Post-menopause describes the stage of a woman’s life after she has experienced menopause. Menopause is defined by a woman ceasing to have a monthly period or menstrual cycle. Menopause is confirmed when a woman has not had a period for 12 months. Post-menopause encompasses the rest of a woman’s life after she has experienced menopause.

Symptoms/Functional Problems
Some women may continue to experience menopause symptoms into the post-menopause stage. This can include hot flashes, irritability, insomnia, weakness, urinary incontinence or urgency, osteoporosis (decreased bone density), vaginal dryness, dyspareunia (painful intercourse), cognitive changes, low back pain, and more. ⁽¹⁾

Causes
As a woman’s body ages, around late 40s or early 50s, it is common for her body to cease production of hormones (such as estrogen), and her ovaries no longer release eggs. ⁽²⁾ This is what causes the cessation of a menstrual period (or menopause). This low level of estrogen causes women to have a higher risk of developing osteoporosis (decreased bone density), heart disease, or other health conditions. A hysterectomy is a surgical procedure in which a woman’s uterus is removed. A hysterectomy will not necessarily cause menopause symptoms unless the surgeon also removes one or both ovaries and fallopian tubes ( salpingo-oophorectomy ). If one ovary is removed (unilateral oophorectomy) or both ovaries are removed (bilateral oophorectomy), a woman may experience post-menopause symptoms and require hormone replacement therapy. A hysterectomy may involve removal of one or both ovaries. If both ovaries are removed, menopause begins immediately after the procedure. If only one ovary is removed, menopause may begin within 5 years after the procedure. With the removal of one or both ovaries, you will experience a decrease in estrogen which causes the onset of menopause and post-menopause symptoms. ⁽³⁾

FAQ

Q: Can physical therapy help my menopausal symptoms?
A: Yes. A pelvic floor physical therapist can address many symptoms related to menopause including muscle strengthening for improved bone density to reduce risk of a bone fracture if a fall does occur, balance training for fall prevention, pelvic floor strengthening or relaxation for urinary incontinence difficulties, instruction on exercise to address insomnia, evaluation of the pelvic floor to identify cause of dyspareunia, and more. Early intervention is important to address symptoms before they become worse.

Q: Does every woman experience menopause?
A: Yes. It is a natural process that every woman experiences.

Q: How long do post-menopause symptoms last?
A: Every woman is different. Post-menopause encompasses the rest of a woman’s life after she has gone through menopause. There are interventions, such as physical therapy, that may improve symptoms and quality of life.

Q: Is urinary incontinence treatable after menopause?
A: Yes. Pelvic floor physical therapy can help improve your muscle strength, the quality of your pelvic floor muscle activation, and overall quality of life for those who experience urinary incontinence or urgency. ⁽⁴⁾

Q: Is it normal to have vaginal dryness and/or pain with sexual intercourse after menopause?
A: Yes. Both of these are common symptoms which women experience after they have gone through menopause. These are symptoms that describe the post-menopause period, and both usually respond well to therapy. Pelvic floor physical therapy is highly effective in improving pain with intercourse, your muscle function, sexual function, and quality of life regarding these private topics. ⁽⁵⁾

Q: Would I benefit from pelvic floor physical therapy (PFPT)?
A: If you are a menopausal woman and experiencing any of the symptoms described here, you may benefit from PFPT. This specialized therapy has been shown to improve the discomfort of menopausal symptoms and prevent problems that may show up later on.

Treating and Managing Your Post-Menopause

Physical therapy has been shown to improve many post-menopausal symptoms that women experience. One study states, “Regular exercise has been highly promoted and recognized as the best non-pharmacological treatment for postmenopausal problems”. ⁽⁶⁾ This same study evaluated symptoms of insomnia in women with post-menopause symptoms, and they experienced an overall improvement with the initiation of exercise training. As mentioned before, women are at increased risk for heart disease. Another study demonstrates that exercise training helped women improve their cardiovascular health and fitness while also improving their hypertension. ⁽⁷⁾

At N-Balance Physical Therapy, we offer a comprehensive treatment plan that includes a thorough evaluation to identify the cause of the problems you are experiencing and implement an individualized treatment plan to improve your symptoms and quality of life.

References

1. Dalal, P. K., & Agarwal, M. (2015). Postmenopausal syndrome. Indian journal of psychiatry, 57(Suppl 2), S222–S232. https://doi.org/10.4103/0019-5545.161483
2. Menopause, Perimenopause and Postmenopause. Cleveland Clinic. (n.d.). https://my.clevelandclinic.org/health/diseases/15224-menopause-perimenopause-and-postmenopause. 
3. NHS. (n.d.). NHS Choices. https://www.nhs.uk/conditions/hysterectomy/considerations/. 
4. Bertotto, A., Schvartzman, R., Uchôa, S., & Wender, M. (2017). Effect of electromyographic biofeedback as an add-on to pelvic floor muscle exercises on neuromuscular outcomes and quality of life in postmenopausal women with stress urinary incontinence: A randomized controlled trial. Neurourology and urodynamics, 36(8), 2142–2147. https://doi.org/10.1002/nau.23258
5. Schvartzman, R., Schvartzman, L., Ferreira, C. F., Vettorazzi, J., Bertotto, A., & Wender, M. (2019). Physical Therapy Intervention for Women With Dyspareunia: A Randomized Clinical Trial. Journal of sex & marital therapy, 45(5), 378–394. https://doi.org/10.1080/0092623X.2018.1549631
6. Llanas, A. C., Hachul, H., Bittencourt, L. R., & Tufik, S. (2008). Physical therapy reduces insomnia symptoms in postmenopausal women. Maturitas, 61(3), 281–284. https://doi.org/10.1016/j.maturitas.2008.08.004
7. Lin, Y. Y., & Lee, S. D. (2018). Cardiovascular Benefits of Exercise Training in Postmenopausal Hypertension. International journal of molecular sciences, 19(9),
8. https://doi.org/10.3390/ijms19092523