The human body is a complex symphony of interconnected systems, each playing a vital role in maintaining overall health. Among these intricate systems, the endocrine system stands out as the conductor, orchestrating the release of hormones that regulate various bodily functions. One often-overlooked area influenced by these hormonal fluctuations is the pelvic floor. In this blog post, we delve into the fascinating interplay between hormones and pelvic floor health.
Understanding the Pelvic Floor:
The pelvic floor is a network of muscles, ligaments, and connective tissues that form a sling-like structure at the base of the pelvis. It supports the pelvic organs, including the bladder, uterus (in women), and rectum. Proper functioning of the pelvic floor is crucial for maintaining urinary and bowel control. Pelvic floor function is important to help provide support during activities like standing, walking, and lifting. And, we cannot forget the impact that the pelvic floor has with reproductive and sexual activities. The pelvic floor is active during all of the aspects of our daily lives and maintaining the health of this region is important.
Hormonal Harmony:
The endocrine system secretes hormones that regulate the menstrual cycle, pregnancy, and various physiological processes. Hormones such as estrogen, progesterone, and testosterone play key roles in maintaining pelvic floor health. To keep this informative and avoid the risk of overwhelm, we are only going to focus on those three hormones for the purpose of this blog. However, it is important to acknowledge that the endocrine system is complex and have multiple factors involved with the cascade of reactions and repson
- Estrogen:
Estrogen levels fluctuate during the menstrual cycle, impacting the elasticity and strength of pelvic floor muscles. At the start of your cycle, estrogen levels are low and peak during ovulation. Following the ovulation phase, estrogen levels once again decrease as the body prepares to shed the uterine lining through bleeding in the absence of pregnancy. This cycle is repeated on average every 23-35 days. If you ever wondered why your healthcare provider asks questions about your period, it is because it can serve as an important vital sign and give us key information about your health and well-being.
Just a quick side note: The formal diagnosis of menopause occurs after the cessation of a menstruation for 12 months, but the decline of estrogen happens before menopause truly occurs. This transitional time period is known as perimenopause. Between the ages of 45-55 most women will enter into perimenopause, which simply means approaching menopause. It is also known that around the age of 35 most women will start to have decreases in their estrogen levels.
So, what is estrogen important for the pelvic floor?
Increased estrogen levels contribute to muscle tone, while decreased levels may result in muscle weakness and laxity. With conditions where estrogen levels are not managed and even with normal aging, it can lead to changes in the pelvic floor, including decreased muscle mass and reduced blood flow. This may contribute to issues such as urinary incontinence and pelvic organ prolapse. Decrease in estrogen is also responsible for vaginal dryness and thinning of tissue in the vulva and vaginal region.
- Progesterone:
This hormone is most commonly known to be important during pregnancy as it increases greatly. Progesterone is essential for supporting a growing fetus, but towards the end of the menstrual period it also serves another role. In the absence of pregnancy, progesterone levels drop and serves as a signal to the body to prepare for menstruation and shed the uterine lining. This shedding of the lining is your period. Progesterone can also counteract cortisol levels, a stress hormone, in our bodies and can help to improve mood and decrease anxiety. Just and FYI, cortisol gets a bad wrap, but it is actually in helping your respond to danger and stress. It is the imbalance of cortisol that can cause problems.
So, what is progesterone important for in regards to the pelvic floor?
Elevated progesterone can also contribute to the relaxation of pelvic floor muscles and may have an impact on conditions such as urinary incontinence.
- Testosterone:
Testosterone, though more commonly associated with male reproductive health, also plays a role in maintaining muscle mass and bone density in both men and women. For women, testosterone is made in the ovaries and it is a scientific fact that women make more testosterone than they do estrogen. Adequate testosterone levels contribute to the overall strength and function of pelvic floor muscles. This is important because we know that women are at higher risk of bone density loss because of the decrease in both estrogen and testosterone that is experienced with normal aging. Testosterone is one hormone that is often overlooked when understanding the transition through perimenopause to menopause. The importance that testosterone plays in the body of women, should be considered just as much as estrogen and progesterone.
Although testosterone is not the hormone we commonly associate with women, it is important to understand that it is a factor in the intricate hormonal harmony. It is also important to mention that there are some medical conditions where testosterone levels are higher, such as PCOS, and pelvic floor function may be influenced as well. These conditions should have special considerations when managing the hormonal changes that occur across a female’s lifespan.
Practical Tips for Maintaining Pelvic Floor Health:
- Regular Exercise:
Incorporate exercises into your routine to strengthen these muscles. Engage in activities that promote overall muscle strength and flexibility. And, we are talking about more than just kegels! So what types of exercises are we talking about? Cardio based exercise where you increase your heart rate is important, along with strength training. Make sure you are doing at least 2-3 days of strength training in addition to your cardio based workouts. Strength training includes activities such as body resistance training, use of resistant bands, weight lifting, and impact plyometric activities.
- Hormone Health:
Consult with healthcare professionals about hormonal changes during all life stages, and not just as you near menopause. For some women hormonal therapy may be appropriate and this can occur via topical application, oral medications, and more. And, when we say hormonal therapy we are speaking specifically about bio-identical hormones and not synthetic hormones. The reason we mention this is because years ago, many women were being provided synthetic based hormones and this led to some significant health concerns. Thankfully, with the progression of science and medicine, we have been able to demonstrate that bio-identical hormones can offer beneficial support for eligible women.
Hormones are something that we often do not monitor with standard blood testing. If you want to know more detailed information about your blood work, you may have to see someone other than normal primary care physician, as some may not be familiar with this type of testing. In this case, it is advised that you seek someone familiar with functional and integrative care.
- Nutrition:
Maintain a balanced diet rich in nutrients that supports overall health including muscle, bone, and heart health. Our gut health directly impacts our overall health, including hormones. Make sure you are eating a diet rich in fiber and that your diet contains natural prebiotics and probiotics. It is most important to try to get the nutrition your body needs from the foods that you consume. There is a ton evidence to support that our diets influence our gut health which in return influences our brain function and hormone production.
Three common nutritional deficits that a large number people in the United States experience are omega-3 fatty acid, vitamin D, and magnesium. In cases where you are not able meet nutritional needs through your diet, supplementation should be considered. Before adding any supplements into your diet, please speak with your medical providers. Although, supplements are widely available, they are not well regulated by the FDA and you want to make sure that what you are using as quality substance that is ideal for you. Your medical provider can also advise what supplements are safe to use with any other medications you may be taking.
So, what’s the point of all of this information?
The intricate dance between hormones and pelvic floor health underscores the importance of holistic well-being. Understanding these connections empowers us to make informed lifestyle choices that contribute to not just a a resilient and well-functioning pelvic floor, but our overall health and well-being. By embracing a proactive approach to health, we can cultivate a harmonious balance that enhances overall quality of life.
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