Menopause happens when a woman hasn’t had a period for 12 months and on average occurs at 51 years of age.
Most women will experience some symptoms of menopause, but the degree and number of symptoms varies woman to woman. Symptoms are caused by hormonal changes and can affect various body systems. The average length of symptoms is 5-10 years.
Genitourinary Symptoms of Menopause (GSM) is the term used to describe the
changes to the genital and urinary tissues during menopause. Up to 50% of women will experience GSM.
What changes occur in my vaginal and bladder health during and after menopause?
Aging and reduced levels of oestrogen present during menopause are directly linked to changes in the vaginal and urinary tissues:
Increased sensitivity of the bladder
Reduced number of blood vessels and lower blood flow to the vagina
Decreased moisture and vaginal self-lubrication
Decreased elasticity and strength of the pelvic floor muscles
Increased fragility of tissues
In-drawing of the labia minora and vaginal entrance
Changes to the vaginal flora and lower pH levels
How can this affect my pelvic floor symptoms?
Bladder:
Needing to pass urine more often
Urgency to pass urine
Urinary incontinence
Increased likelihood of urinary infections
Vagina:
Increased genital dryness
Burning/itching sensation of the vulva and vagina
Decreased arousal or ability to orgasm with sex
Pain with sex
Bleeding
Vaginal discharge
Sensation of vaginal heaviness or bulging (pelvic organ prolapse (POP))
How can physiotherapy help?
Women’s and Pelvic Health Physiotherapists are skilled in helping women manage pelvic floor symptoms associated with GSM. Your physiotherapist will undertake a detailed history to understand your symptoms, concerns and goals.
Your Physiotherapist might suggest:
Lifestyle changes
-Changes to your fluid intake
-Reduction of bladder irritants e.g. fizzy drinks, artificial sweeteners, alcohol
-Optimising toilet positioning and practices
-Advice regarding physical activity and lifting
Pelvic floor muscle training
-Strengthening or relaxation of the pelvic floor muscles
Bladder re-training
-Tools to calm bladder urgency
-Drills to re-train your toileting habits
Electrical stimulation
-Use of electrical impulses to reduce bladder frequency or urgency
Vaginal lubricants and moisturisers
-To improve the moisture content of the vaginal tissues
Vaginal support pessary
-Liaison with a gynaecologist regarding fitting of a pessary to reduce POP symptoms.
The above treatment options are some of the many available tools to help you best manage your vaginal and bladder health during and after menopause.
Women’s and Pelvic Health Physiotherapists are a valuable addition to the multidisciplinary team in managing GSM symptoms. Come and meet our friendly and skilled therapists. We can’t wait to empower you with knowledge and skills to address your GSM!
This information is general in nature and does not constitute medical advice. It is always recommended that you seek input from your medical professional when any symptoms are present.
References:
Portman DJ, Gass ML; Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society. Menopause. 2014 Oct;21(10):1063-8. doi: 10.1097/GME.0000000000000329. PMID: 25160739.
Australian Menopause Society. (2024). Vulvovaginal symptoms after menopause. https://www.menopause.org.au/hp/information-sheets/vulvovaginal-symptoms-after-menopause