Unboxing Perimenopause
By: Hannah Lattanzio, PT, DPT
Perimenopause
Perimenopause is defined as the period prior to the cessation of menses, or the decline of periods. For most women, perimenopause begins around 40 years of age and lasts for 5-10 years before menopause. This period consists of two stages: an early stage where there is variability in the menstrual cycle, and a late stage where amenorrhea, or the absence of the menstrual cycle, is greater than 60 days. For women with irregular menses (such as those with polycystic ovarian syndrome), tracking the stages is not currently possible. During this period, the levels of important reproductive hormones change.
Reproductive hormones such as estrogen, progesterone, and testosterone play an important role in maintaining healthy pelvic and reproductive tissue. During perimenopause, follicle stimulating hormone (FSH) increases while estrogen, progesterone, and testosterone decrease. Because vulvovaginal tissue quality depends on hormone levels, the fluctuation in hormone secretion can lead to reduced pelvic floor muscle strength, lubrication, and elasticity of the vaginal walls. These symptoms can lead to irritation of the vulva and vestibule and genitalia atrophy. For these reasons, women going through perimenopause may experience dyspareunia, or pain with intercourse.
More than half of women experiencing perimenopause experience more than one symptom. Common symptoms include hot flashes, depression and other mood changes, sleep disruption, sexual dysfunction, and cognitive impairments.
Other symptoms include:
Vaginal dryness
Urinary incontinence
Somatic pain syndromes
Despite over 80% of women experiencing symptoms, it is estimated only 10% visit a healthcare provider for assistance.
It is important to note that while these symptoms are common, none have been proven to be specifically related to perimenopause as women can experience these symptoms at other times in their life, and men can experience these symptoms as well.
Treatment
Current treatment options include hormone replacement therapy, over the counter medications, prescription medications, and exercise/lifestyle changes.
Oral contraceptives (OC) can be an option for those experiencing symptoms during perimenopause. In addition to contraception, OC’s can significantly reduce the risk of ovarian, colorectal and endometrial cancers. Oral contraceptives can be provided to assist with symptom management during perimenopause as well by counteracting declining estrogen levels. OC’s have been previously avoided as providers throughout prescribing them was dangerous. To date however, there have been no studies that prove OC’s cause breast cancer or cardiovascular events in middle-aged women, thus making them a potentially safe choice for those struggling with perimenopausal symptoms.
How Pelvic Floor Physical Therapy Can Help
As previously discussed above, hormone changes during this period can manifest in a variety of symptoms. Over time, the muscles of the pelvic floor may contract and protectively guard against pain. As the pelvic floor muscles continue to rest in a contracted state, blood flow decreases causing more pain - thus creating a negative feedback loop.
Your physical therapist can perform manual techniques and educate on various strategies to help relax the pelvic floor muscle to reduce pain and restore normal mobility and function. Following manual therapy your therapist can create an individual exercise program to retain the gains made in physical therapy for a more permanent solution.
The restoration of proper muscle function can improve symptoms of dyspareunia (pain with intercourse), urinary incontinence, pelvic pain, increased urinary urgency and frequency, and many more.
Bottom Line
While perimenopause awareness and research has continued to grow, there is still much we do not know. More research and longitudinal studies are needed to determine the relation of symptoms and endocrine levels in addition to other lifestyle factors. Not everything a woman experiences during this transition period can be attributed to perimenopause as there is a link between symptoms and aging, genetics, psychosocial, cultural, health and behavior factors as well.
Still curious if you should see a pelvic floor physical therapist for perimenopause symptoms? Book a discovery call with us today!
