Menopause Is Making a Comeback

Faculty member Christine Stewart, PT, CMPT began her career specializing in orthopedics and manual therapy and became interested in women’s health after the birth of her second child. Her course, Menopause Transitions and Pelvic Rehab is designed for the clinician who wants to understand the multitude of changes that are experienced in the menopause transition and how they affect the aging process. To learn more join Christine in her upcoming course scheduled for February 10-11, 2024.

Conversations about menopause are becoming more mainstream. What used to be a taboo subject has thundered into the media in triumphant fashion. Drew Barrymore, Oprah Winfrey, and Maria Shriver are just a few of the celebrities spreading the word about this transition that will affect all menstruating people at some point in their lives. Despite the headlines and increased coverage, most women feel uneducated and underprepared for how this transition will manifest itself in their bodies concerning symptoms and long-term health (Tariq et al., 2023). Pelvic health providers are the perfect people to educate their patients on these changes.

Menopause is defined as twelve months with no menstrual cycle. Once this has occurred, a patient has then entered a post-menopausal state. However, the process of reaching this twelve-month milestone will begin long before menopause is achieved (Lewis 2021). Symptoms are often experienced in the transitional process leading up to menopause, years before it finally occurs. Perimenopause is the precursor to menopause and represents a time when the ovary begins to change. Hormone levels begin to fluctuate which can affect cycle regularity and intensity. Cycles can now occur every three weeks, ovulation can become irregular, and periods can become heavier. When hormones and cycles change, symptoms can begin. Sleeplessness and night sweats before the onset of menstruation can be an early indicator of perimenopause as well as increased anxiety, brain fog, and irritability (Aninye et al., 2021). These changes can begin in patients as early as their late teens but most commonly will occur in the late 30’s and early 40’s. Knowing how to recognize symptoms that can occur during the perimenopause transition can help to educate patients on what is occurring and what they can anticipate as the ovary continues to age.

Genitourinary Syndrome of Menopause is just one of the many conditions that can occur during this time. It is a cluster of symptoms that can be experienced by patients during this transition. Vaginal dryness, dyspareunia, urinary frequency, and urinary incontinence are included in this disorder (NAMS 2022). To better treat these diagnoses, healthcare providers need to ask questions about menstrual regularity and cycle changes in addition to a patient’s bowel and bladder habits. Often, hormones play a role in their urinary and vulvar symptoms. Without understanding this connection, providers are often missing an important piece that could assist in the treatment of genitourinary complaints.

Changes in hormone levels will also impact other systems in the body. As these fluctuations begin, patients can begin to have effects on their cardiovascular system, brain function, and bone health (Aninye et al., 2021). As health care providers, understanding this impact can help to guide patients down a better path of wellness through lifestyle modifications and referrals to physicians specializing in menopause. Basic recommendations on sleep, exercise, and eating habits during this transition can set up a trajectory of better aging and holistic health.

While the prescription of medications is beyond a therapist’s scope of practice, having a thorough understanding of the risks and benefits of these treatments can help educate our patients on their options for symptom management. Understanding their applications in the treatment of symptoms helps to remove societal and medical biases that have existed for over twenty years. It allows for giving patients more informed choices when it comes to their bodies. Women going through menopause are made to think that bearing their symptoms is a rite of passage, yet proper care and consultation can ease these often life-altering effects. Education on options of treatment and appropriate referral is key to empowering patients.

It is never too early or too late to begin a conversation about menopause. Habits and lifestyle in younger people, such as exercise, sleep hygiene, and self-care can have an impact on the changes they will experience later in life. In our post-menopausal patients, these same habits and lifestyle choices can be implemented to assist with improving health outcomes and the aging process. Understanding this transition is key to any healthcare provider treating current or past menstruating people.

As clinicians, we are often the first line of support when it comes to these patients. There is a lack of education for treating this population (Macpherson and Quinton 2022). Knowing the questions to ask can allow for better treatments, healthcare outcomes, and longevity. Patients are hungry for this information but sometimes need encouragement in pursuing treatments and finding solutions with their healthcare team. As pelvic health specialists, this gap can be bridged by providing patients with information regarding their changing cycles and how this can affect their long-term health. This education can change their lives. Let us keep making menopause mainstream.

References:

1. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause, 2020. 27(9): p. 976-992.
2. Aninye, I.O., et al., Menopause preparedness: perspectives for patient, provider, and policymaker consideration. Menopause, 2021. 28(10): p. 1186-1191.
3. Lewis, R., Why is menopause a priority in primary care?, in Confidence in the Menopause, N.H. Research, Editor. 2021, Fourteen Fish: United Kingdom.
4. Macpherson, B.E. and N.D. Quinton, Menopause and healthcare professional education: A scoping review. Maturitas, 2022. 166: p. 89-95.
5. Tariq, B., et al., Women's knowledge and attitudes to the menopause: a comparison of women over 40 who were in the perimenopause, post menopause and those not in the peri or post-menopause. BMC Women’s Health, 2023. 23(1): p. 460.