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Many people are familiar with typical menopause symptoms, like hot flashes, brain fog, and sleep problems. However, in the years leading up to your last menstrual cycle, it’s not uncommon to experience genitourinary symptoms, like changes in urinary urgency and frequency or pain in your pelvic floor. Fortunately, you don’t have to live with discomfort, as many treatment options can help you find relief from pelvic symptoms related to menopause.
What is the pelvic floor, and what causes pelvic symptoms?
The pelvic floor is a group of muscles located between your hip bone and your tailbone. It supports several organs, including the uterus, bladder, and bowels. Pelvic floor symptoms can include:
- Pain
- Vaginal dryness
- Incontinence
- Heaviness (due to pelvic organ prolapse)
As you approach menopause, your genitourinary tissues are deprived of estrogen, which can cause them to become thin and more easily irritated. In addition, many underlying causes can lead to these symptoms, which is why it’s important to see a provider (or several providers) who will work diligently to identify the root of what’s causing your pain or discomfort.
First, we’ll assess your pelvic pain to determine if it’s acute due to inflammation, infection, or trauma. If you’ve experienced pain that comes and goes for six months or more, it’s considered chronic. From there, we typically explore three different paths:
- Organ-related issues could be related to gynecologic, urologic, or gastrointestinal organs. For example, fibroids, ovarian or pelvic masses, scar tissue from past surgeries, history of kidney stones, recurring urinary tract infections (UTIs), inflammatory bowel disease (IBS), diverticulitis, or other conditions could be related to pelvic pain.
- Muscle-related causes may include fibromyalgia or a history of diabetes.
- Psychosocial components, such as depression, anxiety, abuse, or panic disorders, can significantly affect the pelvic floor.
It’s not uncommon for pelvic pain to be caused by a combination of things, which is why we thoroughly examine each patient to understand their symptoms and how it's affecting their quality of life. During an appointment, we’ll ask detailed questions to understand your medical history.
We’ll also conduct a physical exam to better understand your symptoms. We may also need to gather additional information through imaging, such as a pelvic ultrasound, CT scan, or MRI. This will help us get the full picture of what’s going on.
Treatment for menopause and pelvic symptoms.
Menopause is a normal life transition, not a disease. Therefore, not everyone needs treatment. If you’re functioning well with hot flashes or other menopause symptoms, then you don’t have to do anything about it. However, if you’re suffering and symptoms affect your ability to participate in daily activities, such as work or sleep, then don’t hesitate to ask for help. The more specific you can be about how your pain or symptoms affect your daily life, the more successful we’ll be at finding a solution that improves your quality of life, whether it’s related to your sexual activity, physical activity, or overall well-being.
There are various ways we can help manage and treat menopausal symptoms that affect your pelvic floor. We’ll often begin with the least invasive, most conservative approaches and explore other options if those don’t work. Your treatment will depend on the type and severity of your symptoms and the underlying cause of your pain. Treatment may include one or a combination of the options below.
Lifestyle changes.
Healthy habits, such as avoiding sugar and consuming a diet high in vegetables and fruit, can be an effective way to help manage mild to moderate symptoms. Likewise, staying active and getting 150 minutes of moderate-intensity exercise every week can help to relieve symptoms and improve your quality of life. The best activity is the one you’ll do, so pick an aerobic activity you enjoy, whether it’s walking, biking, swimming, or rowing.
As your body changes, you don’t have to give up your quality of life. If you have pelvic pain that prevents you from getting regular exercise that you enjoy, we can modify how you’ve done activities in the past so you can continue participating more comfortably. A pelvic floor physical therapist can help you find a way to get moving as you work together to strengthen, stretch, or balance the muscles in your pelvic floor so you can continue the activities you love.
Hormone replacement therapy.
Hormone replacement therapy is an effective treatment for hot flashes, provided you don’t have any contraindications. (Hormone replacement therapy is not appropriate for women with a personal history of breast cancer or uncontrolled hypertension). There are also several other prescriptions that may help to relieve disruptive symptoms. Your doctor can help you weigh the pros and cons of each and determine what’s right for you.
Pelvic floor physical therapy.
A pelvic floor specialist is a physical therapist with advanced training and education in managing pelvic floor conditions with exercises and other techniques. Unlike more generalized physical therapy that occurs in an open gym, these appointments are held in a more private setting. We work hard to understand how your symptoms affect your lifestyle so we can design a therapy plan to address your unique challenges and goals.
During your first visit, a pelvic floor physical therapist will ask detailed questions about your pain and examine your pelvic region, internally and/or externally, depending on your preference. The physical exam will help us understand if muscles need to be stretched, strengthened, or balanced. We’ll also evaluate parts of other parts of the body that may be impacting your pelvic floor, such as the lower back and hips.
Treatment may involve strengthening or stretching exercises and with modalities to help ease your pain or discomfort, such as hot or cold compresses or electrical stimulation. Breathing strategies can also be helpful in reducing pain, regulating heart and respiratory rates, and alleviating anxiety.
Minimally invasive surgery.
If your pain or symptoms are caused by a structural issue, you may need surgery. For example, if you have an ovarian cyst that has grown large and is pressing on other organs and causing pain, a minimally invasive procedure can remove the abnormal mass and relieve your pain.
You don’t have to be in pain just because you’re aging.
Menopause is a normal transition for every middle-aged woman, but it doesn’t have to disrupt your life. If you’ve had a change in your quality of life or are unsure if what you are experiencing is normal, talk to your doctor and be persistent about finding relief. Sometimes we must try several treatment modalities before finding what works, so try to stay encouraged through the process. You may also be referred to several specialists who will work together to understand the full picture of what’s going on in your body. This will ultimately lead to the best treatment that effectively addresses the root cause of your symptoms.
Take comfort in knowing that you are not alone. At MedStar Health, there is a team of experts who specialize in helping women like you manage unwanted symptoms and thrive during menopause.
