Perimenopause and Menopause Condition

What is the Perimenopause and Menopause?

The menopause is not a disease or illness but a natural stage in a woman’s life when she stops having menstrual periods.  This happens when the ovaries no longer release an egg each month and production of the hormone oestrogen declines. This usually occurs between the ages of 45-55 but can be earlier either naturally or after surgery to remove the ovaries or with certain treatments.

The perimenopause or menopausal transition refers to period before the menopause. It may be when you first start to experience menopausal symptoms due to hormone changes but are still having periods. For some women the perimenopause may only a few months but for others it can be several years.

What are the symptoms?

Structures within the pelvic area for example, the vagina, vulva, urethra, bladder and pelvic floor muscle are all responsive to changes in oestrogen levels. As a result, as oestrogen levels drop the following changes can occur;

• Tissues become thinner
• Tissues become less elastic or flexible
• Less lubrication causing vaginal dryness
• Ligaments and muscles less supportive
• A rise in pH – the vagina becomes less acidic
• Change in the balance of “good“ bacteria and “bad” bacteria in vagina

Each woman’s experience of the menopause is different. As hormone production by the ovaries start to fall most women do experience some kind of symptoms, although the type and extent of these can vary widely.  The falling levels of oestrogen can lead to a group of genital and urinary symptoms that are called genitourinary syndrome of the menopause or GSM. Some of the symptoms of GSM you may notice include;

• Itching, burning or discomfort in the vaginal area or when emptying your bladder
• Vaginal examinations or smear tests become uncomfortable. If you are still using tampons these
• Light bleeding after sex or vaginal examinations
•  More frequent infections of the urinary tract (UTI) and or vaginal infections
• Symptoms of prolapse (see prolapse section for details)
• Increased frequency and urgency to empty your bladder. You may have to rush to the toilet or get up more than once at night. Sometimes may leak before you get there known as urge incontinence (see Bladder Dysfunction section for more details)
• Leakage of urine if you cough, sneeze, laugh or move suddenly known as stress urinary incontinence (see Bladder Dysfunction section for more details)
• The changes in the tissues make them more fragile so penetration can cause small tears and you may also experience bleeding after intercourse (See Vulval Pain Syndrome section for more details)

How can Physiotherapy help?

A pelvic health physiotherapist has specialist training, so they are able to treat women with pelvic floor dysfunction associated with the menopause.