The After Years
Menopause, the final phase across the life span that we will be discussing. The last big shift we experience in our bodies as females, but unfortunately a shift we may not feel fully prepared for. Most of us are aware of hot flashes, mood swings and the ending of our menstruation, but in my experience a lot of women are not prepared for other changes that can occur, and most wonder why we aren’t educated earlier on.
Two of the main issues are genitourinary syndrome of menopause (GSM) and prolapse. Menopause is marked by the decrease in estrogen and progesterone hormones. Our vaginal tissues rely on estrogen, and without it, the tissues are susceptible to vaginal atrophy, which is the thinning and drying of the walls. This is the basis of GSM, leading to symptoms of burning, irritation, urinary frequency and urgency.
And prolapse? Well prolapse is the descent of one or more organs into the vaginal canal. It can cause symptoms of heaviness, like things are “falling out,” or pressure in the perineum. You may feel an actual bulge out of your vagina, or may notice symptoms of incomplete emptying, or post void dribbling.
While medical treatments include medications, pessaries and surgery to aid in the correction of prolapse if needed, the role of physiotherapy is to help decrease the symptoms. We can do this from strengthening the pelvic floor muscles or help retrain the pelvic floor to relax if it is being over worked, which can also lead to similar symptoms. There is also a variety of general stretches that can help decrease pressure into the pelvic outlet to help relieve uncomfortable sensations in the vaginal region. Legs up the wall happens to be one of my favourites and is demonstrated in the photos. The goal of the stretch is to allow gravity to work with you. You can place a pillow or yoga mat under your hips, and then relax into the position concentrating on diaphragmatic (belly) breaths to help relax the pelvic floor.
The dark horse that many women struggle with or weren’t overly prepared for with the hormonal change is the vaginal dryness related to GSM. Specifically, in regards to sex. Now you may think those days are behind you, but in fact many women can still lead healthy active sex lives after menopause, and this can actually promote blood flow to the tissues keeping them happy. But you may just need a bit ofN help, i.e. lubrication. It is recommended to use a lubrication (at any age really), to help protect the vaginal walls from any irritation. Avoid any containing glycerin and paraben wax, and for menopausal women we usually suggest trialing an oil base lubrication, as it is less likely to dry up and need reapplication.
In the end, if you are struggling with any of the above issues, speak to your local doctor or local pelvic health physiotherapist to see if you can find some relief and enjoy these golden years.