When you think of Menopause, do you think of leakage, pelvic heaviness, osteoporosis or increased risk of stroke? If the answer is no, then I highly encourage you to read on. Most people are familiar with hot flashes, missed periods and restless sleeps but know very little about some of the other very important changes that can occur during this life transition. 

In interest of spreading awareness, we are going to educate you on the less spoken about symptoms of menopause and how physiotherapy can help manage them. 

1. Urinary Incontinence

• Any involuntary loss of urine-it doesn’t matter when or how much
• Stress urinary incontinence is a leak when you jump, sneeze, run or cough and is more prevalent during and after menopause- especially if you have had a previous vaginal delivery
• Pelvic floor strengthening and other physiotherapy techniques are used to manage and prevent further worsening of this condition

2. Pelvic Organ Prolapse

• When your bladder, uterus or rectum sits lower than normal
• This can cause bulging, pressure or incontinence but for many there are no symptoms in the early stage of a prolapse
• Pelvic organ prolapses are more likely to become symptomatic or bothersome during menopause
• Pelvic physiotherapy can help manage the symptoms and progression of a prolapse through education on pressure management and supports, specific exercises and techniques for symptom management

3. Decline in Muscle Mass and Metabolism 

• As we age, it is harder to maintain our muscle mass
• After the age of 30-40, there is about a 3-8% loss in muscle mass per decade and a 2.5-3 % loss in muscle function per year
• This loss of muscle mass and strength occurs more rapidly during the menopause transition and not only leads to strength and function changes, but also lowers our metabolism and alters how our body processes insulin 
• Physiotherapy can provide crucial coaching on what exercises help to mitigate muscle loss to offset these changes

4. Decline in Bone Mass and Increased Risk of Osteoporosis 

• Towards the end of the menopause transition, a person can lose up to 6% of their bone mass
• Postmenopausal bone loss remains elevated due to the lack of estrogen and can put us at an elevated risk of developing osteoporosis and consequently, fractures
• It is important to maintain our bone mass because we cannot rebuild it once it is lost
• There are specific exercises that can safely load our bones to help preserve bone mass. Not all exercises are created equal when it comes to bone health which is why consulting with a physiotherapist can be a good idea

5. Cardiovascular Changes

• Cardiovascular Disease (CVD) is the #1 cause of death for women and 1/3 women will die from CVD
• Before Menopause, the risk for CVD is greater for men but after menopause, the risk of CVD becomes similar for both women and men due to an increase in metabolically active visceral fat and decreasing estrogen which has a protective effect on the heart
• Additionally, 53% of women who have heart attack symptoms have them go unrecognized. This is in part because the symptoms of a heart attack in women look very different than for men
• The more common symptoms for women include:
  • Shortness of breath
  • Pressure or pain in the lower chest or upper abdomen
  • Dizziness
  • Light-headedness or fainting
  • Upper back pressure 
  • Extreme fatigue
  • Sense of being “unwell”
• Physiotherapists can review physical activity guidelines with you to ensure you are optimizing the heart health benefits of exercise
• We can also review the risk factors associated with CVD and help you modify your activities to accommodate for any injuries or physical limitations you have to help you move safely and comfortably

Whether you have a specific concern or just want to learn more about what to monitor during menopause physiotherapy, we can play an important role through this transitional period. To learn more, feel free to explore our website or call us to book a complimentary discovery call with one of our physiotherapists to see if pelvic health physiotherapy may be appropriate for you. 

Amanda Baxter holds a Master’s Degree in Physiotherapy. She practices at Healthy Balance Physiotherapy and Wellness where she has a special focus on chronic disease management and healthy aging. She offers in person and online appointments. She is passionate about working with her clients to find a management plan that is integrated into their daily routine and lifestyle.