Menopause (GASP!!)

I know right? Why would anyone want to TALK about menopause?! Well, I can remember that I didn’t want to talk about puberty but thank goodness I did so that I was better prepared!

As we approached puberty, most of us received education and learned about puberty. Learning about puberty helped us feel prepared for those changes in life. Not that everything about puberty was easy and fun, but we often had friends, teachers, moms and other important adult figures in our lives that helped us learn about what to expect and it helped ease that transition.

A patient of mine recently pointed out in conversation the discrepancy in education about puberty versus menopause, and it makes a lot of sense. When we don’t feel educated and prepared for a change in life, it can make whatever that change may be seem scary. Especially “THE change” as menopause is sometimes called by women. Why is menopause such a scary and awful time in life? I would argue it may feel that way because we don’t feel quite as prepared and maybe haven’t given ourselves time to learn about menopause. We have spent the years leading up to this time in our lives in careers, building relationships (romantic relationships, marriages, friendships, etc), perhaps raising children, and generally just moving forward in our lives. I would also argue that most of the education given to us about menopause is focused solely on the NEGATIVE parts of what to expect, rather than an emphasis on what you can do and what you can control. It doesn’t need to be scary and awful!

Let’s start with some basic education and then dive into the changes!

Menopause refers to when the menstrual period/cycle has been absent for 12 months. In the United States, for women who experience “natural menopause” (meaning they weren’t suddenly put into menopause by surgical intervention with removal of the uterus and/or ovaries) it occurs at an average age of 51. The time leading up to menopause, where many of the changes start to occur in the body can begin as early as 40 and can continue into the later 50’s for other women. That time is called peri-menopause, which can be just a few years or up to 10 years prior to reaching menopause - the average is about 4 years. Post-menopause refers to the period of time 2-3 years after the final menstrual cycle, and this is often when symptoms may subside to some degree.

“Hot flashes” “Brittle bones” “Vaginal dryness” “Low libido” “Urinary incontinence” “Weight Gain”— WHOA, why don’t we break this down a little bit…

1. Hot flashes - while these may be uncomfortable moments that occur during peri-menopause and menopause, we can reframe our thinking about this. What you can do: Knowing that this is a symptom many women experience, we can learn to dress in layers to be prepared to remove outer layers as necessary when they do occur. For many of us in the northern climate, there can be times that hot flashes are welcome in the frigid winter months, as we may actually feel a bit of natural warmth rather than feeling like an icicle!

2. Brittle bones - while it is true that women go through more rapid bone density loss due to loss of estrogen, whether or not you have “brittle bones” is highly dependent on a number of factors, including some dietary and activity choices. What you can do: Participate in regular physical activity in a weight bearing position (walking, dancing, tennis, etc) and incorporate strength training several days per week. The younger you are when you incorporate these lifestyle changes, the more protective it will be for your bone health. Nutritionally, be sure to eat/drink calcium and vitamin D in recommended levels and avoid heavy alcohol use. Lastly, participate in recommended screening of bone density per your physician recommendation so that you can have medical management of your bone density if needed during/after menopause.

3. Vaginal dryness - as estrogen decreases during the transition to menopause, the tissue of the vaginal area can become drier and can make sexual intercourse uncomfortable. What you can do: Just like many of us apply lotion to our legs in the wintertime, or face cream to our faces when the weather dries our skin….there are special moisturizers designed for use in our vulvar/vaginal area that can be applied several times per week to improve our comfort. We make the skin care of our face a regular part of our routine, we can do the same for our vaginal area.

4. Low libido - this is a complicated one because women will often complain about low libido during/after menopause, without thinking a little deeper about what is truly causing the change in their desire. Maybe it has to do with change in body image, maybe it has to do with the vaginal dryness discussed above, maybe it has more to do with changes in their relationship with kids leaving the house or changes in their partner’s sexual function. What you can do: really consider what aspect of your sexual life is changed and be open to discussing those changes with your partner and/or a professional counselor if needed. Consider the positives of changes such as kids leaving the house - maybe there is more opportunity for sexual activities without interruptions. As women go through menopause they may actually feel more desire for sexual activities because they do not fear getting pregnant. If body image is changing your desire, can you improve your self-image through positive self-talk, good nutritional choices, and/or regular physical activity?

5. Urinary incontinence - not everyone in menopause experiences urinary incontinence, but the likelihood does increase. Again, a decrease in estrogen changes the tissue in the pelvic floor and may worsen urinary leakage for people who have struggled with this in the past, or cause new onset of leakage for women who have never experienced it. What you can do: Don’t delay! Even pre-menopause you can work with a pelvic floor physical therapist to gain control and confidence of your bladder. Strengthening your pelvic floor early can help reduce leakage issues when you reach menopause. If you’re already peri-menopausal or in menopause, it’s never too late! Work with a specialist to help you regain control of your bladder symptoms.

6. Weight gain - it is not proven that menopause specifically causes weight gain, versus basic changes associated with aging. What you can do: Participating in regular physical activity and strength training can help reduce fat and maintain muscle mass (which helps burn fat and maintain your metabolism as we age) as well as eating a healthy, well-balanced diet can combat weight gain.

It’s not “THE Change” folks, it’s really a series of changes…..but first, it should be a change in your mindset. Don’t focus on the negative, choose to find the positives and focus on the CONTROL you have over your response to this series of changes. The list of changes here are not comprehensive, but rather just a few of the common symptoms experience during peri-menopause and menopause.

There is a common theme with many of the changes listed above. Diet and exercise can play a significant role in reducing many of the symptoms. Making yourself a priority leading up to this time of life can help in many ways.

1. Make time to learn about what changes to expect

2. Make time to participate in regular physical activity

3. Make time to plan healthy meal choices

4. Make time to assess your emotional responses to changes you are noticing and focus on the positive changes rather than negative ones

Find support. As specialty trained pelvic floor physical therapy providers, fitness coaches, and nutrition coaches at Shift Physical Therapy we can provide you with education, empowerment, support, and encouragement throughout any stage of your life changes.

Written by: Renee Hancock, Pelvic Floor Specialist