Perimenopause and Your Pelvic Health: What Every Woman Should Know
Perimenopause can bring a whole host of changes to your body. You might notice changes to your periods, sleep, mood or energy levels, but there are other changes that are talked about far less often.
Your pelvic health is one of them.
Perhaps you have started leaking a little urine when you cough, sneeze or exercise. Maybe you feel the need to visit the toilet more frequently, experience discomfort during sex, or notice a feeling of heaviness or pressure in your pelvis. You might even feel that your body is behaving differently, without really understanding why.
If any of this sounds familiar, you are certainly not alone.
At Align Osteopathy, we believe that understanding your body is an important first step towards feeling more comfortable and confident in it. So, let’s look at what happens to your pelvic health during perimenopause, what you can do to help yourself, and when it might be time to seek support.
What is perimenopause?
Perimenopause is the stage leading up to menopause, when hormone levels fluctuate and your menstrual cycle may begin to change. It can last for several years, and symptoms vary considerably from one woman to another.
We often associate this stage of life with hot flushes, night sweats and mood changes. However, changing oestrogen levels can also affect the tissues of the vagina, vulva, bladder and urethra, as well as your muscles and joints.
These changes can influence how your pelvic floor functions and how comfortable you feel during everyday activities.
The important thing to remember is that you do not have to wait until menopause to seek help with pelvic health symptoms.
How can perimenopause affect your pelvic health?
1. Bladder leaks and urinary urgency
Have you ever crossed your legs before a sneeze, avoided a trampoline with the children, or quietly planned your day around knowing where the nearest toilet is?
Urinary symptoms can be frustrating and sometimes embarrassing, but they are nothing to feel ashamed of.
During perimenopause, some women experience:
Leaking urine when coughing, sneezing, laughing or exercising.
A sudden, urgent need to pass urine.
Needing to urinate more frequently, including during the night.
Difficulty feeling confident when exercising or enjoying social activities.
These symptoms can have several causes. Changes to the pelvic floor muscles, bladder function and the tissues around the urinary tract may all play a part.
What can help?
Start by noticing when your symptoms occur. Are they associated with exercise, coughing, drinking certain beverages or a sudden urge to go?
Try to drink enough water throughout the day, avoid restricting fluids excessively, and address constipation if this is an issue. If urgency is a problem, bladder training may help, but a personalised assessment can help establish the most appropriate approach.
Pelvic floor muscle training can be helpful for many women with urinary incontinence. However, it is important to understand that pelvic floor problems are not always caused by weakness and are often a sign your body isn’t functioning well somewhere else and your pelvic floor is taking the brunt of that disfunction. Some women have muscles that are overly tense or struggle to relax, so simply doing more pelvic floor exercises may not be the right answer for everyone.
2. A feeling of heaviness or pressure
Some women notice a sensation of heaviness, dragging or pressure around the vagina or pelvis. Others describe feeling as though something is bulging or that they are not quite as comfortable as they used to be.
These symptoms can sometimes be associated with pelvic organ prolapse, where one or more pelvic organs move downwards towards the vaginal opening because the supporting tissues are no longer providing the same level of support.
Pregnancy, childbirth, ageing, constipation and other factors can contribute to prolapse. Hormonal changes may also influence pelvic tissues.
If you notice a new feeling of heaviness, a vaginal bulge or persistent pelvic pressure, it is worth discussing this with your GP or an appropriately qualified pelvic health professionals, like Align
Osteopathy.
There are treatment options available, and support may include supervised pelvic floor muscle training, lifestyle changes, self massage, breath work, stretching and strength training or other treatments depending on your individual needs.
You do not need to put up with symptoms that are affecting your daily life.
3. Vaginal dryness and discomfort during sex
This is an area that many women find difficult to talk about, even with their healthcare professional that is why we have a supportive, comfortable, less clinical environment, to help our patients feel comfortable and relaxed.
Changing hormone levels can contribute to vaginal dryness, irritation, burning and discomfort during sex. These symptoms are part of what healthcare professionals call genitourinary syndrome of menopause, which can begin during perimenopause.
You may notice that sex feels different, that you need more time to feel comfortable, or that you experience soreness afterwards.
There is no need to feel embarrassed, and you should never feel that you simply have to accept painful sex as part of getting older.
Things that may help include:
Using a suitable lubricant during sexual activity.
Trying a vaginal moisturiser regularly if dryness is an ongoing issue.
Allowing time for arousal and avoiding activities that cause pain.
Speaking to your GP about whether vaginal oestrogen or another treatment may be appropriate.
Vaginal oestrogen is an established treatment for many menopause-related vaginal and urinary symptoms. Your GP or another suitably qualified prescriber can discuss the options with you, taking your medical history into account.
If pain persists, it is important to have it assessed rather than assuming that hormones are the only explanation.
4. Pelvic pain, tension and discomfort
Your pelvic floor is a group of muscles that help support your pelvic organs and contribute to bladder and bowel control and sexual function.
Like other muscles in your body, these muscles need to coordinate, contract and relax appropriately.
Changes in activity levels, stress, pain, previous injuries, pregnancy and childbirth can all influence how the pelvic floor and surrounding muscles function.
Some women experience pelvic discomfort, difficulty relaxing their pelvic floor or pain during certain movements or sexual activity. Others notice associated discomfort around their lower back, hips or pelvis.
It is important not to assume that every ache or pain is caused by perimenopause. There can be several contributing factors, and persistent or new symptoms deserve an appropriate assessment.
Depending on the findings, treatment may involve advice about movement, relaxation, breathing, posture and activity modification.
At Align Osteopathy, we look at the person as a whole, considering how the muscles, joints and surrounding structures may contribute to their symptoms. Where appropriate, we can help you understand your options and identify the most suitable next steps.
Five simple ways to support your pelvic health
You do not need to overhaul your entire lifestyle to start looking after your pelvic health. Small, consistent changes can be a useful starting point.
1. Keep moving
Walking, strength training and other activities you enjoy can help maintain muscle strength, mobility and general health (when executed properly). If exercise triggers bladder leaks or pelvic discomfort, consider modifying the activity while you seek advice rather than giving up movement altogether. This is where we come in!
2. Look after your bowel health
Constipation and regularly straining to pass stools can increase pressure on the pelvic floor. Adequate fluids, fibre, movement and a comfortable toilet position may help. If constipation persists, we can also help.
3. Learn how your pelvic floor works
Pelvic floor exercises can be beneficial, but technique matters. The muscles need to contract and fully relax. If you are unsure whether you are doing them correctly, or they cause pain or discomfort, come and see us and we can guide you to optimal movement.
4. Pay attention to changes
Keep a simple note of any bladder, bowel, sexual or pelvic symptoms, including when they occur and what seems to make them better or worse. This can make conversations with us much easier and it gives us key information, as to what is the cause of your issues.
5. Do not ignore symptoms because you think they are just part of getting older
There are effective treatment options for many pelvic health problems. Early advice can help you understand what is happening and what support may be available.
How can Align Osteopathy help?
We understand that discussing pelvic health can feel personal. Many women have spent years putting everyone else first, and it can be easy to dismiss their own symptoms or assume that nothing can be done.
Our approach is to listen, understand your concerns and help you make sense of what you are experiencing.
A pelvic health appointment with me at Align Osteopathy provides an opportunity to discuss your symptoms, relevant medical and health history, and how they are affecting your everyday life.
Depending on your needs, we can consider the role of your muscles, joints, movement and general musculoskeletal health, assess your pelvic floor movement, offer appropriate advice, and discuss whether osteopathic care may be helpful. Where symptoms require specific pelvic floor assessment or other medical input, we can guide you towards the appropriate professional.
You do not need to know exactly what is wrong before making an appointment. You simply need to feel ready to talk about it.
When should you seek medical advice?
Please speak to your GP if you have persistent bladder symptoms, recurrent urinary tract infection, blood in your urine, unexplained vaginal bleeding, or new or persistent symptoms that concern you. Any bleeding after menopause, once you have gone 12 months without a period, should be assessed by a healthcare professional. Very often its nothing to worry about, but it is important that this is checked each time.
Severe or sudden pelvic pain, particularly with heavy bleeding, fever or feeling very unwell, requires urgent medical attention.
These symptoms should not automatically be attributed to perimenopause.
You deserve to feel comfortable in your body
Perimenopause is a significant transition, and it can affect far more than your periods or your temperature regulation. Your pelvic health matters too.
Whether you are experiencing occasional bladder leaks, discomfort during sex, pelvic pressure or simply have questions about changes you have noticed, you deserve to be listened to and supported.
You do not have to feel embarrassed, and you do not have to navigate these changes alone.
At Align Osteopathy, we are here to help you understand your body, explore appropriate options and take positive steps towards feeling more comfortable in everyday life.
Would you like to talk about your pelvic health?
If you are experiencing symptoms or would simply like some guidance, you are welcome to book a pelvic health appointment with me at Align Osteopathy.
Sometimes, the first step is simply having a conversation.
This article is for general information and is not a substitute for individual medical advice or assessment.
Gayle Jordan M.Ost DWHO
Womens Health Specialist Osteopath
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