Menopause is a normal part of life for those born with a vagina. It is a turning point in which the ovaries stop producing hormones and menstrual bleeding ceases.

Menopause occurs either naturally with age or by factors such as chemotherapy or surgery (which we’ll discuss more later). It is considered official once an individual has not had any menstruation, even spotting, for a full consecutive year.

At this point in time, pregnancy would no longer be possible. Menopause usually occurs in a person’s 40s or 50s, but most people reach menopause around their early 50s.

Once you reach this turning point, the period of life immediately afterward is referred to as postmenopause (which is the rest of your life). However, menopause doesn’t just occur out of nowhere.

It actually slowly develops over the course of several years during a stage known as perimenopause.

During perimenopause, the body undergoes changes leading up to menopause: The ovaries slowly lessen their hormone production, and the body begins to experience a variety of symptoms.

Perimenopause can last anywhere from several months to several years, but most people experience it for many years.

During perimenopause, your periods will likely become irregular. This irregularity can vary widely from person to person.

Some may experience their periods closer together first, and then over time experience them farther and farther apart—even months at a time.

Your period may occur every few weeks, disappear for several months, and then return again.

Additionally, your period may become longer or shorter than usual, and can vary in terms of flow, too. Despite these irregularities, you can still get pregnant during perimenopause, so contraceptives may still be necessary for those who don’t wish to become pregnant.

Due to the changes in your hormones, you may experience some uncomfortable symptoms. These symptoms can begin during perimenopause and may continue into menopause.

However, each person’s experience with perimenopause and menopause can vary greatly. Some individuals may have very mild or no symptoms, while others experience a variety. Some possible symptoms include:

• Sexual dysfunction
• Hot flashes
• Night sweats
• Insomnia
• Urinary urgency
• Incontinence
• PMS
• Skin, mouth, vaginal, or eye dryness
• Breast tenderness
• Changes in hair density
• Libido changes
• Weight gain
• Emotional changes
• Lower bone density
• And more

Many of the symptoms listed above—urinary urgency, incontinence, sexual dysfunction—are directly related to the pelvic floor.

The decrease in hormone production causes vaginal dryness and thinning, reduced tissue elasticity, and weakened pelvic floor muscles.

The pelvic floor controls essential urinary, bowel, and sexual functions, and therefore those experiencing perimenopause or menopause should take extra care of their pelvic floor.

Be sure to read the third section of this article to learn how pelvic floor physical therapy can support you during perimenopause or menopause!

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As mentioned before, menopause is a natural part of aging that occurs as the ovaries produce less hormones and menstruation stops. However, that technically isn’t the only time menopause happens.

Those who undergo ovarian surgeries such as oophorectomy may experience menopause sooner.

This is because surgeries that affect the ovaries can cause early or premature menopause. Some forms of chemotherapy and radiation therapy can also cause menopause, particularly the types of treatment aimed at the lower body and pelvis.

Additionally, there are certain risk factors that can affect the natural menopause response and its symptoms. For example, Black and Latinx individuals are more likely to experience early or worse menopause.

Those who smoke cigarettes are also more likely to experience menopause earlier or have worse symptoms. Lifestyle aspects such as exercise and stress can affect the menopause experience and severity of symptoms.

While these aspects aren’t necessarily causes of menopause, they are factors that may affect your symptoms and how you manage them.

Pelvic floor physical therapy plays an essential role in providing support and a better quality of life for individuals as they enter perimenopause and manage menopause symptoms long-term.

If you are able to engage in pelvic floor therapy early, such as the beginning of perimenopause, this can help proactively address the bodily changes and possible symptoms associated with the process.

Your physical therapist can help you maintain good pelvic floor health and function, which in turn can lessen the symptoms associated with the bodily change—keeping you confident and healthy!

It is also important that you seek pelvic floor therapy if you already have forms of pelvic floor dysfunction before perimenopause begins, such as incontinence or pelvic pain.

Your symptoms will become more difficult to manage over time as you get closer to menopause, so addressing any dysfunctions proactively will give you a head start. This involves pelvic floor dysfunctions such as:

• Urinary incontinence
• Urinary urgency
• Urinary frequency
• Incomplete bladder emptying
• Constipation
• Fecal incontinence
• Painful sex
• Prolapse (uterine, bladder, vaginal, or rectal)
• Pelvic pain, back pain, or hip pain
• And more

Whether you are worried about symptoms with the start of perimenopause, or you are already experiencing these symptoms in postmenopause, your pelvic floor physical therapist will be able to help!

They can address (or help prevent) these concerns with a comprehensive treatment plan that aims to improve pelvic floor function and coordination, reduce tension, and allow for better long-term comfort and confidence.

Your pelvic floor therapist will start by assessing your current symptoms, concerns, and pelvic floor health.

Along with other important aspects like medical history, they’ll create a unique treatment plan that addresses your direct needs and works to prevent future complications.

To achieve these goals, they’ll use treatment methods such as the following:

Pelvic Floor Training

The pelvic floor is a very important part of the body—as mentioned earlier, it allows for healthy functions like urination, defecation, sexual function, and sexual appreciation.

When the pelvic floor muscles become weak, uncoordinated, or inflexible such as with menopause, these functions start to become more difficult, painful, or uncomfortable.

Therefore, an obvious treatment for those experiencing perimenopause or menopause is pelvic floor training!

This process involves treatments like neuromuscular re-education and biofeedback, which allow you to feel and recognize pelvic floor movements (contractions and relaxations) in real time!

These treatments help you better understand your pelvic floor and how to actively relax or engage those muscles.

Once you have started to understand your pelvic floor and how to control it, you can also begin strengthening exercises and relaxation practice—which helps to address dysfunctions caused by weak or hyperactive muscles.

Perimenopause and menopause can also cause sexual dysfunctions, especially with symptoms like vaginal dryness or thinning.

Luckily, pelvic floor training can help address sexual dysfunctions by improving blood flow, sensation, and tissue elasticity through the above-mentioned treatment methods.

Additionally, for some individuals with sexual dysfunction, pelvic floor training may include dilator therapy.

Dilators are insertable tools that allow you to practice penetration at your own pace, while gently stretching vaginal or rectal tissue. This therapy is very effective and perfectly safe.

Dilators are available in a wide variety of sizes, so you can start as slow as needed. Dilator therapy is a great practice for individuals who experience painful sex or vaginismus!

Sexual dysfunction can often become more difficult to manage due to perimenopause or menopause, so gaining the help of a pelvic floor professional to guide you into better pelvic floor health can be a tremendous benefit.

Behavioral Modifications

Gaining control and strengthening your pelvic floor is just the first step! You’ll also have to incorporate preventative strategies that will help you maintain your good pelvic floor health.

This means identifying different lifestyle aspects that could be negatively impacting your health through muscle strain or tension. Lifestyle aspects that can harm your pelvic floor include things like:

• Poor sitting, standing, or toilet posture
• Muscle imbalances between the pelvis, hips, back, and abdominals
• Restroom habits—straining, holding urine, frequent urination
• Improper hydration or fiber intake
• Certain movements, sports, or exercises that strain the pelvic floor

Your pelvic floor therapist will help you identify any possible contributors to your pelvic floor dysfunction, and teach you how to avoid or modify them!

Pain Management

Pelvic floor physical therapy can also address pelvic, hip, or back pain created by perimenopause or menopause. The providers at Hive Therapy and Wellness offer many manual therapies that lessen pain, reduce tension, and target trigger points.

Manual therapy refers to hands-on techniques or methods using tools that work to manipulate, mobilize, and massage tissues.

Manual therapies are beneficial for tight muscles, and also help mobilize other important structures like ligaments, nerves, and fascia.

Some specific pain-relieving manual therapy treatments offered at Hive include dry needling, tissue scraping, cupping, and more. These treatments not only reduce tension, but also improve function, promote blood flow, and provide significant pain relief!

Exercise Prescription

Your physical therapist will prescribe you an exercise and stretching routine, which will help balance your body and reduce tension.

By balancing the muscles of the hips, core, and pelvis, your body will be more stable and less likely to experience tension-related pain.

Not only does an exercise routine address pain in the pelvis, hips, and back, but it is also important for addressing bone health concerns of menopause.

Menopause unfortunately affects bone density due to a decline in estrogen.

Resistance exercises and movement strategies can be taught by your pelvic floor therapist to promote better overall bone health and reduce the possibility of fractures.

Education and Long-Term Maintenance

Lastly, your physical therapist can provide education for maintaining good health during menopause, such as self-care tips and suggestions on nutrition and hydration.

Self-care can include relaxation techniques, exercises and stretching, and pain management at home.

Engaging in regular check-ins with your physical therapist can help maintain your good health and prevent future symptoms.

If needed, your Hive physical therapist is able to collaborate with health professionals such as gynecologists, sex therapists, or others in order to provide you with a holistic treatment experience and better management of your menopause symptoms.

By reading this article, you will have learned the ways that pelvic floor physical therapy helps address symptoms of perimenopause and menopause: By strengthening and relaxing your pelvic floor, addressing habits that cause tension, relieving pain, and supporting overall health.

This allows individuals to maintain the comfort, function, and confidence necessary for a better quality of life as they enter menopause.

At Hive Therapy and Wellness, we want to support you in any way we can. Therefore, each patient receives an individualized treatment plan that best suits their needs.

Our providers utilize a wide variety of treatments in order to create a holistic treatment experience, so you can expect any of the following to be used in your care plan:

• Neuromuscular re-education 
• Manual therapy
• Exercise prescription 
• Dry needling 
• Cupping 
• Tissue scraping 
• Behavioral modifications 
• Therapeutic activities 
• Electrical muscle stimulation
• Spinal manipulation 
• Therapeutic modalities 
• Biofeedback