Rx for Post-Menopausal Pelvic Health

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Jan 24

Karny Jacoby FPMRS

Rx for Post-Menopausal Pelvic Health

by Karny Jacoby FPMRS

The Three Pillars of Success©

By: Dr. Karny Jacoby, FMPRS 


Maintaining Female Pelvic Health is dependent on the integrity of vaginal tissue, pelvic floor strength and mobility, and bowel health. By focusing on each of these 3 pelvic functions together, women can increase the strength of these muscles, avoid additional degradation and help prevent or manage pelvic organ prolapse (POP).

What is Pelvic Organ Prolapse?

Pelvic Organ Prolapse or vaginal prolapse is a condition in which the uterus, rectum, bladder, urethra, small bowel, or the vagina itself may begin to prolapse, or fall out of their normal positions. Without medical treatment or surgery, these structures may become worse and prolapse even farther into the vagina.

Vaginal prolapse commonly affects sexual function, urination and bowel health. Pelvic pressure and discomfort are also common symptoms that have a negative impact on quality of life.

What are the causes of vaginal prolapse?

Primary causes include:

  • Genetics
  • Childbirth
  • Menopause (loss of estrogen)
  • Hysterectomy (destabilizes ligaments)

Other risk factors include:

  • Aging
  • Obesity
  • Smoking
  • Connective tissue abnormalities
  • Chronic illness
  • Prior pelvic surgery

To help prevent and manage prolapse I have created The 3 Pillars of Pelvic Health that I recommend to my own patients.

The THREE Pillars of Pelvic Health©

Vaginal Health & Estrogen

During and after menopause, estrogen production slows and then stops. When that happens, a number of unwelcome changes happen in a women’s body.

Normally, the walls of the vagina stay lubricated with a thin layer of clear fluid. The hormone estrogen helps maintain that fluid and keeps the lining of the vagina thick, elastic and healthy. During menopause, the drop in estrogen levels results in less elasticity and moisture within the vaginal wall causing a feeling of dryness. This is called vaginal atrophy.

The most common treatment for atrophic vaginitis due to low estrogen levels is topical, local vaginal estrogen therapy. Topical estrogen replaces some of the hormone that your body is no longer producing. That helps to relieve vaginal dryness symptoms, without causing as much estrogen in your bloodstream as oral estrogen hormone therapy (HT).

A non-hormonal option is the MonaLisa Touch vagina laser. The MonaLisa Touch laser is an in-office procedure that takes less than 5-minutes, doesn’t require anesthesia, has no downtime and minimal discomfort. It is used to treat the following symptoms:

  • Vaginal dryness
  • Itching, burning and irritation
  • Dyspareunia (Painful Sex)
  • Urinary Health

As a non-hormonal treatment, the MonaLisa Touch is a great choice for breast cancer survivors.  To learn more about breast cancer survivor, check out "Treating Early Menopause Symptoms in Breast Cancer Survivors".

Pelvic Floor Rehab

Pelvic floor rehab is a term that means to strengthen the muscles that support the bladder, urethra and other organs within the pelvis. It is commonly referred to as Kegel exercises , and is often combined with biofeedback. A physical therapist with a specialty certification in women’s health is the most common provider who helps women learn to do the Kegel exercises correctly.

The muscles not only weaken after childbirth or with aging, they can also have less range of motion. What this means is that they don’t “let go” during a bowel movement resulting in the need to strain. Chronic straining, especially for BM’s is a significant risk factor for POP.

Should prolapse occur vaginal reconstructive surgery can be considered. In order to have a successful outcome from vaginal reconstructive surgery it is essential to engage in pelvic floor rehab before and after your surgery.

Bowel Health

Chronic constipation and straining in general is a risk factor not only for POP but also for hernia and hemorrhoids. It should be avoided in general and especially after pelvic floor reconstructive surgery to prevent the risk of recurrent prolapse.

To ensure proper postoperative bowel movements a daily stool softener and 30 grams of fiber daily for 6 weeks after your reconstructive surgery is recommended. Most patients find these types of bowel programs helpful long after surgery.

Recent studies suggest women need at least 30 grams of fiber for digestive health. For weight loss, fiber should be increased by 5 additional grams. even more.

Constipation can be caused by limited fluid and fiber intake, such as a poor diet, too much sugar and fat, sedentary lifestyle, repeatedly ignoring the urge to have a bowel movement, slow movement of stool, lifestyle, changes such as traveling, or narcotics.

Tips to manage constipation:

  • Drink plenty of fluid at least 6 to 8 glasses of water per day
  • Eat 2-4 servings of fruit each day
  • Eat 3-5 servings of vegetables each day
  • Consume 20 – 35 grams of soluble fiber each day
  • Exercise when appropriate


Whether or not you need vaginal reconstructive surgery, the 3 Pillars of Success© can help your overall pelvic health. Being proactive can limit or reverse damage to your pelvis caused by childbirth, aging or small surgery. I recommend ALL women embark on this proactive approach regardless. Many can forego the need for surgical reconstruction as a result of these changes.

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