In every woman who lives long enough, menopause will occur at some point in their life. Menopause occurs when estrogen and progesterone decrease and ovarian function ceases. It is most commonly defined as when a woman misses menstruation for 12 consecutive months. Approximately 6,000 women enter menopause each day in the United States, the average age being 51 according to the North American Menopause Society(1). With life expectancy increasing in women this means that close to 40% of a women’s life could be spent in the postmenopausal stage(1). As women, we often joke about the hot flashes, mood swings and night sweats but there are several aspects of menopause that are not being addressed as openly: genitourinary, sexual and musculoskeletal health.

Musculoskeletal health

Sarcopenia is the age-related loss of muscle mass, more recently redefined as a decline in muscle function associated with loss of muscle mass (Malmastrom, et al. 2013). Sarcopenia can lead to disability, falls and increased mortality due to menopausal women also having higher incidence of osteoporosis(2). Another study reported “approximately 50% of women over the age of 50 will experience an osteoporosis bone fracture at some point in their life”(3). As physical therapists we use manual muscle testing, functional tests that assess strength and mobility as well as outcome measures that may indicate if you are at risk of a fall. The ability to detect early diagnosis of sarcopenia is important, as early intervention of therapeutic exercise and activities can improve outcomes according to Dr. Theodore Malmstrom, an author in the Journal of American Medical Directors Association.

Pelvic health

The pelvic floor muscles act as a support diaphragm that functions to help us control the passing of urine, gas and feces, as well as holding up the abdominal viscera and organs. Pelvic floor dysfunction is a broad term that means non-optimal function of the pelvic floor muscles. This may lead to urinary and fecal incontinence, pelvic organ prolapse, sexual dysfunction, constipation and pelvic pain. These issues can be present anytime throughout a woman’s life but often we see these issues exacerbated by aging, lifestyle activities and menopause due to the decrease in estrogen and progesterone(4). “Loss of estrogen that naturally occurs with menopause causes vaginal tissue atrophy that can weaken surrounding tissues and muscles”, leading to vaginal dryness, sexual dysfunction and pelvic floor muscle weakness. (Hartzell Leggin, PT, WCS). Although having children is a factor in pelvic floor dysfunction, pelvic floor issues do still exist in women who have not had children, though not as common. As physical therapists specializing in pelvic health we focus on the factors that could be contributing to pelvic floor dysfunction such as: weakness of the muscles, heavy and repetitive lifting, improper mechanics, voiding patterns and excessive bodyweight.

Genito-urinary symptoms of menopause

The genitourinary syndrome of menopause (GSM) is a new term that describes various menopausal symptoms and signs associated with physical changes of the vulva, vagina, and lower urinary tract (5). GSM describes the following various symptoms and signs:

• genital symptoms: dryness, burning, and irritation

• sexual symptoms: lack of lubrication, discomfort or pain, and impaired function

• urinary symptoms: urgency, dysuria, and recurrent urinary tract infections

Since GSM may have a profound negative impact on the quality of life of postmenopausal women, women should be made aware of these problems and treated with an appropriate effective therapy(5).

One of the topics I am most passionate about is sexual dysfunction, specifically painful sex in peri-menopausal and postmenopausal women. The decrease in estrogen causes tissue thinning which can in turn lead to vaginal dryness, irritation and painful intercourse. When the tissues of the vestibule (opening of the vagina) tighten it can cause tightness of the superficial and deep pelvic floor muscles as well. Also, the pain-tension-cycle can occur and without intervention can continue to cause pelvic floor overactivity and avoidance of sexual intercourse. In a survey performed by CLOSER (Clarifying Vaginal Atrophy’s Impact on Sex and Relationship), 58% of women who are postmenopausal cited to be avoiding intimacy because of pain or vaginal discomfort(4). For some women a topical estrogen cream is useful; 56% of women who used locally applied estrogen experienced less painful sex(4). Though locally applied estrogen can be safe and effective for some women when prescribed by a physician, others may need a more comprehensive approach including manual therapy, gentle exercise for mobility and techniques to help with tissue elasticity.

At Wasatch Physical Therapy we have a team of physical therapists specializing in pelvic health at each of our four locations. We focus on a comprehensive approach to your healing whether it be weakness leading to a fall, incontinence affecting your pickle ball playing, or painful intercourse leading to loss of intimacy with your partner - trust us with the care you deserve so we can help you get Back to Life.

Danielle Khoury, PT, DPT

Wasatch Physical Therapy - South Ogden Clinic

References: 1. Menopause FAQs: Understanding the Symptoms. North American Menopause Society; 2019. http://www.menopause.org/for-women/expert-answers-to-frequently-asked-questions-about-menopause/menopause-faqs-understanding-the-symptoms

2. Malmstrom K., Theodore, Morley E, John. SARC-F: A Simple Questionnaire to Rapidly Diagnose Sarcopenia. JAMDA 2013; 14:531-532.

3. Women’s Health Stats and Facts. American COllege of Gynecologists and Obstetricians; 2011;33. https://www.acog.org/-/media/NewsRoom/MediaKit.pdf.

4. Love Bullen, Danielle. “PT’s Help to Ease The Change”. PTinMotion.mag/org September 2019. 18-25. Print.

5. Kim HK, Kang SY, Chung YJ, Kim JH, Kim MR. The Recent Review of the Genitourinary Syndrome of Menopause. J Menopausal Med. 2015;21(2):65–71. doi:10.6118/jmm.2015.21.2.65

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