Five things you didn’t know about menopause

“Women don't always associate certain physical symptoms with menopause,” said Adi Saar Locker, Senior Coordinator of Women’s Health with HYMC’s Physical Therapy Service. “Most women have heard about hot flashes, excessive sweating, mood swings and even lack of sleep,” she said, “but not about the fact that around the time of menopause and afterwards there may be other lesser-known symptoms related to the health of the pelvis and pelvic floor that affect 50% of the women who reach menopause. Even Michelle Obama and Gwyneth Paltrow speak about these symptoms on their various social media platforms.”

 

Let's talk about a few “lesser-known” effects of menopause.

 

1. Having a hard time waiting or urinary incontinence due to coughing, sneezing, laughing or physical activity: Frequent visits to the bathroom, difficulty controlling urination, use of absorbent aids and getting up to go to the bathroom numerous times at night - all these effects are related to urinary frequency and urgency. Another mechanism is stress incontinence - leakage of urine when sneezing, coughing, laughing or raising your voice, during physical activity and when jumping.

 

2. New pain when having sexual intercourse, vaginal pain or itching: Generally due to vaginal dryness that did not previously exist.

 

3. Feeling of vaginal heaviness, something “not in the right place”: Feeling of heaviness or feeling of vaginal protrusion due to the fact that gravity pulls the pelvic organs downward.

 

4. Urinary tract or vaginal infections more frequently than previously.

 

5. New collection of fat, particularly in the lower abdomen and great difficulty getting rid of it despite maintaining a proper diet: Did you know that there's something called menopause belly?

 

Why does this happen?

 

The reason for most of these symptoms relates to hormonal changes. More precisely - the drop in estrogen levels in the body. Estrogen is an important hormone that affects numerous systems, including the genitourinary system.

 

In the presence of estrogen, the vaginal linings flourish and, without it, the lining thins, tends to become injured, there is less lubrication and therefore a tendency towards vaginal dryness which leads to vaginal pain and pain when having intercourse. Additionally, there is a decline in vaginal Ph and therefore a higher risk of developing bacterial and fungal urinary tract infections.

 

Estrogen also affects the lining of the urethra, which becomes thinner with fewer blood vessels and a wider opening. Degeneration of the fibers of the bladder muscle and a decline in strength of contraction leads to a disorder in the emptying of the bladder and decrease in volume, which is why women experience more urinary tract infections, urinary frequency and urgency, nighttime urination and stress incontinence.

 

Regarding weight gain around the abdomen, with the decrease in estrogen, metabolism begins to slow down, and fat also begins to accumulate, especially around the hips and less around the pelvis and thighs, which leads to increased belly fat. This weight gain increases the risk of developing heart disease, diabetes, breast cancer and dementia.

 

So what can you do about it? What solutions are out there? Can it be prevented?

 

“Just like you can't completely prevent wrinkles, you also can’t completely prevent menopause systems,” noted Saar Locker. But you can relieve the symptoms.

 

Medication therapy

 

Systemic hormone replacement therapy, which is provided after consulting a doctor who specializes in menopause and a lack of contraindications may significantly improve the effects of menopause and improve a woman’s quality of life. Hormones also have a positive impact on bone health, in preventing osteoporosis and preventing cardiovascular disease, when given around the time your period stops.

 

Local hormone therapy includes vaginal estrogen cream or vaginal suppositories to prevent dryness and itching, to reduce the risk of vaginal and urinary tract infections. Additionally, estrogen improves the lining of the urethra and vagina, which may help relieve symptoms such as leakage due to urinary urgency or stress incontinence. Note that local therapy does not have to be hormonal.

 

Water or silicon-based lubricants are recommended when engaging in sexual intercourse to alleviate pain on penetration.

 

There is also medication for urinary urgency.

 

You can contact a doctor who is a specialist in menopause to receive appropriate advice.

 

Pelvic floor exercises

 

Physical activity

 

Regular physical activity is essential to maintaining good health. There are many benefits of physical activity at any age, including during menopause: improved function of the cardiovascular and respiratory systems, help controlling blood pressure and reducing the risk of cardiovascular disease, strokes, malignancies and other diseases, improved joint flexibility and mobility, strengthening of muscles and bones, improved coordination and balance, improved safety when walking and reducing the risk of falls, improved mood (reducing the sense of depression), improved ability to focus and generally feeling good.

 

During menopause, physical activity helps maintain normal weight, improve the lipid profile, increase muscle mass, strengthen muscle mass and improve metabolism as well promoting a general feeling of wellness. The recommendation is for two-and-a half to five hours of moderate activity or 90-120 minutes of intense activity a week. Additionally, it is advisable to add two days a week of moderate or high intensity muscle-strengthening activity for all muscles of the body. The key is activity that is pleasurable and, mainly, consistent.

 

Types of activity:

 

Note that many women experience symptoms related to the pelvic floor during physical activity (stress incontinence, heavy feeling in the vagina and more). Consult a physical therapist who deals with the pelvic floor to adjust activity.

 

High impact weight-bearing aerobics - dancing, running, jump rope, volleyball, basketball, high-intensity interval training (HITT).

 

Low impact weight-bearing aerobic exercise - walking on a treadmill/outdoors, elliptical trainer, stairs.

 

Strength and resistance training - with arm/leg weights, resistance bands.

 

Non-weight bearing aerobic exercise - swimming, pedaling on a bike - recommended to be included in exercise routine, but alone does not improve bone mass.

 

Flexibility and balance exercises - yoga, Pilates.

 

Specific pelvic floor exercises:

 

Exercises to strengthen the pelvic floor muscles improve ability to control stress incontinence. Proper use and timing as well as maintaining proper urinary habits can help the feeling of urinary urgency and frequency.

 

Strengthening the muscles along with proper work of the core muscles and properly management of loads when performing everyday activity and physical activity may improve symptoms of vaginal heaviness and pelvic organ prolapse.

 

Saar Locker summarized, “As a rule, the same way you contact a menopause professional to adjust medication, the same is recommended for contacting a pelvic floor physical therapist to examine and tailor a personalized exercise program.”