Your Pelvic Floor In Menopause

Menopause starts after one year of no menstrual periods. You can enter menopause at a variety of ages, but most Canadian women enter menopause at age 51. Menopause occurs because your ovaries stop producing estrogen and other hormones. If you enter menopause before age 40, it needs to be investigated and treated by a gynecologist.

Your pelvic floor likes estrogen and can tell immediately when it does not get enough. Without estrogen, your muscles and skin are thinner and stiffer. This makes them more prone to mini tears, which can cause dryness, itching, burning, bleeding, and less lubrication during intimate activities with your partner. It also makes it harder for your muscles to work properly and you may find it challenging to exercise your pelvic floor, which might result in less support for your pelvic organs. Without enough estrogen, it’s also easier for bad bacteria to hang out in your vagina, and this can give you repetitive infections in your bladder too.  

This time in your life can be quite uncomfortable, with your body facing changes like hot flashes, night sweats, mood changes, and dryness in the vagina (to name a few!). You may have very mild symptoms, or you may find that they have a significant impact on your life. If you are bothered by any of the above symptoms, there is help for you: 

1. Use a vaginal lubricant during insertive vaginal sex. There are many out there and you have to find one that works for you. You can get a lubricant from any pharmacy without a prescription.

2.    Use a vaginal moisturizer several times a week (but not with insertive vaginal sex). There are some over the counter moisturizing creams or gels; however, the best moisturizer is estrogen, which comes in a prescription cream or pill. If you would prefer not insert these into the vagina on a regular basis, there are silicone rings that slowly release estrogen and can be left inside the vagina for 3 months.

Estrogen you insert vaginally is typically low dose and does not circulate in the rest of your body, so it is safe to use for many years, if needed. Other hormones can also be inserted vaginally for comfort, but estrogen has received the most study so far.  If you already take hormone replacement therapy by mouth it may not offer enough estrogen to reach the vagina, and you should talk to your healthcare provider about the vaginal insert that is best for you (cream, pill or ring). If you start bleeding while using a vaginal estrogen insert, please tell your doctor.

Estrogen inserts may also help you prevent bladder infections if you experience them more than twice in a 6-month interval or more than three times a year. However, estrogen won’t help with a leaky bladder or bowel problem – for more information about these pelvic floor concerns, check out our other webpages.