What’s Up Down There? Menopause & the Problem in Your Pants (Part 1)

Menopause and pelvic prolapse

One thing many of us don’t want to talk about during the menopause transition is what goes on below your belly button. After all, who really wants to have a conversation about what’s going on in your pants? But the truth is, things start to happen that are related to hormone levels and you need to be aware so you won’t feel like you’re alone or worry yourself to death! The problems that start to occur generally fall into 3 Ps: prolapse, peeing and pain. This is a 3-part series where we’ll take a look at each one in detail. Let’s start with pelvic prolapse.

Menopause and pelvic prolapse

Changes in a woman’s pelvic floor function often accompany menopause. Weakening of the pelvic support structures can lead to pelvic organ prolapse. This is when one or more organs (bladder, uterus, urethra, vagina, small bowel or rectum) of the pelvic area drops out of place. This causes a bulge in the vagina that will sometimes protrude through the vagina opening.

While there are many causes of pelvic organ prolapse (heavy lifting, vaginal birth, hysterectomy), the lack of estrogen during menopause worsens the situation by thinning the support structures and tissue that hold pelvic organs in place, causing them to fall.

Pelvic organ prolapse symptoms

Symptoms associated with pelvic organ prolapse can range from minor pain and difficulty urinating to emotional distress. Unlike other experiences of menopause, like hot flashes, pelvic organ prolapse symptoms can increase with age.

Symptoms related to varying types of pelvic organ prolapse include:

  • Pain or a feeling of pressure in the pelvis or vagina
  • Feeling that something is coming out of your vagina or sight of tissue protruding from the vagina (which may bleed or feel tender)
  • Difficulty urinating or a feeling that the bladder will not empty; bowel movement difficulty
  • Lower back pain
  • Urinary incontinence (urine leakage during sneezing, coughing or exertion)
  • Frequent bladder infections
  • Painful sexual intercourse

Treatments for menopausal pelvic organ prolapse

Since lack of estrogen is the primary cause of menopausal pelvic organ prolapse, treatment in postmenopausal women may involve hormone therapy. This can help restore the vagina to premenopausal condition and may help to strengthen the vaginal structures supporting the pelvic floor. The most common hormone therapy is a low-dose vaginal estrogen replacement, using creams, tablets or vaginal rings.

This is a condition where working with a physical therapist trained in pelvic floor therapy can be very beneficial. The goals of physiotherapy are to reduce the symptoms caused by the prolapse and to improve your pelvic floor support. Treatment is often focused around the pelvic floor muscles which help to support and control the bladder.

Physiotherapy will not be able to return the prolapsed pelvic organ(s) to their original position, but it can help improve the strength of the pelvic floor muscles so that they provide more support to the pelvic organs to prevent further slippage. Physiotherapy can also play an important part in teaching you how to avoid certain activities and helping you make simple lifestyle changes that will prevent you from causing further damage and stretching of your pelvic floor muscles. It can also teach you how to improve your bladder control.

For advanced conditions of pelvic floor prolapse, your doctor may prescribe a pessary. A pessary is a device that, when placed into the vagina, holds the pelvic organs in place. Normally, the patient is the one to clean the pessary to avoid infection; however, some pessaries must be taken out by medical professionals for cleaning.

In severe cases, surgery is required to restructure support for the prolapsed organs. This is usually performed through the vagina. The surgeon will secure the falling vaginal walls, bladder, urethra or other organs back to their proper position.

As if the physical problems associated with prolapse aren’t enough, women with pelvic floor disorders may understandably suffer higher rates of clinical depression and anxiety. Additionally, many experience shame associated with their symptoms. Since pelvic issues are not exactly dinner table conversations, women may feel very isolated. The emotional issues related to pelvic prolapse are often unrecognized and poorly managed. Holistic prolapse management needs to recognize both the physical and emotional aspects of living with a prolapse so that more women can access emotional support and coping strategies to improve their long-term quality of life.

Dr. Anna Garrett is a menopause expert and Doctor of Pharmacy. She helps women who are struggling with symptoms of perimenopause and menopause find natural hormone balancing solutions so they can rock their mojo through midlife and beyond. Her clients would tell you that her real gift is helping them reclaim parts of themselves they thought were gone forever.

Find out more about working with her at https://www.drannagarrett.com/work-with-me/.

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Perimenopause: The Savvy Sister’s Guide to Hormone Harmony

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