Menopause: Exposing The Hidden Issues

Our Clinical Specialist Physiotherapist in Pelvic Rehabilitation, Debbie Fallows, explains how pelvic rehabilitation can be helpful in tackling menopausal symptoms.

For over 20 years, I have cared for, assessed and treated people living with pelvic pain and incontinence. I work with men, women and children but take a special interest in women’s health including issues around pregnancy, childbirth and menopause.
— Debbie Fallows MISCP

The symptoms of menopause do not offer us a lot of cheer.

The list is long: - hot flushes, brittle skin and hair, night sweats and insomnia, mood swings and depression to mention only a few. While some are lucky to escape with few issues, others struggle with debilitating unpleasantness lasting for years. Hormones have a lot to answer for.

Some of the symptoms of menopause are easier to talk about than others. Some symptoms are more hidden than others. Some are more embarrassing than others to mention to a GP or health practitioner. So we may choose to keep them under cover. One example of this is urinary incontinence. It has been reported that 45% of women aged between 45 – 55 years report urinary leaking occurring at least a few times per month, with 15% reporting it as a daily occurrence (LE Waetgen, 2015). More than half these women will choose not to tell their health care provider about their problem, particularly if no other health concerns coexist.

Our bladders need oestrogen to function effectively. A decline in circulating oestrogen during the menopause may result in urinary leakage when we cough or sneeze, exercise or dance for example. 70% of women relate the onset of urinary incontinence to their final menstrual period (Robinson D et al, 2013.) Frequent toilet visits during the day or night are often associated with a strong sense of urgency. The stress of not being able to reach the toilet on time, especially in public, can result in avoidance of the social events and activities we previously enjoyed. We start to isolate ourselves rather than risk the shame of losing control. We choose to wear dark rather than bright coloured clothes to conceal any urinary leakage. We fear smelling of urine. Over time we lose confidence in ourselves and our body image deteriorates.

These issues also significantly affect our desire to have sex. Fear of leakage during sex results in a decrease in motivation and willingness to engage in intimate sexual activity. This in addition to the vaginal discomfort and thinning of the vaginal tissues associated with menopause can become a reason to cease having sex altogether.

Clinical guidelines recommend physiotherapy and pelvic floor muscle training as the first line of treatment for managing and treating urinary incontinence. Other simple strategies such as bladder retraining and advice on lifestyle changes might also help. Most important is someone who will listen in a confidential and non-threatening manner to how these distressing issues affect you on a day to day basis.

Perhaps the stress of living with these more embarrassing menopausal symptoms provide an opportunity for us as women in mid-life to bring our own needs out of hiding and back into the foreground. You are not suffering alone.

Contact our Physiotherapy team today at Strive clinic to make an appointment.