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Post-Menopause Wellness Guide

Overcoming Gynecologic Challenges

When you think of common health concerns among women sixty-five and older, what comes to mind? Osteoporosis, breast cancer, diabetes, and hypertension are common challenges faced by older women, but there is so much more than that. 

Many women assume that once they enter menopause and their baby-making days are in the past, their need for an OB/GYN
diminishes. In fact, the exact opposite is true. Women sixty-five and older often find themselves needing to spend more time at their gynecology office – aside from their routine screening exams. Menopause marks the end of menstruation and the challenges that come with it; but on the flip side, it marks the beginning of a new phase of life – and new potential health challenges. Let’s review some of the changes and challenges that often follow menopause.

Decreased estrogen causes new challenges in a new phase of life.

Estrogen plays a major role in the overall health and wellness of a woman’s body. From puberty until menopause, estrogen helps with regulation of menstruation, monthly ovulation, lactation after pregnancy, and mood swing management. However, after menopause, a woman’s ovaries do not produce nearly as much estrogen or other hormones. This decrease in estrogen levels can lead to several gynecological challenges for older women. In fact, most women in their mid-sixties and older will likely experience some ill-effects from estrogen deficiency.

Challenges such as vaginal atrophy, chronic urinary tract infections, urinary incontinence, pelvic organ prolapse, and postmenopausal bleeding most often occur after menopause, in part due to an estrogen deficiency. Any of these can have a major impact on a woman’s wellbeing.

Women tend to associate these issues with getting older and think it’s normal to experience them once we reach a certain age. But just because these issues are common does not mean they are normal, or that you are doomed to suffer because you are aging. Your women’s health provider can help you find management methods to achieve and maintain a better quality of life. Let’s talk through some of the most common post-menopausal challenges women face but often hesitate to bring up
with their provider.

Vaginal atrophy: After menopause, the vaginal walls can become thin, dry, and inflamed. This is called vaginal atrophy. This change in vaginal tissue occurs as a direct result of estrogen deficiency combined with the effects of aging. Vaginal atrophy can affect women in different ways. A woman with vaginal atrophy can often experience chronic burning, itching, inflammation, painful intercourse, recurrent urinary tract infections, and/or urinary incontinence. Vaginal atrophy and the issues that come with it can be managed in a variety of ways. There are both hormonal and non-hormonal management options for patients, and your women’s health provider can determine what is most appropriate to suit your needs.

Urinary incontinence: Imagine every time you cough, sneeze, laugh, or jump… you leak urine. While incontinence is not normal, it is a reality for many women, especially later in life. It is estimated that up to 30 percent of women ages sixty-five and older suffer from urinary incontinence and that 50 percent of all women who live in senior residential facilities have some form of urinary incontinence.

There are a few age-related changes in the female body that put older women at a greater risk than older men for developing incontinence. These include a diminishing estrogen supply, weakening of the detrusor muscle (a muscle inside the wall of the bladder), and pelvic organ prolapse. Aside from the physical changes mentioned, there can also be contributing factors that are associated with aging, such as a medication, constipation, limited mobility, confusion/delirium, and chronic urinary tract infections. There are many treatment options for urinary incontinence, and your OB/GYN or urogynecologist can help you find relief. You just have to ask.

Pelvic organ prolapse: Where there is urinary incontinence, there is also likely to be a weakened pelvic floor and with that, pelvic organ prolapse. Prolapse is a disorder where damaged or weakened muscles or tissue in the pelvic floor cause pelvic organs to drop from their normal positions. Symptoms of prolapse include feelings of pressure, discomfort, aching or fullness in the pelvic floor that often worsen as the day goes on. Sometimes, patients can even see a bulge coming out of the vagina. The uterus, bladder, and rectum are the three most common of the pelvic floor organs to potentially prolapse.

What puts you at increased risk for experiencing a pelvic organ prolapse? The usual culprit, estrogen deficiency,  can cause decreased turgor (the pressure inside cells that causses tissue elasticity), which can result in a weakening or stretching of the pelvic floor during and after menopause. Aging can also cause prolapse. Women who are older than eighty are most likely to be affected by pelvic prolapse, although approximately 37 percent of all pelvic floor disorders occur in women between the ages of sixty and seventy-nine. 

Often, this condition is the result of childbirth, as vaginal delivery can strain and eventually stretch the connective tissue of the pelvic floor. The risk increases with multiple deliveries or if the baby weighed more than eight pounds at birth. There are some other causes: obesity puts pressure on your abdomen which can lead to a weakened pelvic floor; straining to have a bowel movement can weaken the pelvic floor; and frequent coughing can put a strain on your pelvic floor.

Unfortunately, women often ignore the symptoms of prolapse due to embarrassment or fear. But there are several ways your provider can help mitigate the problem. Physical therapy, pessary devices (an elastic or rigid device that is inserted into the vagina to support the uterus), and surgical intervention are the three most common ways your women’s health provider can treat pelvic organ prolapse. This is another area where urogynecologists can help determine the best solution.

Do not suffer in silence.

While the gynecologic challenges women encounter after menopause are common, women shouldn’t see them as normal or something to be accepted. There are many options to ensure an all-around quality of life; however, your women’s health provider won’t be able to help you find a solution if she doesn’t know you are suffering. The goal of women’s health providers is to make women feel comfortable and confident in talking to us about their struggles so that we can help find treatment options that meet their individual needs. With everything women’s bodies endure throughout our lives, we deserve to live our golden years in comfort. Your OB/GYN will strive to help you get there. 

Lauren Cook, NP, became passionate about women’s health working in the women’s health and oncology units at Johnston-Willis Hospital. She decided to become a nurse practitioner and landed her dream job at Virginia Physicians for Women where she could provide the knowledge, patient education, and counseling that women deserve. She and her husband live in Chesterfield with their two nieces and two fur babies.
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