Written by: Betty Staff
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If you’re a woman over 40, it might seem like everyone’s suddenly talking about perimenopause and menopause—but only above the waist. It’s less common to hear about effects on the whole body—especially anorectal and perineal health.
Fear not! Betty Health is here with facts and tips for caring for your body as you move through these transitions.
What (and When) is Menopause?
Defining menopause seems simple: It’s the natural end to menstruation, generally considered permanent after 12 consecutive months without a period.
That definition seems straightforward. The experience is anything but.
- The typical age for menopause is between 45 and 55. But perimenopause—the phase leading up to menopause, when symptoms start—can begin up to 10 years earlier. In other words, women spend 30–40% of their lives in menopause!
- If you’ve had a hysterectomy and your ovaries are removed (a bilateral oophorectomy), you will go into surgical menopause immediately following the procedures.
- If you’ve had a hysterectomy and kept your ovaries, you’ll likely experience “natural” menopause, but not a last period. (Note: About 1 in 3 women in the United States undergo some type of hysterectomy.)
We don’t use “postmenopause” or “postmenopausal” because the transition is permanent. Once you’ve arrived, you’re in menopause for the rest of your life. Welcome 🙂
Common Vaginal and Anorectal Health Issues in Menopause
Beyond hot flashes, mood changes, and sleep patterns, menopause can also cause urinary tract infections (UTIs), pain during sex, and increase your risk of experiencing inflamed hemorrhoids.
Let’s break down some common vaginal, perineal, and anorectal challenges, and what you can do to help keep your body healthy through menopause.
1. Skin irritation and painful sex
As estrogen levels decline, the vaginal and perineal tissues get thinner, making them more prone to irritation and weakness. This is called genitourinary syndrome of menopause, or GSM. The cause is decreased estrogen in the genital area, which affects the vaginal and vulvar tissue.
Dry, irritated skin down there can be painful, especially during sex. Along with hormonal changes, that discomfort can reduce sex drive.
What you can do:
- Use lube. There are many options with different ingredients, but the type of lube really matters during perimenopause and menopause. In fact, water-based lubes can even make your symptoms worse. Consider using silicone- or oil-based lubrication, like Delight from Bloomi or Uberlube.
- Try a non-hormonal vaginal moisturizer. Vaginal hyaluronic acid suppositories (like Revaree® from Bonafide) help replenish vaginal moisture.
- Discuss with your healthcare provider whether local estrogen (which strengthens the tissue and helps it generate vaginal lubrication) is an option for you. Another possibility is a vaginal suppository like Intrarosa®. These inserts contain DHEA, a synthetic hormone that the body converts to estradiol and testosterone. That combination works better for some women than estradiol alone.
- Have more sex! No, really. Once lube or other treatments make it more comfortable, vaginal stimulation (with or without a partner) can increase the flow of blood and moisture to the vagina. It also strengthens the pelvic floor (the muscles that stretch from the pubic bone to the tailbone, supporting the bladder, bowel, and reproductive organs).
2. Bladder problems
Changing estrogen levels don’t just change vaginal and vulvar tissue. GSM also weakens the muscles of the bladder and pelvic floor. And the bladder has a surprisingly large number of estrogen receptors, so GSM-related hormonal changes can cause symptoms like feeling you need to pee more often, or more urgently.
(Side note: It’s tempting to label these symptoms generally as “overactive bladder,” but that’s a separate medical condition. GSM-related bladder issues have different treatment protocols.)
Recurring UTIs are another potential challenge in menopause. If you have UTI symptoms, talk to your provider right away. If these infections go untreated, there’s a risk of damage to kidney function.
What you can do:
- For any bladder-related symptoms, consulting with a healthcare professional is your best bet. They might prescribe low-dose vaginal or systemic estrogen or advise on other treatments.
- If you’re having more frequent UTI symptoms (burning during urination, needing to pee more often, or pain/pressure in your lower abdomen), don’t wait. Seek treatment.
- Practice preventive self-care: Remember to stay hydrated! And check out our other self-care tips below.
3. Problems with digestion and bowel movements
Because digestion slows down in menopause, your stool might be hard and harder to pass, making bowel movements difficult or painful. Straining to go can cause inflamed hemorrhoids and anal fissures (tears in the anus).
As hormonal changes weaken the pelvic and perineal tissues, you might also experience trouble holding in your stool. This less common challenge, called fecal incontinence, affects between 7% and 15% of women.
What you can do:
- Practice mindful bowel movements. Especially avoid straining to reduce the chances of inflamed hemorrhoids and anal fissures (find other helpful tips in this article).
- Consider your daily practices, making sure to include high-fiber foods, healthy hydration, and exercise that’s right for your body.
- Seek advice from a medical professional to assess your situation and identify the right treatment or supplements.
Getting Professional Medical Advice and Care for your Menopausal Symptoms
If this all seems a bit overwhelming, remember that millions of other women are moving through perimenopause and menopause. Although everyone’s experience with symptoms is different, we’re asking many of the same questions.
Do seek professional medical advice and care as you experience symptoms (or even before then) and get a second opinion if you feel you need one. We offer a starter pack of questions below.
In general, one of the most important things you can do is to continue regular health screenings:
- Continue regular gynecological screenings (including pap smears).
- Add annual anorectal health checkups, including colonoscopies, which doctors now recommend starting at age 45.
Five Questions to Ask Your Doctor About Menopause
Doctors’ appointments go fast, so come prepared with a list of menopause-related questions like the following:
- How will I know when menopause (or perimenopause) is starting?*
- What are your recommendations for monitoring my symptoms?
- Which hormone replacement therapies or other treatments do you recommend for me, specifically, based on my symptoms and my medical history?
- How can I deal with changes in urination and defecation? (AKA: How can I keep control of my bladder and bowel movements?)
- What can I do about pain during sex or vaginal dryness?
At Home Rituals to Manage the Transition into Menopause
In addition to the tips above, these at-home practices can ease your body and mind as you move through the menopause transition.
- Keep track of your symptoms. There are apps for that, or you can go old-school with a handwritten diary or a calendar. Take your tracker to medical appointments.
- Incorporate exercise, good nutrition, and hydration. Mindful lifestyle choices can go a long way in keeping us healthy through all of life’s transitions.
- Talk about your experiences. Sharing stories helps reduce stigma about menopause-related symptoms.
There’s still much to learn about menopause, but there’s more and more evidence about the effects on our body’s whole health. It’s our honor at Betty Health to be a part of this conversation and to offer solutions for healthier living for women at every age.