Menopause. The final frontier of a hormonal roller coaster.

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.  Christine joined Olathe Health in 2010 to further focus on women’s health and obtain her CMPT from the North American Institute of Manual Therapy. She also went through Diane Lee's integrated systems model in 2018. Her course, Menopause Transitions and Pelvic Rehab is designed for the clinician that wants to understand the multitude of changes that are experienced in the menopause transition and how they affect the aging process. 

Menopause. The M-word, the second puberty, is the final frontier of a hormonal roller coaster when there are twelve consecutive months with no menstruation. A time of celebration, right? No more cramps, hygiene products, menstrual cups, or moodiness – FREEDOM! Not so fast my fellow clinician!

The body goes through some serious, hormonal loop-the-loops leading up to the cessation of ovulation. Perimenopause is the stretch leading up to the final cycle and this stretch can feel like yoga on steroids. It can last TEN years, not including symptoms experienced after the transition takes place. Changes in cycle length, flow, anovulation, and yes, even ovulating twice are all stages of perimenopause. (Hale et al., 2009). These changes translate into symptoms: sleeplessness, brain fog, anxiety, palpitations, fatigue, painful intercourse, and joint stiffness are just a few things that can be experienced during this time (Lewis, 2021).

This transition can begin for patients during their mid-thirties, more commonly it begins during their forties, but eventually, all people that ovulate will experience it. For some, perimenopause can be much more challenging than after menopause. The perimenopause hormone guessing game begins. Some months, progesterone makes an appearance. The next month, mostly estrogen, and some months - neither are around very much at all. If there is an abrupt change in ovulation, such as with a complete hysterectomy, the symptoms will most likely be intensified due to the abrupt loss of hormones. (Gunter, 2020). Dealing with the changes of menopause can be challenging in a variety of ways (like a two-year-old wailing for a candy bar in the checkout line), but many things can help ease this transition.

With fluctuating hormones also comes changes to many systems in the body. Estrogen receptors are everywhere, and when hormone levels are changing, so does the body’s internal workings. Glucose metabolism, bone physiology, brain, and urogenital function are just some of the systems affected (Shifren et al., 2014). Perimenopause is not just a time of altered periods. It is also a critical time in a person’s health where an increased incidence of heart disease, diabetes, and bone loss can begin (Lewis 2021).

Preparing for menopause should be on our radar for patients in their twenties, thirties, and early forties before the process starts. Establishing healthy habits earlier instead of later can help for a more successful transition, however, it is never too late! Knowing the signs and symptoms of this phase can help us guide patients and ourselves to a better understanding of what is happening with the body in this adaptation. We can make recommendations on lifestyle, exercise, and meditation, as well as refer them to other knowledgeable providers when needed.

I have had countless patients sent to me for urinary frequency, incontinence, or painful intercourse who are in this transition, but no one has talked to them about what is happening to their bodies. You may be thinking to yourself, these patients have doctors. Why aren’t they getting the information from their physician? After all, these providers have had years of training. The reality is sometimes doctors do not receive the necessary education to treat menopausal patients. 

In a survey of postgraduate trainees in internal medicine, family medicine, and obstetrics/gynecology, 90% felt unprepared to manage women experiencing menopause (Reid, 2021). Insert jaw drop here. As pelvic health providers, we can help to fill this knowledge gap and be a conduit to explaining the process. We can empower patients with education, treatments, and recommendations to flourish in this critical phase of life.

The menopause transition can be a time of great uncertainty. Not only are patients’ lives transforming as their children grow and their parents age, but their bodies are changing as well. We can ease their burden in this period of adaptation. By calming their fears through education, we can assure them that indeed, they are not losing their minds.

Knowledge is power, and I am all in when it comes to empowering patients. They can learn that menopause is a phase and does not define who they are as a person. It is possible to survive and come out on the other side still thriving, while learning how to cope during the process. There is hope! 

Menopause Transitions and Pelvic Rehab is an excellent opportunity to understand the physiological consequences to the body as hormones decline, in order to assist our patients in lifestyle habits for successful aging. Lecture topics include cardiovascular changes, metabolic syndrome, bone loss and sarcopenia, neurological changes (headache, brain fog, sleeplessness), Alzheimer’s risk, urogenital changes, as well as symptoms and treatment options. These include hormone replacement, non-hormonal options, dietary choices, and exercise considerations.