The M Word: Menopause and Your Pelvic Floor - Episode Transcript

Helen

Hi, I'm Helen, and this is Why Mums Don't Jump: busting taboos about leaks and lumps after childbirth. All the stuff that happens to your pelvic floor that no one ever talks about - incontinence prolapse, pelvic pain. Problems that affect millions of women, one-in-three! I'm one of them. I have a prolapse. My pelvic organs fell out of place after the birth of my second child. And if you had told me back then that I would be speaking about this stuff out loud, I would have told you to give your head a wobble.

Hello. Welcome back. Thank you so much for all your lovely messages after the launch of season three last week. Obviously, I still find it nerve wracking putting this stuff out there, so to hear that it's kind of landing in the right place at the right time, it means a lot. And you always make such great points. One person told me this week that the podcast is their main source of information about prolapse and made the point that that is actually ridiculous and it really is. Knowledge about our bodies and what we go through as women and as mothers should be baked in from an early age. Help and support should be freely available to everyone who needs it. We shouldn't have to be searching for it in the darkest corners of the Internet. But having said that, I'm very glad you're here. And do stick around because there's tons of great stuff coming up.

Today's episode, I am delighted to say, is sponsored by Modibodi, the original period and leak proof underwear. I came across them a couple of years ago because a side effect of my prolapse is that I can't wear tampons or cups anymore. They just don't stay in. Then I heard about period pants and I haven't looked back. Modibodi are my absolute go-to. They come in a range of different absorbences, a ton of different colours and shapes, and because they're reusable, they're better for the planet. I recently bought myself a Modibodi swimsuit, which I tried on holiday. It was great. There's even a maternity and postpartum range, which includes leak proof bras and camis. If you're fancy trying Modibodi for periods or for leaks, you can use the discount code WMDJ15 to get yourself 15% off (expired). Thanks very much to the good people at Modibodi for that.

Way back in the second episode, Pelvic Floor Problems 101, Katie Syrett, my physio, and I did a sort of beginner's guide to all things pelvic floor, and menopause came up and I promised that we'd talk some more about it. So here we are. Yes, okay. It's taken a while, but in that time there's been a bit of a menopause revolution. It's everywhere. There's so much more awareness now. There was the Channel Four documentary with Davina McCall. All the celebrities have been speaking out. There's a ton of brilliant books here in the UK. Prescription charges for HRT have been cut massively and workplaces are announcing menopause will leave policies. It's amazing. The stigma is really starting to fall away and it gives me hope that change is happening, that we can talk openly about women's health issues and that they're starting to get the attention and support they deserve. So that's all good stuff.

When I started all of this, I really didn't consider menopause to be something I needed to worry about at that point. Like a lot of us, I thought it was something that would happen way down the line and I had enough on my plate, to be honest. I'd only just become a mum. And then I started hearing about pelvic floors and menopause and how it's oooh not good news. And then I really wanted to stick my head in the sand because nobody wants this stuff to get any worse. But this is me now, getting my head out of the sand and really embracing it. And I have the perfect person to walk us through it. Michelle Lyons, a physio of 30 years who has qualifications not just in that, but in yoga, Pilates, mindfulness nutrition, but to put it simply...

Michelle

Hello, my name is Michelle and I'm a pelvic health nerd.

Helen

I think you can see why I wanted Michelle to come on the podcast. Trust me, she's going to make us all feel much better

Helen

...and all you hear about is, well, you know, pelvic floor problems. Yeah, that's bad. But when menopause comes, well, that's game over.

Michelle

Boom! Hang up your boots!

Helen

It's terrifying! Yeah.

So so, right. So let's just start right at the beginning and let's just try and get across some useful information. So when does menopause really start, or perimenopause? What age? Is there an age?

Michelle

Well, kind of. So one of my favourite answers is always going to be 'it depends'. So on average, women around the world experience menopause at the age of 51 and that seems to be a fairly global phenomenon. But here's the thing. Menopause technically only lasts for one day because all menopause means is that it's been twelve months since you've had a period.

So technically menopause - one day - then you're postmenopausal. But actually a lot of the issues that women face in terms of the symptoms that we, and I hesitate to even use that word because it makes it sound like a disease. The issues that women face are actually happening in perimenopause, which is going on for that ten to 15 years before your last period. And that's when we see a lot of kind of almost like a roller coaster of our hormones and that can lead to a lot of issues. You know, everybody, you ask anybody, you know, what's the main symptom of menopause? And they're probably going to say hot flushes, you know, or night sweats. But there's so much more to that, to perimenopause. You know mood changes, insomnia, super heavy, irregular periods that can leave you quite tired and anemic and caught out sometimes as well. Breast pain, weight gain, unexplained weight gain around the centre of your body out of nowhere. Joint aches and pains, particularly shoulders and hips...and feet. Obviously you probably hear a lot about bone health, but it's the muscle and tendon changes that can be quite problematic.

And then the pelvic health issues. And often at perimenopause, what can happen is maybe some of the issues that we developed after we had our babies come back and say hello, remember me? Haven't quite gone away and now that there's no estrogen, let's talk about leaky bladder's, bowel leakage -one in five women over the age of 40 has some sort of bowel leakage - pelvic organ prolapse, that sense of heaviness and dragging in the vagina that can lead to back pain. And all of these issues can seem so much worse when you're not sleeping, which I think is just such an important underrated part of perimenopause as well. Everything seems big and bad and powerful and overwhelming when you're not sleeping. So there's so much going on and it can feel like, where do I start?

Helen

I mean, that is a whole list of complaints there that could be related to anything. It's quite outfacing as well, actually, and a bit daunting. The idea that you're going to go through all that.

You've talked a little bit about all the different symptoms and what that might mean for the pelvic floor. Without getting too technical, what is the science around that?

Michelle

So the, the short answer is often estrogen.

Helen

Okay

Michelle

Because estrogen is this amazing hormone that does about 400 different things in the female body and it's really important when it comes to pelvic health, to bladder health. So if you're having increased frequency of trips to the loo, increased urgency that you're not going to make it there on time, that can be because decreased estrogen means that your bladder is less elastic. It can actually shrink your bladder when you've got low estrogen, so you're going that bit more often. Also, the main way that we have of keeping bladder control is, yes, our pelvic floor muscles are super important, but estrogen also, it plumps up the tissues around the openings in our pelvic floor as well. So if we're low in estrogen, then that just means that there's a little bit less of a secure closure mechanism going on around the urethra, the opening to the bladder or the opening to the bowel as well. So the tissues get a little thinner, a little bit less elastic, a little bit more irritable when we've got low hormone state.

Can I just though, circle back to all that list of doom and gloom symptoms? The good news is they're all workable with - all of them. So lest everybody be despairing after my list, everything is figureoutable. So don't panic. That's the most important message.

Helen

We'll get on to some of those ways that you might sort of help yourself in a minute, but one of the things I'm wondering and many of the people who listen to the podcast probably feel the same, is because I already know that I have a prolapse. I already know that I've got issues with my pelvic floor. Will it automatically get worse?

Michelle

Doomed haha

Helen

Are we in just a worse position than the rest of female kind because we're already there?

Michelle

No, not at all!

Helen

Yay. More good news hurrah!

Michelle

Because the first thing is really just to remember that knowledge is power. Okay? So for example, from a prolapse perspective. So we know that with a prolapse we're getting maybe a loss of support from the ligaments that keep the organs up where they're supposed to be, and maybe a little bit of weakness in the pelvic floor as well. So in the same way that we will strengthen the muscles, we'll do our pelvic floor muscle rehab. Brilliant. But in the same way that if you were going out for a run, you'd wear a sports bra, you can get these wonderful things called pessaries that are like sports bras for your pelvic organs. And they're brilliant. If you've just got a really mild prolapse, sometimes just doing things like your pelvic floor muscle training, avoiding constipation - because you're straining to have a bowel movement and that puts a lot of downward pressure - and being careful with your lifting that you're not holding your breath when you're lifting things or going from sitting to standing. Sometimes if it's just a really mild prolapse, that's enough. But there's no reason for women to suffer through any part of menopause because there are solutions for all of it.

Helen

This is making me feel much better. Thank you very much.

So what are some of the things that we can all do to try and avoid some of these problems or avoid making whatever problems we've got any worse?

Michelle

Okay, so for anybody who's heard me talk about this before - because I spend most of my time kind of educating other healthcare providers about menopause - one of my topics of obsession is constipation.

Helen

Okay

Michelle

Because it's so important.

For women with back pain. We know that bladder control, bowel health and breathing are more important than if you're overweight or if you're not very active. Those are the three key things.

Helen

Really? Ok.

Michelle

Absolutely. For hormone balance, we need to be having these happy, healthy bowel movements, ideally every day, because that's how your body gets rid of excess hormones. So again, if we're looking for a nice kind of stability from our hormones as we go through perimenopause, bowel movements are key. If you're prone to a bit of prolapse or you're prone to a bit of bladder urgency or frequency, constipation makes those worse.

So how do we counteract constipation? Looking for a healthy, whole food, primarily plant based diets. We're moving our bodies every day, a 20 minutes walk every day. Brilliant for constipation. A little bit of gentle yoga, also good drinking enough water. Because sometimes with this bladder leakage, we're afraid we're going to leak if we drink too much water. But if you're not drinking enough water, that's also problematic, isn't it? So making sure you're drinking enough water, moving your body, relaxing your pelvic floor - really important because that's one of the problems with constipation, where we're holding everything super tight. So just letting go, literally, and having good bowel movements every day.

From a mental health perspective, hormones, gut health and pelvic health, that's really the foundation for everything else. And then you can get into more kind of prescriptive exercise for shoulders and hips and feet, eating well, sleeping well - having good sleep hygiene strategies, vital. And this one is going to be - for me, it was a hard pill to swallow because I liked my gin and tonic on a Friday night...

Helen

No. Don't say it, Michelle.

Michelle

I have to say it. I have to say it. Alcohol is not the friend of a perimenopausal woman. I'm sorry. I'm so sorry.

Helen

I think we all already know that.

Michelle

I know. There's knowing and there's knowing, though. I'm not saying never, but if you're struggling with sleep, it's the first one that I look at eliminating.

Helen

That's the issue with the alcohol, the sleep, right? Is that the thing?

Michelle

Well, it's the sleep, but also it's really a disruptor to good hormone balance, because when you drink alcohol, your liver sees that as a toxin. And so it prioritises dealing with that and processing that and getting rid of it, which means that it can't deal with the excess hormones that you might have. And unfortunately - more bad news for booze - alcohol is strongly correlated to breast cancer, and it's in our perimenopause and postmenopausal years that we're most at risk. So there's a strong correlation between breast cancer and drinking alcohol regularly. So it's one of those things that there can be a lot of resistance to it, because it's so tied in for some of us with our social lives or unwinding at the end of the day. But honestly, it is just...I'm not saying never, but rarely is it a good idea. It's just a good idea to scale back, if not eliminate.

Helen

A lot of these things that you're talking about, I guess, are things that often we can work out by ourselves, I suppose. Like, I mean, do we need specialist care? Do we need to go to the GP? When do we need to seek that kind of support? How much can we do by ourselves?

Michelle

We can do a lot by ourselves. And sometimes hormone therapy is brilliant as well. I'm a big, big fan of topical estrogen creams for pelvic health. If you're having, like, chronic urinary tract infections, topical estrogen cream, it's really this very minimal systemic absorption. So it's safe even if you've had breast cancer. For most women who've had breast cancer, it's even safe because it just doesn't get into your system. But if you're having frequency, urgency, repeat infections, if you're having pain with sex because your vulva and vagina are really dry and irritated. Topical estrogen can be an absolute game changer. I would try vaginal moisturizers and lubricant first, but really vaginal estrogen is very, very safe.

You know we've really seen an explosion in the discussion around hormone therapy. And for women, it can be an absolute game changer. It's not a magic bullet - hormone therapy - that you can use by itself, but it can be a really good adjunct to helping women feel better. And then... I always think of that quote from Brene Brown. She talks about how at midlife the universe comes up and kind of takes you by the shoulders and says, it's time to stop screwing around. We're halfway through. Get your act together, start looking after yourself. And I think for many women, hormone therapy can be that boat to get you to the other side.

Helen

Yeah, it's not like - I'm going through perimenopause. I go through my GP, I get HRT, I am fixed. That is it. - We've got to take a bit more responsibility. I suppose.

Michelle

We have to do the work as well in looking after ourselves because the rewards are great. We know after menopause, women are just at this increased risk of brain health. Like, twice as many women as men end up with dementia. And heart health. Our risk for heart attacks goes up so much after menopause. And because women don't have what's referred to as the typical symptoms, ie The male symptoms, of a heart attack, it's missed. So there's so much that we can do to prevent these things from happening in the first place. But a lot of it just comes back to those big rocks of eating well, sleeping well, moving well, and managing your stress.

Helen

And I suppose this is another one of those times when I think about the message that we often give to women with pelvic floor problems don't run, don't jump, don't lift.

Michelle

I know.

Helen

And it leaves - I was left for years with this fear of movement and obviously you're laying it out that movement is good. We need to be able to move, we need strength

Michelle

It's essential

Helen

Yeah, I just don't think that message is...it's just starting to change.

Michelle

Yeah. Strength training is vital for women at menopause because - and the research shows that strength training is probably I hesitate to use the word safer, but strength training is better for your pelvic floor maybe, than running because if you're strong, first of all, it's going to load your muscles and your bones. That's going to help with your metabolic health. You're going to burn more calories even while you're sleeping. So yay for that. But strength training means that if you're going to lift something heavy, you've got strong arms and legs to do the power of the move. And you're not holding your breath and bearing down your poor old pelvic floor and maybe putting your bladder or your prolapse under a little bit of pressure. So strength training is suitable for everybody. It's just having this graded approach that you start where you are and then you find somebody to work with who can progress you through.

So it's to find some sort of strength training that you actually enjoy doing. That could be body weight. You can use body weight in yoga for loading your bones. It could be TheraBand, it could be free weights. It could be going to CrossFit and having somebody scale a workout for you. It's about finding something that you actually enjoy and that you'll be consistent with. Like, it could be air squats. It could be you and I, when we're finished chatting here, standing about of our chair and doing ten air squats.

Helen

Hang on, hang on. What's an air squat?

Michelle

So if you stand up, hold on. Oh, she's going to do it. Okay, now stick your bum out as if you were going to sit down, but don't actually sit down. Just tap the chair with your bum and stand back up again.

Helen

Okay, so a squat basically?

Michelle

Basically a squat, yeah. But you're not going down too far. You're controlling it. And the key is, can you breathe during the movement? Because if you're holding your breath, you're probably bearing down a little bit on the pelvic floor.

And then once air squats like that get easy, then you can maybe start holding some weights. And it could be just holding a couple of water bottles and then holding a couple of bigger water bottles and then maybe going out, going to Lidl or Aldi and getting one of their kettlebells on sale, something like that. And just really trying to integrate movement snacks into your day, because lots of us are super busy and we maybe don't have the time to go to the gym two or three times a week. So how can we bring strength training into our daily lives? But again, just to really be clear, don't hold your breath while you're lifting because that's going to put a lot of downward pressure on the pelvic floor, but also on your blood pressure as well, which isn't great.

Helen

I love this. I feel like we've had some really kind of practical, useful advice that people can use. If you had a real sort of take home message for women who are just starting to think about perimenopause and menopause and what that might mean for their bodies, what would the real simple advice be?

Michelle

Okay, so if we could break it down to three short sentences. Okay. Move your body every day, in a way that brings you joy. Don't get constipated, and don't put up with not feeling well. If you're suffering with some of these symptoms of menopause, go talk to somebody. Go talk to your GP. Ask them if they or somebody else in the practice has a special interest in menopause. Ask to go see your pelvic floor physio. Don't put up with not feeling great.

Helen

I love this. I think we all just need to channel a little bit more Michelle, take ownership of our own perimenopause, menopause, whatever it might be. Get it sorted. Maybe just have a little drink. Just sometime. Just on Friday or Saturday.

Michelle

Once in a blue moon. Maybe a small one.

Helen

Well, I'll leave that one up to you.

But it's so true that knowledge is power, so I hope that's giving you some comfort. Michelle Lyons, pelvic health nerd can be found on instagram and online. I'll put links in the show notes.

She mentioned pessaries there - if you want to know about my personal saga, you can catch up on Instagram.

Please don't take any of this as medical advice. Do seek out your own support, and do get in touch and let me know what you think.

Next week, we're going to hear from a listener with bowel incontinence who tells her story so bravely and beautifully. It's honestly really inspiring.

Thanks to everyone who has shared the podcast this week. It makes such a difference, and please keep on doing it in whatever way you can. And if you've got a few minutes to spare, I'd be so grateful if you consider leaving a review on Apple podcasts or wherever you listen. You can support the podcast on buymeacoffee.com/whymumsdontjump and you can find me on social @whymumsdontjump online whymumsdontjump.com. Bye for now.