  • Loss of lean muscle mass
  • Loss of bone density (and increased risk of fracture)
  • Increased tendon and ligament injury
  • Adhesive capsulitis (otherwise known as frozen shoulder)
  • Osteoarthritis

 

MSM happens when estrogen (more specifically, estradiol) levels decline. This can lead to five major changes:

  1. An increase in inflammation, which can contribute to joint and muscle pain (also known as arthralgia).
  2. Osteoarthritis, which tends to be prevalent around the time of menopause.
  3. Loss of bone density, which can lead to osteopenia or osteoporosis, and potential fractures. 
  4. Loss of muscle mass, also known as sarcopenia.
  5. A decrease in muscle stem cells, which act as a repair system to help us heal from injury and build new muscle.

 

MSM Screening and Treatment

Preventative screening plays an important role in helping support your body through the changes it experiences in menopause. The following can be helpful in helping you understand and manage symptoms:

  • Bone density screening
  • Working with a dietitian to ensure your food intake is supporting you through this transitional period
  • Working with your doctor to understand, test, and monitor your hormones
  • Getting an assessment from a pelvic health physiotherapist to evaluate your general muscle strength and pelvic floor function specifically 

 

Treatments for MSM include:

  • Hormone replacement therapy (HRT)
  • Strength training, proper nutrition, and supplementation (especially Vitamin D and magnesium)
  • Pelvic floor screening and physiotherapy to support muscle strength

 

Woman and man enjoying the sun's warmth while on a hike.

How Pelvic Health Physiotherapy Can Help With Menopause and Perimenopause

Pelvic floor muscle exercises (PFME) as prescribed by a pelvic health physiotherapist can help support your genital and urinary organs as well as your pelvic floor muscles. 

PFME can improve:

  • Blood flow: This increases vaginal secretions to help with vaginal dryness and increases the thickness of the vaginal walls.
  • Muscle function: PFME tones the muscles, providing more support, which can improve urinary symptoms. The ability to relax these muscles can help decrease tissue friction and pain during penetrative sex. 
  • Tissue elasticity: This can help decrease the feeling of vaginal tightness during penetrative sex.

 

Woman doing yoga in the park.

Other Things to Know About Treating Menopause and Perimenopause

Early education about pelvic health, menopause, and perimenopause can go a long way in setting folks up to navigate this transitional period. Don’t wait for menopause or perimenopause to begin to take good care of your pelvic health; being proactive with physiotherapy and other care will help you prevent issues or complications, and support you in maintaining great pelvic health throughout your life.

 

Need support navigating menopause or perimenopause?

We can help screen for symptoms and support you with a personalized treatment plan. If you’re a new client, get matched with a physiotherapist here. If you’re a current client, book here. 

Wright, V. J., Schwartzman, J. D., Itinoche, R., & Wittstein, J. (2024). The musculoskeletal syndrome of menopause. Climacteric, 1–7.

Mercier, C. Dumoulin & G. Carrier-Noreau (2023) Pelvic floor muscle rehabilitation for genitourinary syndrome of menopause: why, how and when?, Climacteric, 26:4, 302-308.

Woods NF, Shaver JF, Berg JA. Genitourinary Syndrome of Menopause: Prevalence and Predictors. Clin Obstet Gynecol. 2024 Mar 1;67(1):27-42.