Journey of womanhood - Understanding perimenopause and menopause

You see all the memes and stories on the social channels of women making fun of themselves as they experience perimenopause and menopause.

With so many mental and physical changes in this stage of life, it's not hard to make light of some of the most commonly talked about symptoms like hot flashes and mood swings.

In reality, it's no laughing matter. The symptoms are varied, not just isolated to the female reproductive system, and can affect every aspect of life.

Even celebrities like Oprah Winfrey, Brooke Shields, Drew Barrymore and Naomi Watts are normalizing the conversation around the topic and some of its more serious symptoms. These transparent and open discussions are forging new paths for women to be comfortable, embrace the changes and seek medical professionals for positive experiences in aging.

Aging happens

Let’s face it, every part of aging is a difficult concept for women. With pressures to stay youthful visible in all mainstream and societal venues, it's hard to accept that aging is inevitable.

Accepting that the body changes over time can not only make transitioning to the later stages of womanhood more tolerable, it can empower you to age gracefully, with as much strength and resilience as possible.

Perimenopause vs. menopause, is there a difference?

Perimenopause and menopause are two distinct parts of the full journey of womanhood, both marking the transition from fertility to infertility.

What is perimenopause?

• The period of time before menopause when hormone levels fluctuate and menstrual cycles become irregular.
• Average age of perimenopause: Between the ages of 40 and 50.
• Signs of perimenopause: Can include hot flashes, night sweats, irregular periods, mood changes, brain fog, vaginal dryness and difficulty sleeping.
• Can last for several years.

What is menopause?

• The permanent ending of menstrual periods, occurring when a woman has not had a period for 12 consecutive months.
• Average age of menopause: Usually occurs around the age of 51, but can vary widely.
• Signs of menopause: Similar to perimenopause, but hot flashes and night sweats may become more intense and persistent.

Menopause is considered a permanent state because you can no longer have children. You may be saying, those sound like the same thing to me. So what’s the difference?

In the most general sense, menopause is the more final stage of transitioning from fertility to infertility where hormones go on a steep decline and the body reacts accordingly.

Typically turning to OB/GYN or primary providers, who are excellent resources when the body starts to change, women can also fully benefit from rehabilitation - that's right, physical therapy and more specifically, pelvic health therapy, can be the answer to some of the more uncomfortable symptoms of perimenopause and menopause.

Physical therapy

Hormone decline (estrogen, progesterone, testosterone and insulin) creates a whole body response, often referred to as musculoskeletal syndrome of menopause. Bones, joints, tendons and ligaments all count on hormones to feed them so when there is a decline, women can start to see:

• Joint pain and stiffness
• Muscle loss (sarcopenia)
• Bone loss (osteopenia and osteoporosis)
• Connective tissue changes (decreased flexibility)
• Full-body inflammation

The musculoskeletal symptoms associated with menopause can significantly impact quality of life, affecting mobility, physical activity and overall well-being.

It is estimated more than 47 million women worldwide enter menopause transition annually. More than 70% will experience musculoskeletal symptoms and 25% will be disabled by those symptoms through the transition from perimenopause to post-menopause.

Exercise and movement is critical. Physical therapists look at conditions like plantar fasciitis, hip pain, rotator cuff, arthritis and more from the medical understanding of hormone loss and work on strength training, building up bone and muscle and decreasing inflammation, making symptoms manageable.

Musculoskeletal syndrome of menopause is chronic and progressive when left to evolve on its own, but enlisting the help of a physical rehabilitation specialist - or movement expert - can give you power over the process and is a super important part of the perimenopause/menopausal journey, reducing the chance of disability.

Pelvic health therapy

There is a more intimate side of perimenopause/menopause (medically called genitourinary syndrome of menopause). Women actually begin losing muscle mass in their 30s and often note certain changes in their bodies as they reach their 40s and 50s.

We’re talking about pelvic floor muscles, the urinary sphincter and their associated responsibilities — bowel, bladder and sexual function — all tied to quality of life and all subjects that may be harder to talk about or scarier to address with a health care professional.

Suffering in silence

Many women keep their struggles hidden as they start to experience leakage when laughing, sneezing or bending to pick things up. They may get urinary urgency, frequency or become increasingly uncomfortable from constipation or loose bowel. They may also secretly let their relationships suffer because of painful or uncomfortable sexual intercourse.

Pelvic health therapists are physical therapists who specialize in treating pelvic floor dysfunction — conditions related to pelvic floor muscles that are responsible for continence, sexual function and core stability. They have advanced training that allows them to do internal work and provide a thorough assessment of what is happening within the body. The treatment is individualized and unique to each person’s situation.

Treating all genders and identities, when it comes to women, these professionals prefer to start early in the lifespan. Understanding how the pelvic floor works and how it will change again and again as milestones in life are reached during young adulthood, pregnancy and childbirth, mid-life and menopause can be a powerful tool.

As specialists, pelvic health therapists address functions and dysfunctions of the pelvic floor assisting with:

• Fertility
• Ability to carry a child to term
• Recovery from natural birth or C-section
• Return to safe exercise post-partum or after gynecological surgeries
• Bladder and bowel control
• Pain reduction
• Enhanced sexual function and more

Let’s explore some of the ways these individuals will work with you to get you healthy, strong and ready to face the symptoms of perimenopause and menopause.

Don’t forget to breathe

Breathing is super important for pelvic floor health. Shallow breathing can do harm, while diaphragmatic breathing, also known as belly breathing, can help restore proper pelvic health function.

Pelvic health physical therapists often include breathing exercises as part of their treatment programs because the diaphragm and pelvic floor have an important relationship. In diaphragmatic breathing, inhaling through the nose lengthens and relaxes the pelvic floor muscles, while exhaling returns the pelvic floor muscles to their place. When there is dysfunction in the pelvic floor, people lose this important coordinated relationship.

Under the guidance of a therapist, women can learn the proper breathing method and tell when they are engaging all the right muscles. This knowledge is power and once taught can be slipped into an average day whenever it’s convenient to relax and support pelvic health muscles.

More than Kegels

Knowing how to contract and relax your pelvic floor muscles can benefit pelvic health, and a pelvic health therapist can help teach you these tools for a strong and dynamic pelvic floor. While the commonly heard of Kegel exercises can help to strengthen the floor, combining them with other focused exercises provided by a pelvic health therapist can make for a well-rounded approach to function.

And…it’s important to note that not all women have a problem with weakness of the floor; some have tight pelvic floor muscles and would instead benefit from muscle relaxation instead of strengthening.

Working that core

Here’s a good rhyme to keep in mind, your floor and core help you do more.

Most people think of the core as the abdominal muscles — the true functional core is actually made up of several muscles and muscle groups that lay deep beneath the surface, and the pelvic floor is one of those muscle groups. These muscles work with the deep abdominal and back muscles and the diaphragm to support the spine and control the pressure inside the tummy.

If any of the muscles of the core are weakened or damaged, their coordinated actions may be altered. Over time this may place strain on the pelvic organs and result in loss of bladder or bowel control or cause pelvic organ prolapse.

A pelvic health therapist understands the coordinated dance of these muscle groups and works one-on-one with you to address any issues you may be experiencing directly by targeting where actions are going off-course and what muscles are involved.

Don’t be a slave to the bladder

As hormones change, the tissue and PH of the vagina and bladder responds, changing the urogenital microbiome (a community of microorganisms that live in a particular environment). These changes can lead to a thinning of the urethra and vaginal tissues, reduced mucus production and result in an imbalance of normal bacteria that fight against infection. These changes may increase the regularity of urinary tract infections (UTIs) or the urge to go to the bathroom.

Pelvic health therapists work through those issues not only with exercises and understanding, but also through education.

They discuss behavioral changes of the bladder, dietary irritants that can be avoided, how to control the urge to use the bathroom and the importance of drinking water. While drinking water may sound like a bad idea to those experiencing frequency, urgency and leakage, it is important to maintaining balance in the human body.

Instead of cutting back on water, pelvic health therapists help to understand how to fill up the bladder better, how to control the urge and how to bring blood flow to the tissues.

Not time to retire intimacy

Though much focus is on bladder and bowel issues, sexual function is a key part of menopause. The same hormone, tissue and muscle changes that impact body function affect the ability to have and enjoy sexual intercourse.

According to John’s Hopkins Medicine, more than a third of women in perimenopause or menopause report having sexual difficulties, from lack of interest in sex to trouble having an orgasm. It is not uncommon to experience:

• Reduced libido: Decreased estrogen equals a decline in sexual desire.
• Vaginal dryness: Lower estrogen can thin vaginal walls and reduce lubrication, making intercourse uncomfortable or painful.
• Decreased elasticity: Can cause pain during penetration, throbbing/aching feeling after intercourse, cramping and muscle tightness.
• Changes in arousal: Estrogen decline can affect the way the body responds to stimulation.

Everything listed above can be addressed through pelvic health therapy (breathing, strengthening or loosening) in conjunction with hormone replacement (pills, patches, gels, or creams), lubrication and just plain understanding what your body is doing and why.

Sex can be enjoyable post-menopause. Trust the process of learning what is happening to your body, what you can do to adjust and trust the experts to help you learn methods needed to make it better.

Don’t let fear or shame be the guiding principle for avoidance of sex, but instead be willing to be open about what is happening and what you may experiment with to make sex work for you and your partner.

It’s a phase

Perimenopause and menopause are a phase of life for women. That is not a downplay, it’s a fact.

Also a fact — there are tools available that can be learned in a safe, private space and at a pace that is defined by the patient’s level of comfort. When physical therapy/pelvic health therapy is combined with hormone therapy/prescribed topical estrogen, lifestyle changes and, most importantly, open communication, you can achieve or maintain well-being — physical, mental, emotional, sexual and social.

To learn more about taking control of perimenopause and menopause, find a location near you to make an appointment with a physical or pelvic health specialist today.

Clinical contribution to this blog provided by Pelvic Health Physical Therapist Donna Chirico.