Norwich Natural Fertility Partnership

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< Previous Menopause and Pelvic Pain and discomfort

Our physiotherapist Hanna tells her how she can help with some of the more uncomfortable issues that can be triggered by menopause.

'A precursor to menopause is typically decreasing frequency of periods, often occurring between 45 and 55 years of age; in the UK the average age being 50. With menopause comes a plethora of changes that you can expect to last for up to four years, though many women report their symptoms extend well beyond this timeframe.These symptoms can combine to affect your lifestyle both physical and emotional. These changes are often interlinked, and many symptoms and problems can lead to each other and cause a cascade effect of health worries.
 
The most common changes in menopause include hot flushes and night sweats but I want to focus on the bits related to Women’s Health physiotherapy, Vaginal dryness and other vulvovaginal symptoms (roughly half of women will have these) as well as menopause and urinary/bowel issues or prolapse are particularly prevalent. 
One recent consideration is how Bladder Pain Syndrome (BPS) has been found to be more common in over 40s, and some of this is believed to be  linked to menopause. The disorder is characterised by frequent urination or simply the urgency to do so as well as pain during and after. The pain usually eases on emptying. BPS also often contributes to pain in and around the vagina and is a good example of how one issue will lead to another. It is yet uncertain how these interactions come to be, but it is likely related to hormonal changes and/or the effects this has in the pelvic area.
 
One of these effects can be pain on penetration or during sexual activities. Known as 'dyspareunia' it is present in between one in six to just under half of postmenopausal women. For menopausal women, vaginal thinning and dryness are the leading causes but from experience I can also say that we also see existing vulvodynia (pain in vulva or external genitals) get worse as well as biomechanical changes around the pelvic area lead to pain. This pain often leads to issues with emotional well-being, with fear of pain and intimacy often leading to anxiety. This in turn may cause involuntary tightening of the vaginal muscles, something that could be the contributory cause of other issues.
 


 

Luckily, these are all issues where rehabilitation can and have been proven to help. As menopause, urinary/bowel problems and vulvovaginal symptoms often go hand in hand, taking care off one problem may help with the others. This is  particularly true for bladder/bowel dysfunctions, pelvic pain, sexual health and prolapse. 
 
Common treatments for menopause will nearly always start with some form of hormonal treatment as well as regular pelvic floor muscle exercises. (Often topical oestrogen cream is a first step that often helps).  Research has found this combination has good success and is a key first step to promoting post-menopausal health. While this is a first step, there is more to be done, in particular if you have co-existing problems or your menopause has had more unusual symptoms. It is here that a thorough examination for pelvic floor dysfunctions, both musculoskeletal and otherwise can be very helpful to pinpoint various problems and address them in order. 
 
With some luck, improving in one area will help the others as well and Women’s Health physiotherapists are well placed to help with this. Not only are menopausal problems often part of our normal workload, we can also help with sexual education, assess musculoskeletal problems and dysfunctions caused by menopause and are particularly well suited to deal with bladder/bowel and prolapse problems.'
 
If you are suffering with any of the issues above please contact Hanna on dabbourphysio@gmail.com to arrange a time to speak with her directly.