Menopause can be a time of great change in a woman’s life. Many women will experience pelvic health symptoms during this time, which can have a considerable impact on their quality of life. In fact, vulvovaginal symptoms are common and present in over 50% of postmenopausal women, and many will report emotional, lifestyle, and sexual impact from these symptoms. (1)
Fortunately, there is something that can be done about it. When considering how to help women through their journey into menopause, research provides us with key evidence to support targeting the pelvic floor. Pelvic floor muscle training has been found to improve blood flow to vulvovaginal tissues, pelvic floor muscle relaxation capacity, and vulvovaginal tissue elasticity in postmenopausal women with genitourinary syndrome of menopause and urinary incontinence. (2) Moreover, pelvic floor muscle training programs have been found to be effective in increasing pelvic floor muscle contractility, decreasing anterior pelvic organ prolapse, and decreasing urinary symptoms in postmenopausal women. (3)
Let’s dive into what the pelvic floor is, and its link to menopause and associated pelvic health symptoms.
The Pelvic Floor
The pelvic floor muscles sit within the pelvis, attaching to the pubic bone, tailbone, and sitting bones, acting as a hammock to support our organs. In addition, their functions include bladder and bowel control, sexual health, circulation, and, importantly, core strength.
Common Pelvic Health Symptoms in Menopause
Urinary incontinence, urgency or frequency
Fecal incontinence, urgency, or frequency
Sensation of pressure or heaviness in the pelvis
Diastasis recti abdominis
Pelvic Organ Prolapse
Sexual pain and dysfunction
Post hysterectomy or pelvic surgery
Vulvodynia and Vestibulodynia
Persistent Genital Arousal Disorder
Interstitial Cystitis/Bladder Pain Syndrome
Genitourinary Syndrome of Menopause
The Link: The Impact of Menopause on the Pelvic Floor
The vagina, pelvic floor muscles, and lower urinary tract tissues (including the urethra) all contain estrogen receptors. This makes them susceptible to drops in estrogen levels, such as during menopause. Amongst other effects, this results in atrophy of the pelvic floor muscles and a decrease in blood flow, which can impact the strength of these muscles. (4, 5)
How can Pelvic Health Physiotherapy help?
A Pelvic Health Physiotherapist specializes in the assessment, management, and treatment of pelvic health symptoms related to menopause. The initial assessment will include completing a detailed health questionnaire, which will enable your Physiotherapist to better understand your symptoms and health concerns. The physical exam will involve the assessment of the muscles, ligaments, tendons and connective tissue of the pelvis, hips, sacroiliac joints, low back, abdomen, and thorax. With your consent, an internal examination of your pelvis and pelvic floor muscles may be performed. An internal examination enables your Pelvic Health Physiotherapist to examine anatomical changes, symmetry to a contraction, muscle tone, and painful areas (6, 7). However, if an alternative is required, many external techniques can be performed to determine the root cause of your symptoms.
What does Treatment involve?
Treatment is always tailored and specific to each individual. Your Physiotherapist will evaluate your health history, the physical exam findings, and your functional goals to determine the best course of treatment. Options may include:
● Education regarding your symptoms, condition, assessment findings, and treatment plan
● Breathing coordination and training
● Bladder retraining
● Constipation management and bowel retraining
● Targeted manual therapy of the myofascial system
● Visceral mobilizations
● Pelvic floor muscle downregulation and relaxation
● Pelvic floor muscle strengthening and training
● Motor control training and strengthening of the deep core musculature
● Motor control training and strengthening of the abdominal wall, hips and thorax
● Postural education and retraining
● Diastasis Recti Abdominis retraining
● Functional retraining of the neuro-muscular system to achieve movement and activity goals
● Neuromuscular stimulation of the Pelvic Floor
● Liaising with your other healthcare professionals to achieve holistic and comprehensive treatment outcomes
If you are unsure of whether Pelvic Floor Physiotherapy will help with your symptoms and condition, we highly encourage you to contact us for a 15 minute Free Phone Consultation. One of our specialised Pelvic Floor Physiotherapists will discuss your concerns with you, and help you determine whether this is the best course of treatment for you.
Erekson EA, Li FY, Martin DK, Fried TR. Vulvovaginal symptoms prevalence in postmenopausal women and relationship to other menopausal symptoms and pelvic floor disorders. Menopause. 2016 Apr;23(4):368-75. doi: 10.1097/GME.0000000000000549. PMID: 26645820; PMCID: PMC4814326.
Mercier J, Morin M, Tang A, Reichetzer B, Lemieux MC, Samir K, Zaki D, Gougeon F, Dumoulin C. Pelvic floor muscle training: mechanisms of action for the improvement of genitourinary syndrome of menopause. Climacteric. 2020 Oct;23(5):468-473. doi: 10.1080/13697137.2020.1724942. Epub 2020 Feb 27. PMID: 32105155.
Alves FK, Riccetto C, Adami DB, Marques J, Pereira LC, Palma P, Botelho S. A pelvic floor muscle training program in postmenopausal women: A randomized controlled trial. Maturitas. 2015 Jun;81(2):300-5. doi: 10.1016/j.maturitas.2015.03.006. Epub 2015 Mar 14. PMID: 25862491.
JOGC September 2014. Chapter 5 - Managing Menopause. Urogenital Health. S35-41. http://dx.doi.org/10.1016/S1701-2163(15)30461-8 (accessed November 1, 2021)
Ahinoam L. Postpartum Dyspareunia Resulting From Vaginal Atrophy. ClinicalTrials.gov Identifier: NCT01319968. Last updated April 7, 2015. https://clinicaltrials.gov/ct2/show/NCT01319968 (accessed November 1, 2021)
Navarro Brazález B, Torres Lacomba M, de la Villa P, Sanchez Sanchez B, Prieto Gómez V, Asúnsolo del Barco Á, McLean L. The evaluation of pelvic floor muscle strength in women with pelvic floor dysfunction: A reliability and correlation study. Neurourology and urodynamics. 2018 Jan;37(1):269-77. available from : https://www.ncbi.nlm.nih.gov/pubmed/28455942
Sherburn M, Murphy CA, Carroll S, Allen TJ, Galea MP. Investigation of transabdominal real-time ultrasound to visualise the muscles of the pelvic floor. Australian Journal of Physiotherapy. 2005 Jan 1;51(3):167-70.