Perimenopause & Menopause

Menopause is the point at which menstrual periods have stopped for twelve consecutive months, and perimenopause is the transition leading up to it. During this transition the ovaries produce less estrogen. Because estrogen helps maintain the thickness, elasticity and blood supply of the tissues of the vulva, vagina, urethra and bladder, its decline can change how the pelvic floor and lower urinary tract function.

Genitourinary syndrome of menopause (GSM)

Many of the urinary and genital changes associated with declining estrogen are grouped under the term genitourinary syndrome of menopause (GSM). GSM can include vaginal dryness, tissue thinning, discomfort with intercourse, urinary urgency, more frequent urinary tract infections and changes in bladder control. These are recognised, assessable changes rather than an inevitable part of ageing, and several respond to physiotherapy and to medical treatment.

How physiotherapy can help

Pelvic health physiotherapy addresses the musculoskeletal and neuromuscular aspects of pelvic floor function. It works alongside medical management — including vaginal estrogen prescribed by your physician or a pessary — rather than replacing it. An estimated 40 to 50 percent of postmenopausal women have some degree of pelvic floor dysfunction. Physiotherapy may help with:

• Urinary incontinence and urgency — leakage with coughing, laughing or exertion (stress incontinence) or a sudden strong need to void (urgency). Assessment and pelvic floor muscle training, together with bladder and fluid strategies, can support improved bladder control.
• Pelvic organ prolapse — a sensation of heaviness or pressure when reduced tissue support allows a pelvic organ to descend. Physiotherapy supports pelvic floor function and, where appropriate, we coordinate pessary fitting and management. Surgical and medical options remain the physician's domain.
• Vaginal dryness and pain with intercourse — physiotherapy can help address pelvic floor muscle tension and tissue mobility that contribute to discomfort, in coordination with medical treatments such as vaginal estrogen or lubricants.

Coordinated, whole-person care

Strength, bone density and general conditioning also change during midlife. Where relevant, exercise guidance and nutrition counselling can be offered as part of a plan, and we communicate with your physician so that physiotherapy and medical care work together. The aim is to reduce symptom burden and support daily function, not to promise a cure.