5 things they don’t tell you about the menopause

Demystifying the menopause

All women will go through the menopause at some stage in their lifetime, whether it’s induced after a total hysterectomy or cancer treatments or as part of our bodies natural hormonal decline associated with age. Some women will sail through without so much as a single complaint and others will struggle considerably more.

What is known is that more than half of all women going through the menopause may experience vaginal symptoms affecting either their emotional wellbeing, lifestyle or sexual health and possible co-existing problems with bladder and bowel. Experienced pelvic and women’s health physiotherapists can be highly effective in the treatment and management of these symptoms. Some common issues and topics are discussed below in an attempt to demystify the menopause.

menopause surreyVaginal dryness

Vaginal dryness and discomfort during intercourse is one of the most common and often distressing symptoms of the menopause. Thinning and loss of elasticity of the vaginal tissues, increased pH and diminishing secretions are the main culprits for this, caused by lack of oestrogen. Overall our vagina becomes a bit more fragile and can become easily irritated.

Up to 45% of post-menopausal women report pain with sex and unsurprisingly subsequent fear, decreased arousal, libido and further decreased lubrication! The good news is that this often-distressing symptom can be easily treated and the ‘fear-pain-dryness-low libido/ cycle’ can be broken. The answer is to use a good, non-irritable vaginal lubricant and moisturiser either. This can be on its own or in combination with some oestrogen cream, which can be prescribed by your GP. This is an extremely effective, easy and safe treatment which can hugely improve vaginal comfort, sexual function and libido.

Try vaginal moisturiser (VM) on a regular basis and an oil based (OB) or water based (WB) moisturiser during intercourse. For a paraben free, organic certified product, try ‘Yes, Yes, Yes.’

menopause surreyWeight Management

Long cardio workouts will not burn abdominal fat often associated with the menopause. Cardio sessions of longer than 30 minutes stress our systems causing adrenalin and sugar to be released into our bloodstream. Cortisol, released to control this, combined with insulin is not a good weight management strategy and will not burn fat. Avoid sugary foods, dairy, wholegrain bread and complex carbs which release insulin and enjoy foods that have a low insulin release such as proteins, good fats, dark fruit and colourful veg. Keep exercise to short HIIT type sessions for the best fat burning results. Visit Les Mills for HIIT online classes.

menopause surreyLifestyle choices

Our lifestyle choices directly affect our oestrogen levels, and therefore can either exacerbate or alleviate the symptoms of menopause. Our diet (especially sugar, caffeine and alcohol intake), exercise (type and frequency), levels of day to day stress (both work and relationship) and how we manage that stress are the most common factors for disrupted hormone balance. All these issues can be addressed by coping strategies to reduce cortisol (stress hormone) levels, improved diet ideally with the help of a functional nutritionist to get the correct combination of nutrition, supplementation and lifestyle management and exercise.


menopause surreySleep

Getting quality sleep is the key to optimal hormonal health for women. Up to 70% of post-menopausal women may experience some degree of obstructive sleep apnea resulting in disturbed sleep patterns. Weight gain and anatomical changes to upper airways combined with decreasing progesterone levels can affect our airway muscle activity.

Try to reduce blue light screen exposure in the hours before bed time and reduce stress levels. Possible supplementation with vitamin B6 and magnesium to support progesterone levels can be helpful. And finally, exercise for short bursts, ideally outdoors in the daylight to naturally increase blood melatonin levels.

menopause surreyPhysical trauma in childbirth

Perineal and obstetric trauma experienced during childbirth such as 3rd and 4th degree tear, high forceps delivery, multiple babies or heavy babies may predispose us to pelvic floor issues during the menopause. As decreasing oestrogen levels cause changes in our smooth muscles, elasticity and support of our vagina, symptoms often experienced early postnatally may return in menopausal years.

Your genetic makeup and collagen type will also be determining factors in explaining why some people experience more pelvic floor symptoms than others. To be well informed about pelvic health, to understand how your breathing, pelvic floor and postures can directly affect symptoms of prolapse, incontinence and bladder and bowel urgency is the key to early and effective management. A specialist women’s health physiotherapist can successfully help to assess, treat and manage all of the aforementioned issues.



Gemma Pilkington is a specialist Women’s Health Physiotherapist in Surrey and Kent, with almost 20 years experience in clinical practise. She has helped countless patients return to their optimum health and wellbeing.

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