How Perimenopause + Menopause Affect Your Pelvic Floor

As your body enters perimenopause and then eventually beomes postmenopausal, there are a long list of symptoms your body might experience. Here I’m going to discuss what happens to the vulva, vagina, bladder, and urethra, from the perspective of a pelvic floor physical therapist.

There’s a term for what we’re discussing: Genitourinary Syndrome of Menopause, abbreviated to GSM.

What is it?

GSM encompasses the changes in the vulva, vagina, and urinary system related to hormone shifts in the menopausal transition. It can begin in perimenopause, as early as the late 30’s or 40’s. These changes persist as you hit menopause (defined as 1 year since your last menstrual period) and become postmenopausal.

What are the symptoms?

• Increased urinary urgency and/or frequency

• Pain with penetration, most often around the vaginal opening

• Vaginal dryness

• Urinary incontinence

• Increased UTIs

Why does it happen?

Declining estrogen is the primary driver of GSM. The vulva, vagina, bladder, and urethra have many estrogen receptors. When estrogen decreases these areas, among many others, can experience changes. A reduction in estrogen also reduces blood flow and collagen to the vagina, vulva, and bladder. This reduces vaginal lubrication and makes vaginal tissue thinner and more prone to irritation, which can cause painful sex. This also reduces the stretch capacity of the bladder and decreases the closure pressure at the urethra, contributing to both urinary frequency and incontinence.

what can you do about it?

• Lubricant for sexual activity - apply just before sexual activity

• Vaginal moisturizers for dryness - apply a few times per week

• Topical estrogen for local vaginal issues

  • Very safe and effective for GSM

  • Discuss with your gynecologist

• Systemic hormone therapy can be used alone or in conjunction with local topical estrogen

  • Discuss with your gynecologist

• Pelvic floor PT for management of incontinence, urgency/frequency, and painful penetration

  • Bladder training and behavior modification

  • Pelvic floor strengthening and/or downtraining

  • Manual therapy for muscle release

  • Training in dilators or other tools to improve comfort with penetration

If you’re experiencing these symptoms, discuss them with your gynecologist to determine what treatment options would be a good fit for you. Also consider seeking out a pelvic floor physical therapist to help manage and improve things like urinary frequency, incontinence, and painful sex. While GSM may be a common symptom of perimenopause and menopause, it is not one you need to suffer through!