Pelvic Health and Perimenopause

This week we talk with Kate Hines about Pelvic Health and Perimenopause (You First Physio) (Femhealth).

A Pelvic and musculoskeletal physiotherapist based in Ōtautahi, Christchurch, Kate is passionate about helping women from all stages of life, from women navigating pregnancy and postnatal recovery, to peri- and post-menopausal changes. She finds helping women with pelvic pain especially rewarding, as even small improvements can make a significant difference in their quality of life. Perimenopause can be a time when women experience changes in pelvic health, which can be upsetting and uncomfortable.

During perimenopause, you might notice:

• Aches and pains in muscles and joints, particularly in the hips, lower back, and pelvis
• Changes in bladder and bowel function, such as struggling to “hold on,” just making it to the toilet, or not quite making it in time
• Leaking when coughing, sneezing, or laughing, which may be new for you or may be less manageable
• A feeling of heaviness or bulging in the vaginal area
• A decrease in libido or discomfort during intercourse
• Vaginal dryness

If you are experiencing or interested in any of these symptoms, read on for Kate’s expert advice. 

The advice below is general advice; for any specific tailored advice relevant to any health conditions, please talk to your health professional.

Why do we experience changes in pelvic health during perimenopause?

This is due to declining levels of oestrogen and progesterone, two essential female reproductive hormones. Oestrogen supports the growth, development, and strength of various tissues all over our bodies, while progesterone helps regulate that growth. Together, these hormones help maintain a balance of bone density, muscle strength, and joint health. Their decline during perimenopause can result in increased joint pain, stiffness, and a higher risk of musculoskeletal disorders, along with a myriad of other side effects.

This can mean that the muscles of the pelvic floor, along with their connective tissues, may thin or weaken, losing their bounce, thickness, and responsiveness. This can lead to new pelvic health issues or exacerbate existing ones, making them more noticeable or harder to manage than before.

What types of treatments or exercises do you commonly recommend for perimenopausal women?

Treatment depends on your specific symptoms, but pelvic floor exercise, also known as Kegel exercises, are often a staple. These exercises strengthen the pelvic floor muscles, which are just like any other muscles in your body: “use it or lose it!”

To perform an effective pelvic floor exercise:

1. Imagine stopping yourself from passing wind and urine simultaneously.
2. Hold this contraction for a few seconds, then fully relax the muscles before repeating.
3. Aim for 10 repetitions of 10-second holds and 10 quick contractions.

If you’re new to pelvic floor exercises, it’s okay to start with shorter holds and fewer reps. 5 reps of 2 seconds may be all you can manage, and this is a great starting point to build up from.

A pelvic health physio can help you ensure you’re engaging the correct muscles without compensating with others.

Other treatments may include:

• Stretches or breathing exercises to release tension in tight pelvic floor muscles
• Strengthening exercises for your hips, glutes, and core to support your pelvic floor

Are there lifestyle changes (diet, hydration, exercise) that can support pelvic health during perimenopause?

Absolutely! Supporting pelvic health during perimenopause includes:

• Diet: Ensure adequate hydration and fibre intake for optimal bowel function. Poor bowel health can negatively affect bladder function. Consulting a nutritionist (VB Nutrition) or dietitian can help tailor a diet to your needs, especially as hormonal changes can impact gut health.
• Hydration: Sip water throughout the day. Hydration needs vary, so monitor your urine colour to gauge if you’re drinking enough. Aim for a pale straw – light yellow colour!
• Exercise: Resistance training is essential to counteract the loss of muscle and bone mass due to hormonal changes. Strengthening your entire body, including your hips, glutes, core, and lower back, to support pelvic floor health.

What are some signs that a woman should see a pelvic health physiotherapist during perimenopause?

If you experience any of the issues mentioned, such as a feeling of heaviness or bulging, pelvic pain, bladder or bowel changes, leaking, or discomfort during intercourse – or maybe you are just curious to know more about the changes and what you can do about them – it’s a good idea to consult a pelvic health physiotherapist.

Can you describe the typical assessment process for a new patient experiencing perimenopausal pelvic health issues?

Your first session will start with a chat about your symptoms, medical history, past surgeries, pregnancies, deliveries, and bladder, bowel, and sexual function. We cover it all! Together, we’ll create a clear picture of what’s happening in your body.

From there, if you’re comfortable, we may assess your pelvic floor. With your consent, this could involve:

• A vaginal examination (the gold standard for understanding pelvic floor function).
• Alternatively, if preferred, we can use a transabdominal ultrasound to assess pelvic floor muscle function externally via your abdomen.

This will help us to determine your best individualised treatment and recovery plan. That may include exercises, lifestyle changes, referral to other specialists, education, and collaboration with yourself to devise goals and plan the steps to helping you achieve them.

What advice do you have for women who are hesitant to seek help for pelvic health issues?

Reach out for a chat. I’m always happy to discuss whether pelvic health physiotherapy is right for you. Talking to friends or family can also help break down the stigma around pelvic health. Remember, we all have the same body systems and it’s okay to talk about them. Pelvic health issues are common, treatable, and nothing to feel embarrassed about.

What are your go-to websites/resources for trusted information on pelvic health?

As a physiotherapist, I rely heavily on research. I attend courses and research updates regularly to stay informed and share the latest evidence with my clients. There is such a variety of information online that is not always fact-checked. So, I always recommend seeking out advice from a professional.

Websites such as Continence NZ or Continence Foundation of Australia have good resources on bladder, bowel, pelvic floor, etc.

There is also an app I recommend to my clients called Squeezy, which is very user-friendly and great to help you remember to do your pelvic floor exercises.

How can people contact you if they’d like some pelvic health support?

Contact Details:

• You First Physio, Longhurst: Phone: 03 595 0050 | www.youfirstphysio.co.nz
• Femhealth Gynaecology: Phone: 03 925 8777 | www.femhealth.co.nz