Menopause is a moment in time that occurs after 12 months of not having a period. Most women go through this transition between 45 and 55 with the average occurring around 51 years old (The North American Menopause Society, 2020). The time leading up to menopause, when hormones are starting to fluctuate, and women may start getting symptoms of lowered estrogen, is termed perimenopause. The period following menopause is known as post-menopause.
Up to 84% of postmenopausal women experience symptoms of genitourinary syndrome of menopause (GSM), including vaginal dryness, bladder symptoms, and discomfort with intercourse (The North American Menopause Society, 2020). These symptoms can severely affect someone’s quality of life. Despite how high this percentage is, many women do not discuss these symptoms with their medical provider as they assume they are a normal part of aging and that there is nothing they can do. This is simply not true and one of the ways they can gain evidence-based information, feel empowered and supported through this transitional time is pelvic health physiotherapy.
What happens to cause these symptoms of GSM?
During perimenopause, hormones begin to fluctuate. Symptoms can come from the decline in estrogen. Estrogen plays an important role in bone, cardiovascular, brain, immune and reproductive health (Hamilton K et al, 2017). There are receptors for estrogen on the bladder, urethra, vagina, and pelvic floor muscles which is why a lack of estrogen can cause urinary urgency, frequency, and recurrent urinary tract infections (UTI’s). It also explains why there can be vaginal dryness, vaginal narrowing and pain as well as pelvic floor muscle dysfunction. (The North American Menopause Society, 2020).
How can pelvic health physiotherapy help?
A physiotherapist can help by listening to the client’s concerns, how these symptoms are affecting their life and what their goals are. Physiotherapists can help educate clients on optimal bladder, bowel, and sexual health as well as pelvic organ prolapse and pelvic pain conditions. They can also provide encouragement on lifestyle choices that will optimize the function of these organs and the pelvic floor muscles including topics such as sleep, stress management, nutrition, and exercise.
Another important role a pelvic health physiotherapist plays is being an advocate for clients on when it is time to return to their family doctor if further medical care or investigation is needed. Vaginal moisturizers and estrogen therapy have been shown to be very effective and can be discussed with their physicians to see if these may also be helpful for their symptoms (The North American Menopause Society, 2020).
Pelvic health physiotherapy for pain may include soft tissue release techniques if there is tension found in the pelvic floor muscles or a narrowing of the vaginal canal. Education on self-stretching techniques and vaginal trainers (dilators) may be discussed if appropriate (The North American Menopause Society, 2020). Treatment of bladder urgency, frequency and/or incontinence (leakage) could include a bladder diary, bladder retraining, urge regulation techniques and pelvic floor muscle training. Pelvic floor muscle training describes exercises which involve squeezing and relaxing the pelvic floor muscles (“kegels”) to improve strength, endurance, power, relaxation, coordination, or any combination of these factors (Dumoulin C et al, 2018). In this review, it is stated that women with urinary incontinence who participated in a pelvic floor muscle training program were eight times more likely to report being cured compared to no treatment (Dumoulin C et al, 2018). Pelvic floor muscle training has also been shown to have positive effects on the sexual health of postmenopausal women including orgasm, arousal, and satisfaction (Garcia-Laria, R et al, 2025).
There is no need to travel this journey alone. Reach out and find the care and support that you deserve!
