On Menopause

My schedule is typically booked full of people who are pregnant, postpartum, or trying to conceive. It feels like a unique time to be working with folks in this season, being in the same season myself.

However, recently I’ve realized that I have had full days of treating women over 50. And with that, have been having a lot more conversations about estrogen, hot flashes, and all the feelings that come with The Change: Menopause.

The experiences these particular women are having around this topic range about as widely as the symptoms associated with perimenopause itself. (Note: I have a list of OVER 100 SYMPTOMS associated with the decade-long season of perimenopause—so if you’re feeling something that a friend is not, you’re not crazy!) Some of them are discouraged, distraught, and frustrated. Some are feeling it’s been easy-peasy.

But all of them are uncomfortable.

• The most common symptoms I see folks for within my practice are:

• Vaginal dryness

• Painful intercourse (typically attributed to the aforementioned dryness)

• Urinary incontinence

• Urinary urgency

• Grief & disorientation

I have the honor of working through some less medical/traditional PT topics, like grief and disorientation. I get to sit with them in the in-between, holding space as they process this change, the transformation from Mother to Wise Woman. To hold space for the unknowns that are in part due to a medical system that hasn’t done much research in this area, despite the fact that half the population goes through it. And even what knowledge is out there, it is still such a taboo topic that it’s often not brought up by individuals, or by their providers.

Thankfully there are more and more resources out there. This particular bunch of women I’m working with have each brought up a book or resource they’ve come across recently, as well as their own desire that everyone should know this! I couldn’t agree more, so I’m sharing those resources here.

I would be remiss if I didn’t let you know what role we as physical therapists play in walking through this season with you (whether you’re post-menopausal, peri-menopausal, or just looking ahead at what’s inevitably to come). Here are 7 things to know:

1. Topical estrogen (which you would get prescribed through your PCP) can help with vaginal dryness, incontinence, and urinary urgency. Estrogen has a bad reputation due to a study called the Women’s Health Initiative, which reported adverse effects that were later disproven. Talk with your PCP for more information and to know if it’s right for you—it is very much an individual decision to make, but you should have all the information you can get.

2. Vaginal moisturizers (without scents or herbs, please!) can help with dryness, or simply coconut oil from the kitchen! (Make sure it’s a new jar and not one that’s been up there for a decade or so...)

3. Coconut oil suppositories: Get yourself a mini-round ice cube tray and clean it real good. Melt down some organic coconut oil (without any additives) and fill the tray. Pop it in the freezer or fridge, then when they are solid, pop them out and put them in a bag or jar. You can use as a suppository (yes, put it into your vagina) for moisturizing, or before intercourse to mimic your own natural lubrication.

4. Use lube for sex! With less estrogen, the tissue around the vagina becomes more dry and irritable. It’s common to have increased sensitivity and discomfort with penetration, so take your time and don’t be afraid to use lube. If lubrication and/or estrogen aren’t helping, see a PT.

5. What a PT does for painful sex: When sex becomes painful, our bodies do what is natural—they defend themselves from the perceived danger. Your head knows that your partner is not dangerous, but your body isn’t getting the memo when it hurts. The defense they mount is tightening the pelvic floor, which in turn actually makes sex more painful, and we’re in a cycle. In PT we work on connecting with the pelvic floor to realize when we’re clenching, teach you to release the tension through yoga postures, stretches, and awareness, and can provide hands-on treatment through vaginal massage to help the muscles relax.

6. Urinary symptoms: Estrogen provides a “plumpness” to the vulva, around both the vaginal opening and the urethra. In menopause, estrogen is decreased, leading to less plumpness and more stiffness of the tissues. This can contribute to stress incontinence (ie. leaking with coughing, sneezing, exercise, etc) as well as urgency and urge incontinence (ie. the strong urge to pee and sometimes not making it in time). A pelvic floor PT can teach you about optimal bladder habits, normalize your pelvic floor tone (it can be both weak and too tight, and both contribute to urinary symptoms), and help you have more control over your bladder.

7. Energy shifts: You probably started bleeding around age 10, so aside from birth control, pregnancy, or a hysterectomy, you’ve spent most of your life with some regularity of a bleed. Menopause can be a disorienting time when you lose those cycles, especially if you have come to rely on them for some grounding. A lot of my work with people during this shift is acknowledging the grief that may accompany this change, as well as reorienting to shifting energy elsewhere and looking to things like the cycle of the moon to anchor to for orientation. Some of this work is more energy focused, and I use the modality of Holistic Pelvic Care along with traditional PT to address this facet of the change.

If you are curious if physical therapy is right for you during this shift, reach out to me or someone in your area. You don’t have to suffer, and there are providers to walk through it with you.