If you’re new to perimenopause, you might not yet be aware of the multitude of ways your body can be affected by this change.
For years, you would have heard about the hot flushes and the mood swings, but did you know perimenopause can affect your bladder? And your pelvic floor?
As our oestrogen levels dip along with hormone fluctuations, it’s important to be aware of how your pelvic floor might begin to work differently, especially when it comes to avoiding things like bladder leakage and risk of prolapse.
Mia Freedman recently sat down for a chat with Dr Charlotte Gooding for the Very Peri Summit UK. Dr Gooding is a GP with a particular interest in menopause care, who has been able to clearly explain just how aware we need to be when it comes to perimenopause and the pelvic floor.
How will perimenopause affect our pelvic floor?
The function of our pelvic floor is subject to change as our hormones do. Because our hormones fluctuate so much during peri, we get great highs and lows when it comes to oestrogen.
"In those dips, when there are periods of low oestrogen, that’s when it can affect the tissues of the vagina, the bladder, the pelvic floor, and also the vaginal area," Dr Gooding told Mia.
"We’re talking about the effects of lack of oestrogen on all those tissues, because all those tissues are absolutely rich in oestrogen receptors, and they need oestrogen to function well," she explains.
This lack of oestrogen in a lower period of hormone fluctuation can mean a weakening of your pelvic floor muscles.
What does it mean to have a 'weak' pelvic floor?
Dr Gooding describes the pelvic floor as 'a big sling' which holds up all your pelvic contents, including pathways to your bladder, your rectum, and your vagina.
"It’s a time where most women are coming into perimenopause, they may have had children, and their weight may be fluctuating - so they may be a little bit overweight," Dr Gooding says.
"That all puts strain on the pelvic floor as well. So if you add that situation to a combination of low oestrogen, you can get a lot of urinary symptoms," she explains.
To begin with, you might notice that a weakened pelvic floor will lead to bladder leakage. It can also increase your risk of uterine prolapse - where the muscles of the pelvic floor can no longer provide enough support for the uterus, which then slips down into or can even protrude out of the vagina.
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How can you strengthen your pelvic floor?
Pelvic floor exercises, or kegels, can make a world of difference. However, we need to be diligent with them, and certain that we’re doing them correctly.
Dr Gooding recommends that every woman should go and see a pelvic floor physiotherapist at least once in their life in order to make sure they’re doing kegels correctly, given how easy they are to get wrong.
"I think that every woman should see one at some point and just learn that technique, and learn a technique right for them," she explains.
"They can give you some feedback as well on whether you're doing it properly," she continues.
"You can take a hand mirror and actually have a look and see if you can see some slight contraction at the rectum and then at the vaginal canal... or some women will just pop a finger into the vaginal canal and see if they can feel the squeeze around their finger."
Can anything else be done?
Dr Gooding also recommends vaginal oestrogen, which you can get in the form of creams, pessaries, and gels.
While she primarily recommends this for women who find they’re experiencing UTIs during perimenopause, it can also be an effective treatment for avoiding prolapse.
"You can use oestrogen creams... to the vulval area if the vulva is where the particular issue is," she shares.
"And it can also help with the symptoms of things like prolapse and bladder overactivity as well."
A long-term issue.
Dr Gooding stresses the importance of tending to your pelvic floor in order to keep it strong, given weakened muscles will leave you with long-term perimenopausal symptoms.
"The hot flushes, the mood symptoms, they will generally improve after the menopause. Symptoms of GSM (genitourinary syndrome of menopause) will not, they will get worse," she says.
"I think we need to be thinking about GSM as a chronic long-term condition, actually. And if you leave these symptoms, they will get worse," she says.
"That's why we see so many admissions into hospital for women, you know in their 80s and 90s with chronic UTIs and getting things like sepsis, because we're not thinking about this as a chronic long term condition and something that needs consistent treatment."
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Feature Image: Getty.