The average age we start Menstruating is 12 years this is called Menses. The average age we stop is 51 years, called Menopause.
The regular menstrual cycle commences with a follicle growing in the ovaries. This growth is stimulated by a hormone in the pituitary gland, Follicle Stimulating Hormone (FSH). As the follicle grows, it stimulates the production of Estradiol (one of the three types of Oestrogen produced in our bodies). The bigger the follicle, the more Estradiol is produced. Once the optimal level of estradiol is reached, this will stimulate a sudden release of a different hormone from the pituitary gland called Lutienizing Hormone ( LH), which triggers the release of the egg. The release of the egg is ovulation.
So what changes as women get older?
In early “Peri-menopause”, there is a fall in the follicular function and production. The pituitary hormone levels (FSH) will rise to try to encourage and stimulate this production. These high sustained levels of FSH can cause cycles to be long and variable. As a result, ovulation will occur less frequently in cycles. The other pituitary hormone (LH) doesn’t get triggered and thus NO egg released.
Heavy blood loss is seen in late “Peri-menopause” and is likely to be a result of raised Estradiol levels for longer periods of time, leading to increased thickening of endometrial tissue. This process can occur for several years prior to menopause.
Eventually Estradiol levels peter off to such a low level periods cease. Menopause is defined as 12 months without a period.
Music to a women’s ears - No Period!… BUT.. Oestrogen plays a key role in keeping our skeletal muscles ( including the pelvic floor muscles ) robust, our connective tissue strong and our blood vessels plump. It is estimated that we loose 2% of our urethral muscle fibres every year starting in our mid 20’s! A study by Trowbridge et al 2007 found that the urethral closure pressure in 30-40 year olds was on average 92cmH20, in the 70-80 year range it dropped to 37cmH20! Remembering from the first blog of this series, one of the things we need to be continent is high pressure around the urethra.
As a result, post menopausal women can present to a women’s health physiotherapist with symptoms of urinary incontinence, urinary frequency or urinary urgency, pelvic organ prolapse and dyspareunia (painful sexual intercourse).
Physiotherapy management of these symptoms includes pelvic floor strengthening, sometimes fitting of pessaries, if pelvic organs need supporting. Physiotherapists may also refer patients back to their treating GP to discuss Oestrogen replacement options, or to a naturopath for natural alternatives. If dyspareunia is a problem we discuss lubricant options and discuss other ways to maintain intimacy should intercourse be too difficult.
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