Every woman who lives long enough will experience menopause. Our life expectancy has increased tremendously over the past century and now women can spend as much as 1/3 of their lives in post menopause period. According to research, approximately 25 million women worldwide pass through menopause every year. By the year 2030, there will be 1.2 billion menopausal and postmenopausal women.
So, why do we not talk about it more openly?
1. What`s menopause?
Menopause occurs when oestrogen and progesterone decrease and a woman’s ovarian function stops. It’s defined as happening when a woman misses menstruation for 12 consecutive months. According to research, it occurs most often between ages 45 and 55, with the average age being 51.
2. What are the symptoms of menopause?
Recent scientific reports indicate that already before the onset of menopause, referred to as the perimenopause, it causes many unpleasant symptoms such as:
- hot flashes
- night sweats
- vaginal dryness
- weight gain
- mood changes and sleep disturbance
3. Is heart disease linked to menopause?
These symptoms are very often the result of hormonal and metabolic changes and, as a consequence, increase the risk of chronic diseases. Recently, there have been reports that show the influence of menopause on the development of cardiovascular diseases. According to statistics, cardiovascular diseases are the main cause of death in women (and not a breast cancer as it is commonly thought). The increased risk of cardiovascular disease is also due to the increase in low-density lipoprotein (LDL, ”bad cholesterol”) and triglycerides and is associated with the decrease in high-density lipoprotein (HDL, ”good cholesterol”). Weight gain is also significant (especially accumulation of abdominal fat), which often correlates with the increase in hypertension, diabetes, lower self-esteem and can be a barrier to exercise.
Menopause also produces many physiological changes, which affect pelvic floor health and musculoskeletal health and physiotherapy can be highly beneficial in helping women through and beyond this phase of life.
4. Can menopause cause bladder problems?
Menopause can cause many changes in your body. A decreased production of estrogen and progesterone in your ovaries can lead to bladder problems.
The International Continence Society (ICS) defines urinary incontinence (UI) as involuntary loss of urine. Urinary incontinence affects 30-60% of all women in the post menopause. More and more women want to remove the taboo attached to incontinence, because they do not accept the impact that it has on their quality of life. Nevertheless, many women still consider incontinence as a natural symptom of aging.
There are several types of incontinence, but the main types are: stress incontinence, urge incontinence and mixed urinary incontinence. Therefore, thorough assessment and appropriate treatment to achieve best results.
Conservative treatment is recommended as the first defence against urinary incontinence and it can involve:
- physiotherapy,
- biofeedback,
- behavioural therapy,
- weight management,
- bladder retraining and change in lifestyle.
Urinary incontinence is also the main symptom of genitourinary syndrome of menopause (GSM) and occurs in over 50% of menopausal women.
5. Can menopause cause dryness?
GSM, previously known as vulvovaginal atrophy or atrophic vaginitis, is a term that describes the spectrum of changes caused by the drop of oestrogen during menopause. Urogenital tissues are very sensitive to oestrogen, and the fluctuations in oestrogen, followed by sustained low levels after menopause, can leave these tissues fragile and distressed. Many studies confirm that about 27% to 60% of menopausal women report moderate to severe symptoms of vaginal dryness or dyspareunia (painful intercourse). In addition to vaginal atrophy, narrowing and shortening of the vagina and uterine prolapse can also occur, leading to dyspareunia. Women sometimes observe bleeding and burning and vulvar itching after sexual activity. Another change that women report is low sex drive. Furthermore, there are oestrogen receptors in the urethra, bladder and anus, and as the loss of oestrogen becomes evident, women may experience incontinence (both, bladder and bowel). Unlike vasomotor symptoms (such as hot flashes, night sweats), GSM does not improve over time without treatment.
First-line treatment consists of non-hormonal therapies such as lubricants and moisturizers, while hormonal therapy with local oestrogen products is generally considered the “gold standard’’ and can be administered in very low doses. Current data is however insufficient to define the minimum effective dose, but vaginal rings, creams, and tablets have all been tested and demonstrated to reduce vaginal symptoms. Women should speak with their GP about options available.
There has been quite a lot of bad press around HRT for postmenopausal women in the past years. Many recent evidence-based studies have highlighted that HRT use led to a decreased risk of osteoporosis fractures, along with no significantly increased risk of breast cancer. Current studies suggest that drinking wine increases that risk far more than oral hormonal therapy.
Research also suggests that topical oestrogen in combination with pelvic floor physiotherapy is better approach than either by itself when treating GSM.
6. Can menopause cause bowel problems?
Faecal incontinence (FI), also called bowel incontinence, can be a very embarrassing topic to discuss. According to research, 1 in 5 women over 40 will experience anal leakage. Many factors can affect the anal sphincter. Not always becoming immediately evident after obstetric events, faecal incontinence may show up decades later, after menopause, when hormone levels begin to fall. In maturing women, the levels of oestrogen and progesterone diminish. With the onset of menopause, hormones decrease in the body and the muscles may weaken causing faecal incontinence.
Too many women are directed towards surgical interventions as a first line, when often conservative management can be helpful (for example lifestyle and dietary changes, bowel retraining program, biofeedback, exercise prescription) which we as physiotherapists can provide.
7. Does menopause make prolapse worse?
Pelvic organ prolapse (POP) occurs when the colon, uterus, and/or bladder descent into the pelvic canal, causing discomfort and pressure. Loss of estrogen, a naturally occurring feature of menopause, promotes tissue loss and weakens surrounding tissues and muscles. Women who have had at least 1 vaginal birth have a 50% chance of prolapse, which may or may not be symptomatic. Vaginal delivery is not the only factor contributing to organ prolapse though. Weight gain is another risk factor for POP. It is common in menopausal and postmenopausal women, and the loss of oestrogen results in redistribution of weight to the abdomen. Symptoms associated with prolapse (such as lower back pain, pressure in the vagina or back passage, urinary frequency or incontinence) can make women very self-conscious and discourage from working out.
Read my blog post on prolapse here:https://mnaphysiotherapy.com/pelvic-organ-prolapse-and-how-physiotherapy-can-help/
8. Can menopause cause tendon pain?
Research has stated that 1 in 4 women over the age of 50 will experience gluteal tendinopathy. A tendinopathy refers to a pathological process which can occur within a tendon. Gluteal tendinopathy is a condition affecting the hip and lumbo-pelvic region. Symptoms can include pain and dysfunction at the outside of your hip and thigh. Oestrogen level has a direct effect on tendons. The reduction of blood oestrogen level is associated with reduction in strength, decrease in collagen production and increase.
A tendinopathy refers to a pathological process which can occur within a tendon. Gluteal tendinopathy is a condition affecting the hip and lumbo-pelvic region. Symptoms can include pain and dysfunction at the outside of your hip and thigh. Oestrogen level has a direct effect on tendons. The reduction of blood oestrogen level is associated with reduction in strength, decrease in collagen production and increase in frequency of tendon injuries.
In a recent study conducted by Abate et al. it was observed that in postmenopausal women there is a dramatic increase in asymptomatic rotator cuff tears and that this higher prevalence was linked also to other metabolic factors like HDL, fasting glucose and Body Mass Index (BMI).
Physiotherapy is first line treatment for tendinopathies and management involves a gradual loading (strengthening) program. As metabolic factors play a role, having a balanced diet and maintaining healthy body weight, will certainly help prevent and/or treat tendinopathy.
9. How does menopause affect my bone health?
The decline in estrogen production can affect the level of calcium in your bones. This can cause significant decrease in bone density, leading to a condition known as osteoporosis. Osteoporosis is when bones become thinner, causing them to fracture more easily. The drop in oestrogen levels that occurs around the time of menopause results in increased bone loss. It affects 1 in 3 women (1 in 2 over 65). It is estimated that, on average, women lose up to 10 per cent of their bone mass in the first five years after menopause. If your peak bone mass before menopause is less than ideal, any bone loss that occurs around menopause may result in osteoporosis. The good news is, it is preventable and treatable in the majority of people and the earlier the intervention the better.
As physiotherapists, we should counsel women to alter modifiable risk factors such as decreased intake of calcium and Vitamin D, smoking, and a sedentary lifestyle. Two types of physical activities that are most beneficial to bones are weight-bearing (such as walking, hiking) and resistance-training exercises (weights). In addition to reducing bone loss, physical activity will improve muscle strength, balance and fitness, and also reduce the incidence of falls and fractures.
Taking certain medications, if prescribed, can help prevent fractures in people who have osteoporosis. Issue with pharmaceutical options from bone health perspective is that you can only take it for 5-6 years before the risks start outweigh the benefits. You should only take it if you have confirmed diagnosis of osteoporosis. It should be highlighted that they are not good on their own. You need to have good, nutritious diet, exercise regular ( this is no negotiable!), avoid smoking in order to manage osteoporosis. Hormone therapy (HT) is effective in preventing and treating osteoporosis.
I know, it is a lot to take in and, as always, is best to seek individual assessment and treatment. The good news is, a lot of the menopausal symptoms can be managed effectively!
To book an appointment click here: https://mnaphysiotherapy.com/contact/

References:
https://www.termedia.pl/Urinary-incontinence-in-postmenopausal-women-causes-symptoms-treatment,4,36258,0,1.html
https://www.sciencedirect.com/science/article/abs/pii/S0378512216301013
https://pubmed.ncbi.nlm.nih.gov/8735350/
https://pubmed.ncbi.nlm.nih.gov/10802896/
https://www.ics.org/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6764929/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212735/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241423/