For World Menopause Day, Anna Goener, physiotherapist at Joint Dynamics Evolve, shares the story of her client Susan and how she helped her to take control of her pelvic health and reclaim her confidence during the menopause transition
It had been two decades since 52-year-old Susan had given birth to her children. Pelvic floor concerns were a distant memory. That was until a significant life stage returned them to front of mind. Susan had entered menopause.
Menopause occurs when a woman hasn’t had a menstrual period for 12 months. The time leading up to this is called perimenopause, during which time female hormones begin to fluctuate and periods can become irregular. This is in comparison to post-menopause, which is the time beyond one year after a final period, and which continues for the remainder of a woman's life.
Most women will experience some symptoms of menopause, but the degree and symptoms vary from woman to woman. Symptoms are influenced by a reduction in oestrogen and can affect different body systems. On average, they last between five and ten years.
See also: Why should I talk to my boss about my menopause symptoms—and how?
Over the course of a few months, Susan began to notice that she was altering her normal daily activities due to her bladder. She would have to excuse herself in the middle of her gym classes to go to the bathroom. She started to plan coffee catch-ups with friends at places where she knew where the nearest toilet was. She was now taking a change of underwear with her on outings in case she leaked.
Susan was also experiencing vaginal dryness, which made sex uncomfortable, and she slowly found herself avoiding all forms of intimacy with her husband, even kissing or touching, out of a fear that this would lead to sex. This began to affect her relationship.
Susan’s experience greatly impacted her confidence and she began to find herself withdrawing both socially and from her own relationship.
Susan was experiencing Genitourinary Symptoms of Menopause (GSM), the term used to describe vaginal and bladder symptoms present during menopause. Up to 50 per cent of women will experience GSM to some degree.
“Vaginal and urinary symptoms that occur around the menopause are often present but can be overlooked,” says Dr Rebecca Lau, GP, family doctor and founder of H3 Medical Clinic in Hong Kong. “Oestrogen helps the tissues stay elastic and moist, aids muscle strength, improves blood flow and helps raise levels of healthy bacteria in the vaginal tract. This protects from vaginal and bladder infections. So, as levels drop and oestrogen receptors down-regulate, the pelvic floor muscles weaken and urethral muscles become more lax. Vaginal dryness, tissue thinning and fragility can appear, which can lead to incontinence, painful intercourse, itch and irritation. This can be distressing and have a major effect on sexual desire, as most women don’t look forward to bleeding, discomfort or a consequential infection.”
See also: It’s time we learnt that menopause usually isn’t a time of poor mental health