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Herman & Wallace Blog

Menopause, Prolapse, and Pelvic Rehab

This post was written by H&W instructor Michelle Lyons, PT, MISCP. Michelle will be instructing her course "Menopause: A Rehabilitation Approach" in Florida this February.

Michelle Lyons

The physiological effects of the decline in circulating estrogen, combined with the aging process, put postmenopausal women at risk of urogynecological dysfunction (Lee 2009). Incontinence, prolapse and sexual dysfunction are common problems, and their symptoms can greatly affect quality of life. Pelvic therapy can offer effective, conservative, and cost effective treatments for these issues.

The most significant aetiological factors for the development of prolapse are advancing age and parity (MacLennan et al, 2000). Several studies have investigated tissue metabolism and properties in postmenopausal women with symptoms of prolapse and/or stress urinary incontinence. Links have been identified between these symptoms and alterations in connective tissue and estrogen levels.

Goepel et al (2003) took biopsies of periurethral tissue from 29 women undergoing anterior repair or sacrospinous fixation surgery for prolapse. The results showed altered metabolism in all the postmenopausal women: less of types 1, 3 and 4 collagen and absent or fragmented vitronectin (a glycoprotein which promotes cell adhesion and inhibits cell membrane damage).

Similarly, Alperin et al (2006) took biopsies of the ATFP from 27 postmenopausal women during repair surgery for anterior vaginal wall prolapse, which showed a decrease in type 1 collagen. It is considered that type 1 is the main determinant of tensile strength within connective tissue, that is, the amount of load that can be exerted on it before it permanently deforms or fails.

In Reay Jones et al’s (2003) study, the uterosacral ligament was measured for resilience in women undergoing hysterectomy and shown to be reduced in postmenopausal women. All of these studies demonstrated a weakness in the connective tissues, with the consequences of pelvic organ support being more reliant on the pelvic floor muscles.

Hagen et al in 2014 in the Poppy trial, did a parallel-group, multicentre, randomised controlled trial at 23 centres in the UK, one in New Zealand, and one in Australia, and showed that ‘one-to-one pelvic floor muscle training for prolapse is effective for improvement of prolapse symptoms’, more so than prolapse lifestyle advice leaflets.

Pelvic therapy, and particularly skilled pelvic floor muscle re-education, has been an under-used resource in the field of menopausal health, but with emerging evidence consistently proving its value in alleviating menopausal dysfunctions.

Learn more about Michelle and her course by joining her in Orlando this February for Menopause: A Rehabilitation Approach

References

Hagen et al (2014): ‘Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial’

Hagen S et al (2006) Conservative management of pelvic organ prolapse in women. Cochrane Database of Systematic Reviews 2006, Issue 4. DOI: 10.1002/14651858.

Goepel C et al (2003) Periurethhral connective tissue status of post menopausal women with genital prolapse with and without stress incontinence. Acta Obstetricia et Gynecologica Scandinavia; 82: 7, 659-664.

Alperin M, Moalli P (2006) Remodelling of vaginal connective tissue in patients with prolapse. Current Opinion in Obstetrics and Gynecology; 18: 5, 544-550.

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