by Ashley Newton, PT, DPT
The average age of onset of menopause is 51 years old. Perimenopause begins in the 40s and continues into the late 50s. Menopause occurs when the menstrual cycle ends permanently due to the decrease in ovarian oocytes as a natural result of the aging process. Given that the pelvic floor tissues are extremely androgen receptive and are a part of the reproductive system, a change in hormonal levels undoubtedly has an effect on these tissues. With menopause, the labia minora shrinks, the vaginal tissues thin, and the vagina becomes more acidic. A more acidic vaginal pH can make one more prone to yeast infections, urinary tract infections, vaginal dryness, and urinary urgency and frequency. Tissue thinness combined with dryness and an acidic pH is a recipe for pelvic pain with gynecologic exams and sexual activity. But this does not have to be your new normal! Start with my top 5 checklist below to get started in improving your vaginal health in the menopausal era:
- GYNECOLOGIC CARE: Establish care with a gynecologist if you have not already. A gynecologist will be able to discuss with you any adjuvant procedures, such as topical estrogen, that can be helpful in reducing painful pelvic floor symptoms.
- UNDERSTAND HRT: In 2002, there was an infamous study on hormone replacement therapy (HRT) in women ages 50-79 years of age. The results were reported and inaccurately interpreted by the public which resulted in decreased use of HRT. In that time frame, women’s mortality rate, osteoporosis, and fracture risk increased. In 2017, the North American Menopause Society issued an updated statement regarding indications for HRT. When discussing hormonal changes with your physician, ask if they are up to date on the use of HRT and indications in menopausal populations. See the statement in the references below.
- START EXPLORING! Vulvar balms and CBD formulated for vaginal use can be helpful in alleviating pelvic floor dryness and pain. Daily vulvar balms can add moisture to tissues to prevent irritation during the day. CBD increases blood flow, eases muscle tension, and can be helpful to decrease tissue irritation.
- LUBE, LUBE FOR EVERYONE! I cannot say this one enough. I believe all folks should be using supplemental lubricant with sexual activity (self and partnered) throughout the lifespan. Have it next to your bedside table and make sure the lubricant is the following: glycerin-free, paraben-free, and fragrance-free. You do not want to put anything in the vagina that will further irritate the tissues. CBD lubricants can be helpful but note they are often oil-based and thus not condom compatible.
- PELVIC PT FOR THE WIN: Talk to your local pelvic PT. We know that pelvic PT is essential when it comes to the evaluation of pelvic floor muscles to determine how best to optimize your core health, but they can also be an invaluable resource when it comes to understanding changes in tissue health and how best to support yourself while aging with a healthy pelvic floor!
The NAMS 2017 Hormone Therapy Position Statement Advisory Panel. The 2017 hormone therapy position statement of The North American Menopause Society. Menopause. 2017 Jul;24(7):728-753. doi: 10.1097/GME.0000000000000921. PMID: 28650869.