Beyond Hot Flashes: What Menopause Really Means for Your Pelvic Health

Menopause is finally getting the attention it deserves. From bestselling books to social media, women are talking more openly about hot flashes, hormone therapy and brain fog. But one part of the conversation is still too often left out: pelvic health.

As we mark World Menopause Day this month, there’s no better time to break the silence. Every woman’s menopause experience is different, but pelvic floor changes are far more common than many people realize. Pelvic floor and urinary symptoms affect millions of women during perimenopause and menopause — and while these things can happen during this life stage, they can also happen any time during your life. Symptoms like these should never be considered “just part of aging.”

During perimenopause and menopause, declining estrogen reduces collagen, blood flow and elasticity in the pelvic floor, weakening the muscles and connective tissue that support the bladder, uterus and rectum. The result can be urinary leakage and other pelvic floor disorders. Rather than talking with a healthcare provider, though, many women assume these symptoms are simply part of aging and learn to live with them.

Women commonly discount symptoms such as:

• Urinary leakage, especially when women jump, sneeze, lift heavy objects or laugh. While urinary leakage is more common during menopause due to our decreasing levels of estrogen, it’s not something you just have to accept.
• Recurring urinary tract infections (UTIs): The drop in estrogen we experience during perimenopause and menopause can cause dryness, irritation and other changes that set the stage for UTIs.
• Pelvic organ prolapse: Pelvic organ prolapse happens when the uterus, bladder or rectum drops from its normal position, often after childbirth or with aging. Symptoms may include a feeling of pressure, a bulge in the vagina or difficulty emptying the bladder.
• Painful intimacy: Thinning vaginal tissues and pelvic floor tension can make sex uncomfortable. While it’s one of the most common complaints I hear as a urogynecologist, it’s also one of the most treatable.

In fact, the idea that women just have to live with these symptoms couldn’t be further from the truth.

Urinary Leakage: Treatments for urinary leakage range from pelvic floor physical therapy and exercises to devices, medications and minimally invasive surgical procedures.

UTIs: If you’ve experienced more than three UTIs in a year, it’s time to talk with a physician. Sex, menopause and hormonal changes can all trigger UTIs. We can treat the infection, but once we know what’s causing the problem, we can also work with patients to prevent recurrence with medication, topical treatments, supplements and more.

Pelvic Organ Prolapse: Treatment options include supportive devices, therapy or surgery, depending on severity.

Painful Sex: A range of treatment options are available, and your gynecologist can work with you to determine what best fits your needs. Options include over-the-counter treatments and hormone therapies, among others.

Pelvic floor disorders are incredibly common, yet many women are still embarrassed to talk about them. The truth is that you don’t have to accept leakage, recurring UTIs, painful sex or prolapse as a normal part of aging. If you’re experiencing these symptoms, talk with your primary care provider or gynecologist. When needed, they can refer you to a urogynecologist for specialized care so you can regain comfort, confidence and control.

Learn more about the Williamson Health Urogynecology and Pelvic Health team and the services we offer at williamsonhealth.org.