Hot Flashes, Hormones and Vaginal Changes, Oh My!

As a pelvic health physical therapist, and a woman currently in the midst of perimenopause, the topic of menopause is taking over my Instagram feed.  The goal of this blog is to help open the conversation and provide some information.  There is also an important announcement at the end so I encourage you to continue.

First off, why has menopause only been a conversational topic in the last year or two?  It’s not a new thing.  Every single woman, if she lives long enough, will experience menopause.  That’s just facts, but why is no one talking about it?  Remember those awkward health classes in the 90’s?  All the girls were in a room watching videos to learn about puberty to prepare us for the changes that were imminent in the coming years.  Where was this in my 20’s to prepare me for the next, and arguably more important, change?!

Let’s break it down.  Menopause is the shift that marks the end of a woman’s reproductive years.  Clinically, the diagnosis is made when there is no menstrual cycle for 12 consecutive months.  The hormone fluctuations leading up to menopause is considered perimenopause.  Some of these changes can be very subtle and women can experience perimenopause symptoms even before any changes have occurred to cycle regularity.  In fact, some symptoms of perimenopause can be experienced 10 years before menopause.  The average age of menopause is between 45-55.  That means some of these subtle changes can start occurring in our early/mid 30’s.  

Estrogen is the hormonal driver for many of our body systems.  The decline of this hormone is the underlying cause for many health concerns as we age.  A few of these can include: cardiovascular disease, dementia, mood changes, migraines, metabolic disease, and musculoskeletal disorders (especially the decline of muscle strength and bone density).  One of the most well known changes is specific to the genitourinary system.

Genitourinary syndrome of menopause (GSM) is the term used to describe the changes to the vagina and vulva.  Estrogen is responsible for keeping the vulvar tissues supple and moisturized.  As estrogen declines, the vaginal tissues become dry and thin.  Urethral close pressures can also be affected leading to new onset of stress incontinence and leakage.  Pain with intercourse is also common.    

There are several techniques we can utilize in pelvic health physical therapy to manage these symptoms.  Topical estrogen is the first line treatment to replenish estrogen levels and reverse tissue change.  There have been concerns previously about topical estrogen’s role in cancer diagnoses.  This has not been supported with recent research.  However, for those who have a personal history of cancer or who do not want to consider hormonal treatments other options are available.

Vaginal moisturizers are the most common secondary recommendation when topical estrogen is not utilized.  Research has shown hyaluronic acid to be effective at reducing dryness and improving sexual satisfaction.  CO2 laser also has been studied and may be promising for an additional consideration.  However, more research is needed especially looking into long term benefits and cost may be a factor limiting treatment.

Menopause is a major shift in hormone levels and another important transition for women.  It can be accompanied by mood changes and symptoms that encompass more than just hot flashes.  For partners, it’s important to learn and understand these symptoms to support your significant other through this transition.  For those of us, myself included, who are currently experiencing subtle changes, don’t write off your symptoms.  It’s important to speak with your medical care team to determine the best pathway moving forward.

That takes me to my important announcement.  NoVaMotion Physical Therapy, in collaboration with Dr. Arnca Sisu from Restore Balance Integrative Medicine, will be hosting a Menopause Workshop!  Bring your friends, humor and questions for a fun and informative gathering.  We can’t wait to see you on January 24th.  Look out for registration details coming soon!