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What's normal for our pelvic health approaching and through the menopause?

The Umi mission was born out of concern for both the current state of pelvic health awareness amongst women of all ages and the disparity in accessibility and availability of information and treatment for a range of symptoms that can, often, be simply managed. In seeking to contribute to tackling these issues, we launched in May 2020 with a free offering - Essentials by Umi - that would speak to all women; covering the foundations of pelvic health knowledge that we want all women to have as standard.


Further in the knowledge that we would be launching our bolt-on courses in the near future, we chose not to dive-deeper into certain topics in our Essentials course so as to allow ourselves scope to create even better, more comprehensive content for our bolt-on courses.


However, we appreciate that there are many of you who are wanting more, now, especially if you are peri/post-menopausal or you have already tried pelvic floor muscle exercises and have seen no benefit.


So, this is a quick-fire guide to pelvic health through and beyond the menopause, produced in response to some commonly asked questions we have received since our launch. Enjoy, and as ever, if you have any further questions, don’t hesitate to contact us!


What are the common or normal age-related changes I should expect when it comes to my pelvic health?


Just as with all other parts of the body, the reproductive system, the vulva, the vagina and the pelvic floor muscles go through normal age-related changes that can impact function and lead to symptoms.


Perimenopause vs Menopause


The perimenopause is the period of time before the menopause proper; a period of transition before the complete cessation of periods. Periods become irregular in frequency and in flow, they may become painful or you might experience other bodily symptoms such as hot flashes, fatigue, low libido, joint pains, sleep disturbance and mood changes. This is due mostly to the natural decline in circulating oestrogen from the ovaries. Not all women will experience these symptoms; if you are taking certain types of hormonal contraception, for example, the symptoms may be masked, and the symptoms themselves vary between women. You may experience none whatsoever, or have severe and frequent symptoms, and it is possible for these to start up to 10 years before your periods stop completely.


The average age for the menopause in the UK and Ireland is 51 years; defined by the absence of a period for at least 12 months. Usually the menopause is a natural phenomenon, however, it is possible to have a surgically or medically-induced menopause after removal of both ovaries, for example, or following chemotherapy or taking certain medications.


To cover all possible pelvic health related changes is beyond the scope of this particular blog but, for now, we will touch on the most common. We are currently working on our Menopause by Umi online course which will be ready in 2021 and is going to be jam-packed full of all the information you’ll need to know.


Vulva


Due to the loss of vulval fat as we age, it gives the appearance of having shrunk. It may also look more pale. Further, pubic hair thins and the skin becomes less elastic. Topical oestrogen from your GP can help counteract these natural changes if you so wish.


Vagina


It is normal for your vagina to feel drier as you age and transition through the menopause. With the decline in circulating oestrogen levels, vaginal pH also changes. This makes us more prone to infections and imbalances e.g. bacterial vaginosis.


Do not use feminine hygiene products – these aren’t necessary – just use water to clean the vulva and never use water or any products inside the vagina. Heavily perfumed or cosmetic products designed to ‘clean’ the vagina and vulva area often disrupt our natural pH and cause further symptoms. You’ll find all the lowdown on lubricants, which can assist with vaginal dryness, in Module 5 of our online Essentials course.




Vaginal laxity


Due to events that may have happened during our life e.g. recurrent constipation, and other excessive and/or repetitive increases in intra-abdominal pressure such as pregnancy and/or vaginal childbirth, our vagina may feel more lax or more open as we age. This is not an inevitability however and can mostly be treated/prevented. Our pelvic floor muscles govern the tone of our vagina and therefore will dictate how lax it is or not. By doing regular pelvic floor squeezes correctly to improve the strength of the pelvic floor, you will also improve the tone and reduce laxity. Check back to Module 3 in Essentials for a refresher on pelvic floor muscles. You’ll also find a selection of pelvic floor muscle exercise programmes to follow specific to your particular circumstances; symptomatic or not.


Pelvic floor muscles


Like all muscles in the body, the rate of muscle loss (sarcopenia) accelerates as we age, and the pelvic floor is no exception. We must keep exercising our pelvic floor muscles correctly and regularly in order to maintain their main functions of bladder and bowel control, organ support, joint support and sexual function. It has been shown that if our pelvic floor muscles sit lower with increasing age (linked with increase in laxity) then we will be more likely to experience pelvic floor symptoms such as urinary incontinence.


Bladder


It has been shown that at least 50% of women over the age of 60 years experience bladder leaks. Changes in laxity to pelvic floor muscles and to general tissue bulk can all contribute to this. The incidence of overactive bladder also increases with advancing age. This can mean that we feel as though we need to go to the toilet more often during the day and during the night. At least 50% of women after the menopause will also have to get up during the night to pass urine.


None of these symptoms are an inevitability though and you do not just need to put up with them. There is lots that can be done, starting with correct pelvic floor exercises - these have been shown to be effective alone for most women and curing urinary symptoms. To specifically address an overactive bladder, make sure you work up to being able to easily hold the pelvic floor muscles for 10 seconds in standing. This will then enable you to retrain the bladder much easier.


Bowel


The rates of constipation have been shown to increase in women over the age of 65 years, but again there is so much that we can easily do, quickly and for free, to reduce and eliminate this. Check out optimal defecation technique in Module 6 of Essentials as this is crucial to avoid weakening, haemorrhoids/piles, increasing laxity of the pelvic floor and pelvic organ prolapse. Regular exercise, lots of different sources of fibre (aiming for 30 per week) and maintaining adequate fluid intake will all help too. We also have a fab video demonstrating tummy massage to help ease constipation in Module 6 of Essentials.


Leaking stool from the bowel affects 1 in 10 of us. Bowel incontinence is not uncommon as we age. This is due to a general increase in laxity again in and around our pelvic floor muscles and ano-rectal tissues. Ensuring stool consistency is optimal (aiming for number 4 on the Bristol stool chart - see diagram) and strong and flexible pelvic floor muscles are again key here at reducing this.




Leaking


Some women may start leaking (either urine, wind or stool) for the first time when peri or post-menopausal. Some women may find the leaking they already have becomes worse. This is due to the loss of some muscle bulk. The good news is that pelvic floor muscle exercises are just as effective at any age. As we age it takes our bodies slightly longer to build and lay down new muscle tissue so it may take slightly longer for pelvic floor squeezes to take effect. Allow for at least 3 - 6 months of consistent and good quality pelvic floor squeezes to see improvements.


Prolapse


Many women live with prolapse in their 20’s and 30’s long before menopausal changes are felt. Some women may notice prolapse symptoms increasing or for the first time during the peri and post-menopausal period. Prolapse symptoms can nearly always be improved by reducing repetitive excess downward pressure and increasing the strength, flexibility and endurance of your pelvic floor muscles. Check out Module 3 in Essentials for all the low down on pelvic floor and how to exercise it. Lots of women find that a pessary can be helpful in managing a prolapse alongside their PF squeezes – see your GP for one of these.


Painful Sex


This is very common around the perimenopausal stage and beyond due to the changes described above. These can usually be easily counteracted by either purchasing a vaginal moisturizer and using a good vaginal lubricant (top tip, use a syringe to get the lubricant inside of you rather than applying it externally on yourself or partner). Avoid scented or jelly based lubricants, instead opt for a decent oil, water or silicone based one. See Module 5 in Essentials for the lowdown on lube.


Also topical oestrogen from the GP can help greatly. If you have had pain/discomfort from sex for a while then it may also have resulted in some tension in your pelvic floor muscles so try lots of deep breathing, stretches, relaxation and booking in with a pelvic health physio if this doesn’t change. Dilators can also really help improve elasticity and reduce tension; you can speak to a pelvic health physio for further guidance, either via GP referral or privately.


Urinary Tract Infections (UTIs):


Due to changes in the pH and increased sensitivity around the urethra, we are more prone to UTIs as we age. Ensure you are drinking plenty of water to help flush things through.



What if I have had, or am having surgery?


Surgery rates for incontinence and prolapse increase as we age. There are many different types of surgery available and the correct procedure for you will be based on your symptoms and your history.


Always consult a pelvic health physio if you can before having any lower abdominal or gynaecological surgery, even if your doctor has not suggested it. It is in the national guidelines to do so and will either lessen the need for surgery or improve the outcome of the surgery. Win win!



When should I consult a doctor?


If you have heavier discharge than usual; any itching; pain during sex; a change in odour; bleeding after the menopause, after sex, between periods or heavier periods than usual; any new lumps and bumps and any sudden changes in your bladder or bowel habits then please consult your GP. And if in doubt about whether or not to consult your GP, err on the side of caution and book an appointment.


It’s always a good idea to check in on your vulva – do this by once a month using a mirror to check for any lumps, bumps, discolourations or anything that doesn’t look quite right or is new. Always report to your GP with any new changes to your vulva. You are the expert of your health and are in control of this.



Is it too late for me?


Genuinely, never! Topical oestrogen in particular can be very beneficial to counteract vulval and vaginal changes and can be easily obtained from your GP. Keeping active generally will help your overall pelvic health, watching all of our Essentials course will give you loads of tricks and tips that you can implement right away, and keep up with those regular, correct, pelvic floor squeezes.

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