Hot flushes, poor sleep and mood changes get talked about a lot. What happens further down gets talked about far less. And yet many women begin to notice, during perimenopause or after their last period, vaginal dryness, burning, discomfort during sex, a more urgent need to pass urine, or a feeling of heaviness.
Many assume it’s “just age” and that nothing can be done. These symptoms are common, but they aren’t normal in the sense of something you must accept in silence. The pelvic floor changes at menopause, and it can, and should, be cared for.
What changes as oestrogen falls
Oestrogen doesn’t only act on the menstrual cycle. It helps maintain the thickness, elasticity and moisture of the tissues of the vulva, vagina, urethra and bladder. It also contributes to the quality of the connective tissue that supports the pelvic organs.
As levels fall, these tissues tend to become thinner, drier and less elastic. The vaginal flora changes too. At the same time, over the years, muscle mass decreases throughout the body, including the pelvic floor muscles, especially if they aren’t exercised.
The result can be a set of symptoms that often appear together.
Signs worth paying attention to
- Vaginal dryness, burning or itching, even outside of sex.
- Pain or discomfort during sex, which can lead you to avoid intimacy.
- Urinary leakage when you cough, laugh or exercise, or with urgency.
- Needing the toilet more often, including at night.
- Recurrent urinary infections.
- A feeling of heaviness or a “bulge” in the vagina, which may indicate prolapse.
- Constipation or difficulty emptying your bowels.
Not every woman experiences all of these, and severity varies a great deal. But if you recognise yourself in some of them, you are not alone.
What may lie at the root
Hormones play a central role, but they rarely act alone. At A Raiz da Cura we try to understand the whole story:
- Previous births, which may have left the pelvic floor more vulnerable even if there were no symptoms for years.
- Weak muscles or, on the contrary, muscles that are too tense. Pain during sex, for example, often leads to a protective tightening that makes the discomfort worse.
- Pressure habits: a chronic cough, constipation, lifting without managing your breathing.
- Posture and breathing, which influence how abdominal pressure reaches the pelvic floor.
- Old scars, from births or from abdominal and pelvic surgery.
- Stress and sleep quality, which affect muscle tension and how pain is perceived.
How we can help
We always start by listening. Then, with your consent and after explaining everything beforehand, we assess the pelvic floor, breathing, posture and abdomen.
Pelvic physiotherapy may include:
- Pelvic floor muscle training, to build strength, endurance and coordination, and also to learn to relax where there is too much tension.
- Hands-on therapy for the pelvic tissues, scars and areas of tension.
- Bladder and bowel education: habits, positions and routines that reduce strain.
- Bringing it into movement: how to lift, return to exercise or stay active while protecting your pelvic floor.
Visceral osteopathy can complement this work by looking at the mobility of the pelvic and abdominal organs. Acupuncture is an option some women seek for general wellbeing at this stage; we describe it with care and include it only when it makes sense for you.
Many women notice improvement with this kind of care, but every journey is different.
Working alongside your doctor
Pelvic physiotherapy complements the care of your gynaecologist or GP; it doesn’t replace it. For vaginal dryness and other menopausal symptoms there are medical treatments, local or systemic, that only a doctor can assess and prescribe. Often the best outcome comes from combining both approaches.
What you can do now
- Bring it up at your next appointment with your doctor. These symptoms can be addressed and are nothing to be embarrassed about.
- Stay active: walking, adapted strength training and daily movement are good for the whole body, pelvic floor included.
- Look after your bowels: fibre, water and a small stool under your feet on the toilet help you avoid straining.
- Avoid perfumed products for intimate hygiene, as they can irritate more sensitive tissues.
- Breathe out as you exert yourself, rather than holding your breath.
When to seek help
Book a pelvic physiotherapy assessment if you have urinary leakage, pain during sex, a feeling of heaviness in the vagina, or difficulty emptying your bladder or bowels.
See your doctor promptly if you have:
- any vaginal bleeding after menopause (more than 12 months without a period), however light;
- blood in your urine, or burning with a fever;
- sudden, severe pelvic pain;
- unexplained weight loss;
- a “bulge” in the vagina that bleeds, becomes sore or doesn’t go back in.
A new chapter, not a full stop
Menopause is a stage of life, not an illness. But it is a stage in which the body asks for attention in a different way. Listening to what it is communicating lets you live these years with more comfort, more confidence and more freedom.
If you’d like to talk about what you’re experiencing, send us a message on WhatsApp. We’ll take the time to reply and, if it makes sense, book an appointment.