Safe Exercise Guidelines for Menopausal Years

You’re convinced; the evidence for exercise is over-whelming; the reasons behind menopausal weight gain and strength loss seem obvious and now it’s time to get more active. Please read on if you’re feeling a bit tentative about taking the next step or unsure where to start.

One thing for sure – there’s been a shift in the speed of reflexes, balance reactions, strength and cardio vascular fitness with menopause, right? If you read through reams of research, the evidence points to weight training and cardio vascular exercise as the key to anti ageing. Individual factors such as medical conditions, injuries and exercise history, joint range of motion, muscle strength and flexibility, affect exercise choice. What’s often over looked when women begin a new exercise program is the potential effect it could have on the pelvic floor muscles (PFMs).

Clinical Note

This month a 46 year old woman attended the clinic for help with worsening stress incontinence and a front vaginal wall prolapse. Six weeks earlier she started a boot camp challenge to improve fitness and strength and help with weight loss. Early in the program she noticed increased leaking and eventually a bulge at the vaginal entrance. When the challenging exercise repeatedly raised intra abdominal pressure (sit ups, planks, running, star jumps), her pelvic floor muscles (PFMs) lacked the strength and endurance to protect her pelvic organs from being repeatedly pushed downwards. 

There is no specific program for ‘menopausal women’ as exercise must be tailored to an individual. Around 50% of child bearing women have pelvic organ prolapse (POP) with most unaware that it’s present. Childbirth, challenging exercise, bowel straining, heavy lifting, BMI over 25, and chronic coughing or sneezing are prime culprits to push the vaginal walls/cervix down to or out of the vaginal entrance.

If you’re pre/post menopausal, had gynaecological surgery (e.g. hysterectomy) or have chronic back pain/injury, take care how you approach exercise. Follow the guidelines below, taking into account individual limitations.

  • Get in touch with the local lifting action of your PFMs and learn to lift them (the ‘knack’) during the day before coughing or lifting. If your PFMs descend when coughing/sneezing, it’s time to reverse this incontinence/prolapse causing action
  • Find an exercise professional with an interest in protective exercise for women. Questions relating to bladder and bowel control, prolapse, pelvic pain, childbirth and back pain should be a standard part of pre exercise assessment. Refer to the pelvic floor pre exercise screening questionnaire
  • Start slowly with pelvic friendly exercise. My 46-year-old client went from occasionally walking to Boot camp 3 times a week. That’s the equivalent of a pre-schooler starting out at university level! The Canadian Air Force designed this tough regime for military personnel.
  • I refer many clients to physiotherapy lead Pilates classes to improve pelvic control, balance and posture. They report less back pain and improved bladder control with regular Pilates exercise
  • To protect the pelvic floor when prolapse and incontinence issues are present, some of my clients benefit through wearing a vaginal pessary support and compression shorts. This is the equivalent of ‘splinting’ the vagina and adding support to the pelvic muscles through compression. This link takes you to the compression shorts I recommend and the ‘guidelines for pelvic friendly exercise’

With realistic expectations, it’s more likely you’ll adopt long lasting exercise habits and not burn out early with injury. At all costs protect your precious pelvic floor from further strain!