Menopause – I don’t know who I am anymore… is this the way it is now?

Menopause – I don’t know who I am anymore… is this the way it is now?

I don’t know who I am anymore… is this the way it is now?

Perimenopause, Menopause and Post-menopause

10 tips to a comfortable menopause journey

So, we know that menopause is a process that happens to all women at some point. Many of us assume that the common symptoms of perimenopause including hot flushes, irritability and discomfort are a “normal” and inescapable part of the process. You may be surprised to know that this is not the case! As with puberty, while our bodies change, it is not a life sentence. It can just be a transition. It is true that many women suffer horribly. It is also true, that with a diet and lifestyle that supports our hormones to balance, including cortisol and DHEA as well as the more widely known oestrogen and progesterone, we can transition through this period of life, comfortably! Life after menopause can be lively, exciting and something to look forward to. A stage of life blessed with increased wisdom and being comfortable in your own skin. Travelling through your Golden years with ease and grace.

Symptoms

These tend to vary from person to person and some women hardly notice any. An incomplete list includes:

  • Hot flushes
  • Breast tenderness
  • Worse PMS
  • Lower Sex drive
  • Headaches and migraines
  • Fatigue
  • Depression
  • Irregular periods
  • Vaginal dryness
  • Discomfort during sex (due to dryness)
  • Urine leakage when coughing or sneezing
  • Urinary urgency
  • Mood swings and irritability
  • Trouble Sleeping

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Perimenopause is the transitional stage between regular monthly periods and reaching menopause (defined as the point in time when a woman has had 12 months since her last period). The stage after this is classified as post-menopause.

Pre-menopause is the stage of life between puberty and menopause. A stage where hormones tend not to fluctuate much, a woman tends not to suffer any symptoms associated with menopause and she is in her reproductive years.

Perimenopause begins when the oestrogen produced in the ovaries starts to reduce. Often resulting in several years of irregular periods due to the more sporadic release of oestrogen and progesterone (as well as cortisol and DHEA). Sometimes the hormonal fluctuations as so large or out of balance that we may experience symptoms such as depression, moodiness and irritability, weight gain, discomfort, reduced memory and concentration, muscle aches, as sense of being uncomfortable in our own skin, hot flushes, hair loss, breast tenderness, reduced libido and sexual pleasure and vaginal dryness, to name a few. This stage may begin sometime between the ages of 35 and 50 years and can last from as little as a few months, to as long as 15 years with the average, being around 4 years. In the final stage, oestrogen levels may decline sharply. Symptoms may be most pronounced at this time, expanding to include things like urinary urgency and frequency or even incontinence; depression and anxiety as well as night sweats, fatigue and skin dryness.

Menopause occurs when there is no longer enough oestrogen produced by the ovaries to trigger the uterine lining to build, the release of an egg or the shedding of the uterine lining. This is the point where fertility ceases. Contrary to what some of us thought, during the perimenopausal stage, conception is still possible.

Treatments:

Medications:

Doctors can prescribe

  • Oestrogen creams for vaginal dryness, pain and discomfort
  •  Progesterone creams for breast tenderness
  •  The pill or other hormone replacement therapies to try to minimise symptoms
  •  Creams or tablets to reduce bladder irritability

Look into the options and side effects for yourself before you decide

10 Natural Tips for a Comfortable Menopause Journey
  • Exercise
  • Stop smoking
  • Get more rest/sleep
  • Reduce alcohol intake
  • Be in a healthy weight range
  • Ensure you don’t have a vitamin or mineral deficiency (magnesium, vitamin D, vitamin C, omega 3, evening primrose oil [internal or topical])
  • Reduce foods that have the potential to alter hormone balance in the body => Processed, hydrogenated and trans-fats; Highly refined carbohydrates (especially sugars); Caffeine; Alcohol
  • Pelvic floor exercises to support the pelvic area and the bladder (as incontinence is a symptom of hormonal imbalance associated with perimenopause)
  • Using natural oils (jojoba, coconut, olive) as lubricants down there as a lubricant during sex, or during the day to allow more comfort
  • Add an anti-inflammatory, alkalising, plant rich diet

Always consult your doctor if you have strong pain, very heavy bleeding or bleeding for more than 7 days longer than your usual period

Are you ready to improve your health and vitality and reclaim your body and life? Dr Anna Cabeca has a new book with one approach to help you do just that.

Pelvic pain and dysfunction part 3: 7 tips to nip that pain in the butt

Pelvic pain and dysfunction part 3: 7 tips to nip that pain in the butt

Pelvic pain and dysfunction part 3: 7 tips to nip that pain in the butt

In part 1 and part 2, we discussed the symptoms and causes of chronic pain and the basics of an effective treatment and management plan. Let’s discuss what you can do NOW to help improve your situation.

Many structures are in the pelvis, underneath the bladder, bowel and uterus. All these structures can irritate each other if inflamed, enlarged, irritable or tight. Gaining improvement can be as simple as reducing irritability to just 1 of these structures, or it may require addressing all of them.

While effective treatment and management requires a multi-faceted approach, there are a number of lifestyle modifications that can be easily implemented to start reducing triggers, allowing the nerves more mobility and reducing the nervous system tension in order to directly impact the negative cycle and start increasing comfort now.

Tip # 1:

Minimise activities that tend to trigger and aggravate pudendal and perineal nerve irritation such as:

  • riding a bicycle (especially for long periods)
  • horse riding
  • jumping (for example, on a trampoline)
  • intense exercise
  • lifting weights (anything over 5 kg is too much)
  • anything that causes intense pain (if 0 is no pain and 10 is the worst pain imaginable, do not go over a pain scale of 7/10).

Tip # 2:

For any activity where you know pain comes on after a certain period of time (for example sitting for more than 5 minutes):

  • Ensure that you set an alarm and only sit for 4 minutes at any one time.
  • When the alarm goes off – get up!
    • go to the toilet or get a drink or stretch before continuing to sit
    • when sitting again, ensure the alarm is set for another 4 minutes.

Tip # 3:

Ensure you have good posture in any activities you perform for a prolonged time (more than a few minutes). Get ergonomic advice if required.

For sitting:

  • ensure that your knees sit at the same level or slightly lower than your hip joints.
  • allow your pelvis to rotate forward slightly, keeping a slight extension in your lower back – this happens naturally when your knees are lower than your hips, helping to keep the natural spinal curves.

This ensures your back is “straight” with your head sitting directly over your pelvis.

It also helps your shoulders to sit in a good position, not rounded forward or held up high towards your ears.

  • Make sure that you don’t lean on your elbows or put too much pressure on your wrists (or you will get elbow or wrist strain injuries) (it also pushes your shoulders up and tends to make you lean to one side).
  • ensure that your feet are flat on the floor (use a floor stool if required for comfort)
  • ensure the seat is cushioned a little (especially if you have pudendal nerve pain) – you can use a doughnut ring if pain is more severe.

Tip # 4:

Lie with your legs up the wall for 5-10 minutes in the evenings

  • lie on your back, on the floor with your shoulders relaxed and rotated backwards
  • get your bottom as close to the wall as possible. Adding a cushion underneath your bottom to raise the angle of your pelvis.
  • place your legs up the wall and relax (you could use a meditation or relaxation app at the same time)
  • only stay for 5 minutes initially, but if it gets painful, stop. Aim to get to 10 minutes per night.

This exercise

  • allows pain relief in the pelvic area – for vaginal issues, haemorrhoids, pudendal nerve pain, period pain and also assists with reducing pressure associated with incontinence issues
  • increases blood return to heart, therefore helps with venous return in general and varicose veins/haemorrhoids etc
  • allows the spine to relax and lengthen after a day of compression forces from standing and sitting.

Tip # 5:

Avoid straining on the toilet

  • To avoid constipation, it’s important to keep hydrated, eat healthy fruit and vegetable fibre, exercise regularly and use a natural laxative if necessary (avoid stimulant laxatives).
  • Don’t sit for extended periods as this stretches the ligaments and increases the pressure in the wrong spots increasing likelihood of pain around the buttock (inferior cluneal nerve) or haemorrhoids. If it’s not coming, stop and go for a little walk and come back when you feel more ready.
  • Aim to sit correctly on the toilet (not squat over it) as this tends to constrict rather than relax the area, increasing downward pressure and reducing ease of toileting.

Tip # 6:

Perform a relaxation and strengthening program for the pelvic floor muscles daily.

  1. Start by massaging the perineum to help relax the pelvic floor muscles, relax the nervous system and improve circulation in the area
  2. In the bathroom or a private area, use a small amount of unscented, natural oil (coconut, olive or jojoba are best)
  3. Locate the area right in the middle – between your anus and your vagina in women or base of the penis in men
  4. Use 2 fingers with the oil and gently rub that central area in a clockwise motion for 20 rotations
  5. Then gently rub in a counter clockwise motion for another 20 rotations.

Use a simplified Kegel-reverse Kegel pelvic floor exercise to help your pelvic floor re-learn to strengthen its contraction as well as relax when contraction is not needed (many issues are due to an over-tense pelvic floor).

  1. Sit or stand with good posture, feeling your head being pulled up in the centre, your shoulders relaxed and back a little, your chest “out”, your natural back curves present and not accentuated and equal pressure either through both sit bones or through the front and back of both feet.
  2. As you breathe in, allow your pelvic floor to relax – feeling that centre point (located in the previous exercise) drop, and breath in for a count of 4-5.
  3. As you breathe out, allow your pelvic floor to gently contract and pull together – feeling that centre point gently squeeze together and up towards your pelvic organs and breathe out holding that squeeze for a count of 6-7.

Tip # 7:

Alter sexual activities. Some people find that sex is painful or that afterwards, symptoms seem to worsen.

  • Always use a gentle lubricant (that works for you – jojoba oil is great)
  • Using a relaxation technique may be of benefit
  • Play around with positions to find what is most comfortable for you.

If you would like to chat about your situation, drop us an email, call, or book an appointment with Alexis.


 [JH1]Link to previous articles on website

Pelvic pain and dysfunction part 3: 7 tips to nip that pain in the butt

Pelvic pain and dysfunction part 2: The basis of management and treatment

Pelvic pain and dysfunction part 2: The basis of management and treatment

In part 1, we shared some of the causes and symptoms of pelvic dysfunction. In part 2, we discuss chronic pain (as compared to an acute condition) and why chronic pain can be so complicated to deal with effectively. It’s important to understand what’s going on in your body first, so that you can work out the steps you need to take in order to help heal yourself. It also helps you feel more confident in your approach and in the fact that improvement CAN happen, as well as give you motivation to keep going (healing has good and bad days and times when it feels like nothing is changing, then suddenly, but only after consistent action, things improve and you suddenly realise, the pain you “always” had is no longer there).

Pelvic dysfunction is a complicated subject, because:

  1. There are so many variations of pelvic dysfunctions and symptoms.
  2. There are multiple possible causes and a large number of associated factors and triggers.
  3. It’s a taboo subject so most people don’t want to talk about it.
  4. People don’t generally ask their GP or health practitioner for help for the above reason and don’t realise that there is anything that can be done to help.
  5. People don’t talk to their physical/manual therapists (such as their Osteopath, Chiropractor or Physiotherapist) as they don’t expect that lifestyle factors and muscle imbalances can be an easily treated part of the solution.

Because of these above issues, it often becomes a chronic pain condition. But what exactly is a chronic pain condition?

The definition of chronic pain is any pain that extends beyond the expected healing time for an injury. Generally, it’s accepted that most tissues have healed by 12 weeks. So, any pain that has continued for longer than 3 months is chronic pain. Conversely, acute pain is any pain condition that has resulted from a direct injury and is still within its expected tissue healing time (thus any pain less than 3 months old).

The brain is a pain modulating unit. That means that any pain stimulus, via nerves, alerts the brain to a potential issue and the brain then uses all the information it can gather before deciding if there is a problem or a potential problem and how dangerous it is. The intensity of the pain we feel is based on the brain’s interpretation of the level of injury or danger at hand. The information the brain uses to decide is vast and includes things like past experience, imminent danger in our surroundings (such as a car coming straight for you) and our fear levels.

Because of this, the brain is able to turn up or down the volume of pain you feel based on its need to keep you safe. Generally, the more threat there is to further harm, the louder the pain signals one feels. Yet, because the brain’s job is to keep us safe, it can turn down the level of pain to allow necessary action, hence the “apparent paradox” in stories you may have heard when for example a person has badly broken their leg, yet managed to walk many kilometres to get to help or run from an explosion etc.

However, when pain continues for extended periods, the wiring in the brain for that location begins to change. Just as a dirt path used over and over again gets deeper, so does the neural pathway. This means that the brain becomes hyper aware of that area of the body and is over sensitive to any nerve input that comes from that location, alerting us to potential injury, via pain, even if there is no risk.

Can you remember a time when you got a cut on your finger and it became inflamed? That area may have begun to feel painful even at the slightest touch such as the gentle swiping of fabric across it? In fact, even the adjacent finger sometimes feels painful, for no apparent reason. This is an example of sensitisation.

This is further intensified by our interpretation of the situation, such as how bad the injury is, our belief that any movement that causes pain is in fact worsening the injury and slowing or preventing healing, the level to which our injury has been affecting our daily life and functioning, and our fear that this situation will never end and might only get worse.

As you can see, the brain collects information from many places and can be influenced by many factors including our individual interpretation of what is happening to us. Thus, we feel increased pain when

  • our general levels of stress are high
  • we avoid all activities that hurt (including ones that help heal) because we believe they are damaging us
  • we fear having pain in general – because
    • it’s not nice
    • we believe that there is something wrong and we are making it worse
    • we don’t understand the biology of our situation
    • we fear that we’ll never improve and we catastrophise the worst about what that might mean for our future
    • we’re afraid that there is something seriously wrong with us.

These factors make treating chronic pain more difficult because in fact the tissues, while they may not be functioning correctly are not “damaged” anymore, so one cannot just deal with the “damaged” tissues nor just the musculoskeletal imbalances that are perpetuating the functional symptoms (such as reduced strength or movement).

Indeed effective management and treatment must therefore deal with as many of the above-mentioned types of psychological aspects as well as the physical factors. This requires education (about pain and the specific process happening in one’s own body), lifestyle modification, minimising triggers, reducing stress, increasing neural relaxation, education and techniques for learning to deal with always having pain (in some cases), rehabilitation exercises and more. Further, all of these components are unique to the individual, so body awareness, support and guidance, and some trial and error are required to build the correct plan of action. Given this complicated and individual nature of chronic pain, I hope the importance of a multi-factorial approach, starting with education and body awareness, is clear.

Once we understand the injury we have, the biology of pain and what is happening inside us, and which activities, if any, to avoid, our fear is reduced. We can also be confident in a stretching and strengthening program and doing activities that cause pain as we understand the difference between hurt and harm. This gives us control, piece of mind and discipline to continue the healing activities required to balance the tissues in the area and re-wire the brain to reduce its pain alert system. Further, we can understand the reason behind any lifestyle, habitual activity and postural modifications as well as stress reduction techniques required, making compliance easier.

Ok, so it’s complicated, where do I go for help?

 A practitioner who has some specific knowledge about pelvic pain and dysfunction is important (potentially an Osteopath, Chiropractor, Physiotherapist or even Acupuncturist – but you need to ask). A good practitioner can:

  • help you deal with the musculoskeletal imbalances and give you exercises
  • discuss and explain chronic pain with you and how you can use techniques and exercises to help re-wire your brain
  • assist with neuro-feedback, to ensure that you are using your pelvic floor correctly and give you both pelvic floor strengthening AND relaxation exercises
  • give advice on correct toileting techniques and support and training for lifestyle interventions to treat different types of incontinence issues (urge and stress)
  • assist with medicated creams, medications and referral to surgical (laser etc) interventions IF and only if necessary (generally a GP or gynaecologist – but you need to ask specifically, and I would recommend seeing a specialist gynaecologist for this type of thing as with a practitioner at Sydney’s WHRIA clinic who are researchers and leaders in this field and have minimal invasive and best results-based interventions).

If you would like to chat about your situation, drop us an email, call, or book an appointment with Alexis.

Stay tuned for part 3 where we share 7 simple tips to improve your situation NOW.


Read Part 1 now

Pelvic pain and dysfunction part 3: 7 tips to nip that pain in the butt

Pelvic pain and dysfunction part 1: Shhh we can’t talk about that!

Pelvic pain and dysfunction part 1: Shhh we can’t talk about that!

Do you suffer from:

  • incontinence (urinary or bowel)
  • urinary frequency; urgency
  • bowel or bladder irritation (with or without pain; can feel like a full sensation)
  • pain (electric shock like, shooting, aching, itching or a raw feeling) of your clitoris, vagina, labia (or penis, scrotum), urethra or perineum (space between your vagina [or scrotum] and your anus)
  • Pain around your sit bone(s) when you sit (especially for long periods)
  • Pain during sex (or afterwards)
  • Pain in your buttocks that may often or sometimes travel down your leg and foot (can be one sided or affect both legs).

Did you know that help is available?

In this three-part series, you’ll learn about the key symptoms and causes of pelvic dysfunction, pain and incontinence. We’ll touch on chronic pain and discuss the basis of an effective management and treatment program. We’ll also reveal 7 simple actions to help you take control of your health and improve your individual symptoms of pelvic pain and dysfunction.

This is a difficult and sensitive subject and often not discussed due to its private nature.

It’s important to realise that in many cases there is a lot that can be done to help – there is no need to suffer in silence!

Symptoms can be wide-ranging, and diagnosis can’t be confirmed with just one test. Instead it requires a look into your personal symptoms and a physical assessment of your pelvic structures to identify imbalances of the joints, ligaments and muscles (tightness, weakness etc) and locations where nerves can become irritated and “trapped”.

Symptoms:

Can include (but are not limited to)

  • pain in the buttocks around where you sit (sometimes in the legs and feet too)
  • sharp, electric type shooting pain around or even within the vagina in women and scrotum (or even shaft of the penis) in men
  • pain during (or after) sex
  • bladder or bowel irritation/discomfort/incontinence/frequency/urgency
  • Pain that can refer or radiate to include part of, or even the length of the leg (generally down the outside) and even go down into the bottom of the foot.

Causes:

There is no one cause, and generally multiple factors are involved

  • Pudendal nerve entrapment – including from
    • long periods of cycling
    • excessive physical exercise
    • straining (from heavy lifting or straining on the toilet)
    • stress
    • posture
    • previous pelvic or perineal trauma/injury
  • Musculoskeletal imbalances – including from
    • long periods of cycling
    • excessive physical exercise
    • straining (from heavy lifting or straining on the toilet)
    • stress
    • posture
    • previous pelvic or perineal trauma/injury
  • Neuropathic (nerve related) pain
  • Trauma – including from
    • difficult childbirth
  • gynaecological and/or colorectal surgery or issues (eg internal abdominal adhesions or uterine fibroids and the like)
  • Infection (including skin conditions).

If you’re suffering from any of the above issues, or some sort of dysfunction of the pelvic/lower abdominal area or genital region, it’s likely that an in-depth history and physical assessment plus a multi-pronged treatment approach can be of great assistance. So, talk to a primary health practitioner (pelvic physiotherapist, GP or Osteopath for example) and find out more. If the advice you receive does not seem logical or if you don’t receive the options that help you gain back control, we suggest you try another practitioner, until you get the support you need.

And remember, working with a combination of such practitioners to get an integrated and diverse treatment and home care plan is your best chance of success.

If you would like to chat about your situation, drop us an email, call, or book an appointment with Alexis.

Stay tuned for part 2, where we discuss chronic pain and its complicated nature as well as the basic idea behind effective treatment and management of pelvic pain and dysfunction.

Author: Dr Alexis Weidland(Osteopath)