Guest Post: Menopause symptoms and how to support yourself - Part 1

Guest Post by Dr. Karah Charette, PT, DPT, RYT

Treatment of Genitourinary Syndrome of Menopause

Have you ever heard of Genitourinary Syndrome of Menopause (GSM)? Unfortunately, this is commonly reported amongst postmenopausal women, but rarely talked about.

GSM is a condition that can result from the hormonal changes of menopause and result in symptoms such as vaginal dryness/burning/itching, urinary frequency/urgency/incontinence, and/or painful intercourse (dyspareunia).

These symptoms may be common, but that does not mean they are normal.  

A major component of treatment for these symptoms usually includes hormonal therapies because many of these symptoms can be driven by a lack of estrogen to these important urinary and genital structures. This should always be discussed with your doctor first.

However, evidence is now revealing that more conservative treatments such as pelvic floor physical therapy can help reduce or eliminate GSM symptoms in addition to hormonal therapies. 

Pelvic floor physical therapy can make a difference with these symptoms because oftentimes the pelvic floor muscles contribute to (or drive) urinary and sexual dysfunction. To understand this more thoroughly, read our comprehensive guide to pelvic floor therapy here.

Many pelvic floor muscles directly insert or connect to the urethra and the vaginal canal. Because of this, if these muscles are too tight (or over-recruited) and stiff, they can pull on these structures in ways that can create painful or irritable symptoms. Tight muscles are also not strong muscles. So in the case of urinary incontinence, you may be experiencing perceived pelvic floor weakness because your muscles are too tight to generate any force to close the urethra in response to increased pressure.

Tight muscles also mean that there is not good blood flow in that area. Blood flow is one of the most important aspects of healing. Nerves love blood, and nerves dictate our sensory experience in our body. If you are not getting enough blood to the nerves in your pelvic floor, this can also create a more painful and irritated environment.

Blood flow is also essential for hormones to get where they need to go. So even if you are using hormonal therapies, if the pelvic floor muscles and fascia are so tight that blood cannot get to those areas in an efficient way, this could lead to a decreased amount of regulating hormonal input in that specific tissue.

Blood flow, elasticity of tissue, and coordination of the pelvic floor muscles are essential in fully eliminating GSM. 

A systematic review and meta-analysis was performed in 2024 by Nguyen et al to review the effectiveness of pelvic floor therapy in relation to GSM.

The studies examined in this review focused on Kegels as the primary intervention. It is important to note that good pelvic floor physical therapy is more than just “kegels”. Kegels (or pelvic floor contractions) are just one aspect of holistic pelvic health and what influences those muscles to be tight or not. Even if kegels are indicated, a majority of people coordinate them incorrectly. A healthy kegel should be taught in the context of “range of motion” meaning that it is just as important to coordinate the muscles fully relaxing as it is to coordinate the contraction. If kegels are taught in this way, then an argument can be made that kegels are doing more than just “tightening” or “strengthening”. Good kegel practices (or pelvic floor contract relax work) can actually contribute to better blood flow, range of motion, and decrease symptoms alongside postural retraining, breathing optimization, and targeted core and gluteal strengthening with a skilled pelvic floor specialist.

All that being said, for the purposes of this study the only intervention that was implemented was “kegels”. And even with that being the sole intervention, there were still positive changes in the participants' quality of life. Imagine what more is possible when care is more comprehensive than just kegels!

This meta-analysis reviewed randomized controlled trials and ended up covering 5 studies with 268 participants. Most of the interventions ranged from 4-12 weeks. They found that with kegel interventions there was a significant improvement in health related quality of life for GSM urinary symptoms. 

Because this is a relatively new area of research, there is a less robust data pool to pull from to show the effectiveness of pelvic floor therapy in relationship to GSM. This type of care has been under studied and stigmatized for a long time. Luckily, more studies are coming out to show the effectiveness of pelvic floor therapy every year.

As a pelvic floor physical therapist, I have also seen firsthand countless amounts of cases where good pelvic floor training had a positive effect on many symptoms of GSM. With the right biofeedback and individualized care, you can change these symptoms and improve your quality of life.

Want to work with Dr. Karah Charette at Bodyful Physical Therapy and Wellness to address your symptoms? Book a discovery call today to learn more.