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The Importance of Pelvic Health During the Menopause Transition and Beyond
Anna Harrelson • June 10, 2024

Understanding and Managing Pelvic Health During the Menopause Transition

Ladies,

You pelvic health is a crucial aspect of your well-being that often gets overlooked, especially during the menopause transition and beyond. Understanding the changes that occur and how to manage them can significantly improve your quality of life. Today, we'll delve into the genitourinary syndrome of menopause (GSM), the importance of pelvic floor health, and effective treatments to ensure comfort and vitality during this phase.


Understanding Genitourinary Syndrome of Menopause (GSM)

Genitourinary syndrome of menopause (GSM) is a term that describes the range of symptoms caused by decreased estrogen and other sex steroids during menopause. GSM affects about 50-70% of postmenopausal women and can also occur in other low estrogen states, such as postpartum and breastfeeding​​. Symptoms include vaginal dryness, burning, irritation, urinary urgency, frequency, and recurrent urinary tract infections (UTIs).


Understanding Hormones

Hormones are like the body’s internal magic wand, transforming tissues and functions as we grow and age. During childhood, the absence of hormones leaves vulvar tissues thin and sensitive. Puberty introduces estrogen, leading to significant changes in genital tissue, making it pink, stretchy, and lubricated. However, as menopause approaches, the decline in estrogen causes these tissues to revert to a more vulnerable state.


Pelvic Anatomy and Hormone Receptors

The pelvic floor is a network of muscles, ligaments, and tissues supporting the bladder, uterus, and rectum. Estrogen and testosterone receptors are abundant in these tissues. Declining hormone levels lead to several changes:

  • pH Changes: The vaginal pH becomes more alkaline, disrupting the natural flora and increasing infection risk.
  • Tissue Atrophy: Vaginal tissues become thinner, less elastic, and more prone to tears and irritation.
  • Anatomical Shifts: The urethra can move closer to the vaginal opening, contributing to urinary symptoms and recurrent UTIs.


The Severe Implications of Recurrent UTIs

Recurrent UTIs are a common and severe implication of GSM. These infections can lead to chronic discomfort, frequent antibiotic use, and significant impact on quality of life. Ensuring the health of vaginal and urinary tissues is crucial in preventing these infections & can be life saving.


Effective Treatments for GSM

Suffering from GSM is not normal, and there are safe and effective treatments available. Vaginal estrogen therapy is highly effective and has minimal contraindications. Unlike systemic hormone replacement therapy (HRT or MHT (menopausal hormone therapy), vaginal estrogen is not absorbed significantly into the bloodstream and specifically targets affected tissues.

Benefits of Vaginal Estrogen:

  • Restores natural pH and flora
  • Increases tissue elasticity and moisture
  • Reduces urinary symptoms and the risk of UTIs

Systemic estrogen therapy with HRT/MHT is not always effective at treating GSM, and many women require topical estrogen treatment for relief.


Lubricants and Moisturizers

Using vaginal lubricants and moisturizers can also help manage GSM symptoms. Lubricants are used during sexual activity to reduce friction, while moisturizers are used regularly to maintain vaginal moisture. When using silicone-based toys, avoid silicone lubricants as they can degrade the material.


Pelvic Floor Dysfunction

Pelvic floor dysfunction involves abnormal activity or function of pelvic floor muscles, leading to urinary incontinence, pelvic pain, and discomfort during intercourse. It’s essential to understand that pelvic floor dysfunction can result from both weakened and overly tight pelvic muscles.

Pelvic Floor Physical Therapy:

  • Addresses both weakness and excessive tightness
  • Helps restore normal function and alleviate symptoms
  • Provides education on proper techniques, as many women do not perform Kegel exercises correctly


Normalizing Pelvic Health Discussions

It’s essential to normalize conversations about pelvic health. This aspect of our health is not taboo but a crucial part of our overall well-being. Even women who no longer need Pap smears should have regular vaginal exams to monitor and maintain pelvic health.

Encourage yourself to be comfortable with your anatomy and seek care from clinicians who are knowledgeable and comfortable discussing and treating pelvic health issues.


Conclusion

Maintaining pelvic health during the menopause transition and beyond is vital for overall well-being. Understanding GSM, utilizing effective treatments like vaginal estrogen, and seeking pelvic floor physical therapy can significantly improve your quality of life. Embrace this phase with knowledge and confidence, ensuring that your health and comfort are prioritized.



Additional Insights and Tips

  1. Estrogen Therapy Safety: There is no data indicating that local vaginal estrogen causes cancer, cardiovascular problems, stroke, or dementia. Studies with over 18 years of observational data show its safety. Even for women with a history of gynecologic cancers, local vaginal estrogens are considered safe.
  2. Long-term Use: Just like brushing your teeth or moisturizing your skin, using vaginal estrogen is a long-term commitment. It works as long as you keep using it, so it's important to continue the therapy even after symptoms improve.
  3. Options for Application: Vaginal estrogen comes in various forms, including creams, inserts, and rings. It may take up to 2-3 months to see the full benefits, but consistency is key.
  4. Pelvic Floor Therapy: Not all pelvic floor dysfunctions are due to weakness. Some are due to excessive tightness. A specialized pelvic floor physical therapist can help determine the right exercises and treatments.
  5. Seek Expert Care: Ensure your healthcare provider is comfortable and knowledgeable about pelvic health. Regular exams and open discussions about any symptoms are crucial.



Embrace this phase with knowledge and confidence, ensuring that your health and comfort are prioritized.

We got this!

Dr. Anna


WonderCreek Health Blog

By Anna Harrelson April 11, 2025
You’re not crazy. You’re not lazy. And no, you’re not just "getting older." If you’re dragging through your days, feeling foggy, heavy, or worn out—but your labs are "normal"—you’re not alone. One of the most overlooked causes I find in my practice is suboptimal ferritin levels. Let’s break it down—with science, a little wit, and a whole lot of hope. Your Body: A High-Performance Machine Imagine your body like a beautifully engineered, high-performance car. Hormones are your spark plugs. Micronutrients are your engine oil. Proteins are your gears and pulleys. Without the right balance of all these building blocks, the engine sputters. It doesn’t matter how good the outside looks—if you're low on fuel or missing key fluids, you’re not getting out of the driveway. And iron —stored as ferritin—is a huge part of that fuel system. What Is Ferritin, and Why Should You Care? Ferritin is your body's iron storage protein. It’s like your gas tank. Not your current speed, not your miles per gallon—your actual reserve of fuel. Iron is essential for carrying oxygen to every cell in your body. It's crucial for energy production (ATP) in your mitochondria. It supports your thyroid, neurotransmitter function, hair growth, immune system, and even mood. If you’re low on ferritin, you might still show " normal " hemoglobin or hematocrit—so traditional screening won’t catch it until you’re running on fumes. Symptoms of suboptimal ferritin can include: Fatigue and poor exercise tolerance Brain fog or poor concentration Mood swings or low mood Headaches Hair shedding Shortness of breath with minimal exertion Restless legs or poor sleep Sound familiar? But My Labs Say I'm Normal... Here's the kicker: most lab ranges are designed to flag anemia — not optimal function. You could have a ferritin of 12 and be told " everything looks fine " — but feel absolutely awful. For most women, especially those who are still menstruating or recently stopped, ferritin levels under 40–60 ng/mL can cause symptoms . Many functional and integrative medicine specialists aim for 70–100+ ng/mL to support optimal energy, cognition, and hair health. Low-normal is not optimal. When your engine light is blinking, topping off the tank halfway doesn’t cut it. Why You Might Be Low Menstruation: Every period can deplete iron stores, especially if cycles were heavy. Pregnancy and postpartum: Even years later, many women never rebuild their iron stores. Gut health issues: Poor absorption due to low stomach acid, celiac disease, or IBS. Dietary patterns: Plant-based diets can be low in easily absorbed heme iron. Chronic inflammation: Inflammatory signals can "hide" your iron from circulation. Food First, But Realistic Yes, food matters. Red meat, poultry, seafood, lentils, spinach, and pumpkin seeds all contribute iron. But rebuilding storage? That’s a bigger lift. Think of dietary iron like filling up your gas tank 10–15% at a time. Helpful, but slow if you're starting on empty. Sometimes you need a boost. That’s where targeted supplementation can help—whether it’s gentle oral iron (like iron bisglycinate) or occasional intravenous iron if needed. And by the way, ever wonder why "senior" vitamins have no iron? Because postmenopausal women typically don’t lose blood monthly. We don’t want too much iron. But we also can’t function with too little. Balance is everything. Final Thoughts If you’re feeling run down, foggy, achy, or unlike yourself—it’s not "all in your head." Your body is whispering (or screaming) for better support. And sometimes the missing piece isn’t fancy. It’s basic, foundational, and fixable. Ferritin matters. Iron matters. You matter. At Wondercreek Health, I believe in digging deeper, connecting the dots, and helping you rebuild the strong, steady foundation your body deserves. Because you weren’t designed to run on empty. Iron-Rich Foods to Boost Your Levels Beef, lamb, liver (heme iron is best absorbed) Dark poultry (chicken thighs, turkey) Shellfish (clams, oysters, mussels) Lentils and chickpeas Spinach and swiss chard Pumpkin seeds and cashews Fortified cereals and oatmeal Tofu and tempeh Tip: Pair iron-rich foods with vitamin C (like bell peppers, oranges, or strawberries) to boost absorption! Ferritin Target Chart Ferritin Level What It Means <15 ng/mL Severe deficiency 15–40 ng/mL Low stores (symptoms likely) 40–60 ng/mL Borderline (may still have symptoms) 70–100+ ng/mL Optimal for energy, cognition, hair health Individual needs vary—always interpret ferritin in the context of your full health picture! When to Suspect Low Iron Feeling tired despite good sleep Exercise feels harder than it used to Brain fog or poor memory Unexplained hair thinning Pale skin or brittle nails Frequent headaches Restless legs or poor sleep Shortness of breath climbing stairs If you’re nodding along to several of these, it’s worth a closer look at your ferritin levels.
By Anna Harrelson March 30, 2025
Let’s start with this: there is nothing shameful or trivial about wanting a healthy sex life. If you're in your 30s, 40s, 50s, or beyond and wondering where your libido went, why sex feels different (or uncomfortable), or why no one ever warned you about vaginal dryness, you’re not alone. And you’re not imagining it. At Wondercreek Health, I talk to people every week who feel confused, dismissed, or ashamed about the sexual changes happening in their bodies. Many are thriving in every other area of life—careers, caregiving, health—but when it comes to intimacy, they feel stuck or unseen. So let’s say this together: sexual health is part of whole-person health. And pleasure is not optional . It’s a reflection of nervous system safety, hormonal balance, connection, and self-awareness. It belongs to you. What Happens to Sexual Health in Midlife and Beyond? Hormonal shifts during perimenopause and menopause can affect every part of your sexual experience. But so can chronic stress, birth control, antidepressants, trauma, and the weight of daily responsibilities. This is never just one thing. Common symptoms include: Vaginal dryness, burning, or itching (genitourinary syndrome of menopause, or GSM) Pain with sex (dyspareunia) Loss of libido or arousal Less intense or harder-to-reach orgasms Urinary urgency or UTIs Pelvic floor tension or dysfunction These changes aren’t "just in your head" and they’re not a moral failure. They reflect real shifts in tissue, blood flow, hormones, and brain chemistry. Sex Isn’t Just for Someone Else’s Benefit Let’s say the quiet part out loud: many of us were raised to believe that sex was about someone else's pleasure. That we should be desirable, responsive, available—regardless of how we felt. That conditioning runs deep. But sex isn’t about performance. It’s about connection, intimacy, and pleasure—for you. Pleasure is your birthright. Intimacy can be tender, playful, spiritual, or wild— but it should never feel like pressure. Your desire may look different than someone else's, and that’s okay. This is true whether your partner is male, female, nonbinary, or you're navigating intimacy solo. There is no one-size-fits-all experience. Why Your Desire Might Feel "Off" Sexual changes can happen at any age. Oral contraceptives (OCPs) can suppress libido by lowering free testosterone. SSRIs and other antidepressants are well known to impact arousal and orgasm. Perimenopause often starts in the mid-30s, long before you notice hot flashes. Chronic stress and the mental load of caregiving, multitasking, and decision fatigue can leave no room for desire. Because here’s the reality: desire doesn’t live in your genitals. It starts in your brain . And when your brain is overloaded with to-dos, responsibilities, or unspoken resentment, it’s nearly impossible to shift into a space of curiosity, connection, and arousal. Unwinding the mind can be hard. For some of us, it means learning to use tools like mindfulness, breathwork, somatic practices, therapy, or just having space and time away from the demands of the world. Creating room for desire isn’t selfish. It’s a form of self-trust and reclamation. The Good News: This Is Treatable Sexual health doesn’t have to decline just because estrogen does. There are safe, effective, empowering ways to reconnect with your body and reclaim your pleasure. 1. Local vaginal estrogen (or DHEA or testosterone): Restores tissue health, lubrication, and blood flow Improves comfort, arousal, and pelvic health Safe for most people, even those with a history of breast cancer (with appropriate guidance) 2. Systemic hormone therapy: Can improve libido, mood, sleep, and confidence Testosterone therapy (when indicated) can support arousal and orgasm 3. Pelvic floor physical therapy: Addresses pain, tension, and coordination issues Supports better sensation and comfort 4. Nervous system regulation: Practices like breathwork, somatic therapy, or trauma-informed care help shift from "fight or flight" into connection When the nervous system feels safe, desire can return 5. Sex therapy or coaching: Helps explore personal blocks, relationship dynamics, and pleasure mapping Let’s Talk About Desire You might notice you don’t feel spontaneous desire anymore— but that doesn’t mean you’re broken . For many people, responsive desire (desire that follows arousal) becomes the norm in midlife. And it’s perfectly valid. Touch, connection, and intimacy may need more warming up. But your ability to experience pleasure is still intact—and it can grow deeper, richer, and more grounded as you reconnect with your body on your own terms. Final Thoughts You don’t need to be fixed. You deserve to be heard. You deserve to feel good in your body. Sexual health is not about keeping up with anyone else’s timeline or expectations. It’s about reclaiming what intimacy and connection mean to you in this season of life. At Wondercreek Health, I’m here to help you connect the dots, reduce shame, and support you with science-backed, judgment-free options that honor your experience. Because this is not the end of your sexual story. It might just be the beginning of the most powerful chapter yet.
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