Pelvic Health Support

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Perimenopause, Menopause and Pelvic Floor Physical Therapy

Perimenopause, Menopause and Pelvic Floor Physical Therapy

By Christine Klein


As a pelvic floor physical therapist, I see so many women in their 40’s, 50’s, 60’s and beyond with pelvic floor problems like urinary leakage, bothersome urinary urgency and frequency, pelvic organ prolapse, vaginal/pelvic pain and pain with sex.  All of these symptoms can be attributed to hormone level changes associated with perimenopause and menopause.

I love being able to educate my patients about these changes and provide solutions to these issues through pelvic floor physical therapy as well as information about products like topical vaginal estrogen cream that helps relieve the above mentioned symptoms.  As a pelvic floor physical therapist I cannot prescribe this medication but I can tell you all about it, how to use it, how to apply it, and tell you that there are no studies that show it leads to an increased risk of cancer or cardiovascular disease.   You then take this information with you to your physician to make sure it’s right for you. 

Many people are unaware of what to expect as they age and that there are things that can be done in your teens, 20’s, 30’s, 40’s, 50’s and beyond to help prepare your future self for peri and post menopause. 

Perimenopause: A period of time of about 5 to 10 years before menopause and usually starts in your 40’s

Menopause: The day you’ve not had a period for 12 consecutive months (with no other obvious causes)

Postmenopause: Life after menopause

Menopause results in changing levels of hormones, most notably estrogen, progesterone, and testosterone.  It is a normal, natural life event that all women experience if they live long enough.  Once you’re in menopause (postmenopause) you are in a new physiological state for the rest of your life. 

Induced menopause occurs when a woman’s menstrual periods end due to a medical intervention, particularly surgical removal of both ovaries or cancer treatments such as chemotherapy or pelvic radiation. 

Smoking and genetics are two factors that can influence the timing of natural menopause.  Smokers reach menopause about 2 years earlier than non-smokers.

There are LOTS of symptoms of perimenopause.  Some of the most common include hot flashes, night sweats, increased anxiety and depression, brain fog, heart palpitations, vaginal atrophy and dryness.  The vulvar and vaginal tissue dries out and loses the acidity it once had to fight infections. 

The whole microbiome changes, which increases the likelihood of urinary tract infections (UTIs).  Other symptoms include urinary frequency, urinary urgency, pelvic pain, pain with urination, and constipation.  Sensitivities to dairy and gluten may start.  This is just a small list of possible symptoms; there could be more, there could be less, everyone is different.

Other symptoms are not as obvious.  These include changes to cardiovascular health, bone health, and increased insulin sensitivity. 

What you can do in your early years (teens and 20’s) AND your 30’s, 40’s, 50’s, to help your future self through perimenopause and menopause:

Strength Train (build up a bank of great, strong muscles and bones) + think about your children or grandchildren now and let them know how important it is to start taking care of their health EARLY!  This can help to PREVENT osteoporosis in their future and help to decrease risk of cardiovascular problems.

strength training

Also, in peri and post menopause, weight training with heavier weight for bigger muscle groups (think so heavy you can’t perform more than 6 reps) helps your body maintain and build muscle mass.  This is the time to lift heavier, not lighter.  Learning how to lift weights with proper form and without increasing risk of prolapse or worsening prolapse is something pelvic PTs can help with.

weight training

  • Weight bearing exercise including jumping
  • Eat a balanced, nutritious diet low in processed foods (The Mediterranean Diet proves to be a winner)
  • Eat before and after a workout (ideally a protein and complex carb) to help your body recover
  • Don’t smoke
  • Limit or do not drink alcohol
  • Limit or do not drink caffeine
  • Start and keep up with a meditation practice/find something you love to do that de-stresses you and do it more often

Why work with a Pelvic Floor Physical Therapist during peri and postmenopause?

80% of peri and post menopause symptoms can be modified with lifestyle changes.  We are the professionals who can help you make these lifestyle changes and set you up with an exercise program designed specifically for you and your needs.  Not everyone can jump or perform weight bearing exercises the same exact way.  We help you figure out what works for you.

We are the go-to professionals you can tell ANYTHING to and get open and honest responses.  Learn about lubricants, moisturizers, hormone creams, pelvic dilators, wands, bladder and bowel habits, effective strength and weight bearing exercises, PLUS give great recommendations for other healthcare professionals you would benefit from working with.

Dr. Christine Klein holds a Master’s and Doctorate degree of physical therapy. She has been practicing orthopedic physical therapy since 2006 and pelvic floor physical therapy since 2015. She is a Board Certified Women’s Health Clinical Specialist, a certified personal trainer, a pregnancy and postpartum corrective exercise specialist, and a certified menopause coaching specialist. Christine owns a private pelvic floor PT practice in Rockledge, FL called Embrace Health & Rehab and offers in person and online appointments as well as virtual coaching for those wanting an in-depth focus on their exercise, nutrition and sleep routine in peri or post menopause.  Her focus has been on educating women about the changes associated with perimenopause and postmenopause and you can access her online courses about pelvic floor physical therapy and peri and postmenopause here.