Pelvic health is one of the areas of Women’s health which is affected by the perimenopause and menopause and simply doing Kegels (pelvic floor exercises) everyday will not make these issues magically disappear.

Good health in the pelvic area requires a multifaceted approach.

Mental stress from women's demanding lives (juggling a career, caring for ageing parents, navigating relationships, and parenting for some) also creates body stress. The more mental stress we experience, the lower our sex hormones impacting on libido but also pelvic health. Exercise can be another cause for pelvic health issues such as doing too little exercise or too much of the wrong type of exercise. This can put strain on the pelvic floor. And don't underestimate the importance of diet. Not keeping hydrated, a diet low in fibre or eating processed foods, all can create constipation which is a major cause for incontinence. In addition, eating a low fat diet coupled with fluctuating hormone levels spikes levels of stress which may exacerbate symptoms. Previous pelvic health issues such as post childbirth injuries, 3rd degree tears, prolapse and faecal incontinence can also be exacerbated. No surprise then that 60% women will experience pelvic health issues post menopause.

Early warning signs

Symptoms may begin with fluctuating hormones in perimenopause (2 to 10 years before menopause), such as a relative reduction in progesterone, resulting in poor sleep, anxiety and aches and pains or oestrogen dominance resulting in hot flushes, breast tenderness, anxiety, and weight gain. This can be followed by oestrogen depletion as menopause ( ie 365 days after your last period) comes closer, causing vaginal dryness, atrophy ( thinning of the tissues), bladder irritation and incontinence, as well as a reduction in testosterone affecting libido and comfort during sex amongst other symptoms such as energy, bone density and muscle mass.

Good pelvic health requires attention, not only to your pelvic floor muscles but also to your sleep habits, mental health and stress management. It requires joyful connection with nature, friends and family. The good news is that through lifestyle choices, we can influence the health of our pelvis - healthy eating including protein, fibre, good fat, good carbohydrates, and supportive supplements plus exercise/build up to exercise as appropriate.

Seeking help

Many women put up with leaking urine when they sneeze or cough or deal with it by popping a pad in their knickers but issues now will likely worsen in our senior years. With specialist support, such as a women's health physiotherapist, available on NHS or privately, in many cases, we can improve our pelvic health - in both the now and for our later years.

An integrative Pelvic Health physio will evaluate all of the above plus check for symptoms of pelvic organ prolapse, urinary frequency and urgency incontinence, cystitis, bladder or pelvic pain, stress urinary incontinence, prolapse pain with intercourse (dyspareunia) , constipation and faecal incontinence. A pelvic physio will evaluate your pelvic floor and teach breath coordination and pelvic floor training, including down-training if you have an overactive pelvic floor. You will be taught pressure management strategies, correct lifting techniques, as well as sleep hygiene, stress management, healthy eating and movement to complement your exercise needs and hormone balance.

Invictus Pelvic Health

Hi I am Nicky Travlos, founder of Invictus Pelvic Health. I use my expertise to work with Women who are struggling to juggle family, work and health and who are suffering from bladder and bowel and hormone issues, such as constipation, incontinence, prolapse, pain with intercourse and body aches and pains. I enjoy working with women to restore confidence in themselves, their bodies and their pelvic floor and use an integrative and holistic approach to improve their self care, lifestyles , energy levels, exercise regimes and bladder and bowel health. To sign up to an online course by Nicky, visit

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Poor hair health is a common lament experienced by women in peri and post menopause, so thanks to Dr Ingrid Wilson, Over The Bloody Moon’s Hair Health Advisor and founder of Crewe Skin and Hair Clinic for sharing her knowledge with us.

Why do we lose hair or experiencing thinning hair during perimenopause?

o We experience age related changes in hair that are nothing to do with the menopause

o The thickness of hair peaks at around 27 years and then decreases from the mid 30s onwards

o The diameter of each hair increases up to age 30 and then declines from the mid 30s onwards

o External factors such as those induced by oxygen free radicals generated by ultraviolet radiation, air pollution and smoking lead to an increase in the porousness of hair, weak hair and hair with a rough surface

o The production of sebum decreases in the post-menopausal period which may affect the quality and texture of the hair

o Hair loss is thought to affect at least 50% of women, by age 50

o The hair follicle is sensitive to changes in hormones which change at the time of menopause – a decline of oestrogen can make androgens more dominant which influences local metabolism

o The associated changes are decreased rate of hair growth, decreased percentage of hairs in the growth phase, reduction in the diameters of hairs (why hair may feel limper or thinner) and the distribution of hairs on the scalp (why partings widen)

o The most common hair loss condition noticed around the time of the menopause is female pattern hair loss

What ways can I support my hair?

Nutrition: Overall it is always best to have a healthy balanced diet with plenty of protein, low GI carbs, plenty of fruit, vegetables and foods with a good iron intake such as organ & red meats, turkey, legumes, pumpkin seeds, raisins, spinach, shellfish and quinoa. For more information listen to Dr Ingrid Wilson chat on the podcast The Doctors Kitchen

Supplements: There is little clinical evidence on the use of supplements for hair thinning in women going through the menopausal transition. For example, Biotin which is on trend currently has little effect other than those who are biotin deficient which is extremely rare. In fact, if people have too much biotin it can interfere with blood tests and give false readings for thyroid or cardio-vascular health so always consult with a GP rather than self-administering.

Minoxidil: is used to treat female pattern hair loss, the most common problem found in women around the menopause – known as Regaine which can be purchased from most pharmacies. However, the response to this is variable.

Low Level Laser Light Therapy: there is some evidence to show that this treatment can be an effective way of stimulating hair follicle growth. Hairmax and Theradrome are two such devices that are designed for home use.

When should I see a specialist?

If you are losing hair or notice a significant change in condition, it's time to book an appointment with your doctor. It’s really important to understand the factors contributing to hair loss, particularly if there is an underlying disease process or deficiencies in vitamins or nutrients.

GP is your first point of call: it might be that further investigations through the GP are necessary to conduct blood tests or a referral.

Dermatologists: seen as the medically approved option but make sure you are referred to one that specialises in hair, rather than skin.

Trichologists are an alternative option for those that want more consultative time and a holistic approach to improving hair health. But be warned, this is not a regulated profession and unlike Dr Ingrid Wilson, the majority of trichologists do not have a medical background and the quality of advice and service may vary.

What treatments might they offer me?

The root cause: Some dermatologists will offer a scalp biopsy and trichologist such as Dr Ingrid Wilson can provide imaging of the hair and scalp through a test called TrichoLab to get a really accurate assessment of the hair counts and likely underlying disease process.

Individualised care: There’s also a personalised test as TrichoTest to give an idea of how likely you are to respond to medications for a particular type of hair loss. It saves you wasting time with treatments that are not likely to work.

Hair Transplants: note these are not suitable for some hair loss conditions, resulting in temporary improvement and in some cases, this procedure can actually accelerate hair loss. Do bear in mind that there is no formal training pathway in the UK for hair transplant surgeons meaning it’s not regulated!

Find out more

Dr Ingrid Wilson is owner of Crewe Hair & Skin Clinic which offers a truly holistic approach to non-surgical hair restoration with bespoke, ethical advice based on her continued education in Trichology and experience of UK General Practice. She is offering 10% discount off Hairmax laser devices by using the code: Crewe1 and £25 off Theradrome by using the code: CREW1 at the check out (terms and conditions apply)

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Two years ago, after Christmas, aged 46, I came off the ‘pill’ after being on it for over 3 decades, apart from breaks to conceive our three daughters. I thought it would be a good time to see whether I was menopausal which I would gauge by whether or not I was still menstruating. It turned out that I was regular as clockwork. My periods arrived every 28 days and were as they had always been – light and painless.

A few months rolled on and I found myself sweating at night, waking up with palpitations, feeling tired and nauseas during the day, with a dull headache that never went away. I started putting on weight and as the sleepless nights continued, I felt foggy and forgetful. This coincided with starting a new job. I felt I wasn’t up for the role which in turn made me feel more anxious and so a viscous cycle began. By summer, I was teary and angry. I felt rage towards my husband who never seemed to emotionally support me in the way I needed. I sat silently at the dinner table unable to engage with the family. I literally felt like I was slipping away. Maybe not slipping away but slipping inside. I didn’t notice the wall building up around me but I did notice something was very wrong with me. Usually, sociable and energetic, I felt withdrawn and lethargic.


The next few months saw me back and forward to the doctors. I was lucky in having a wonderful GP who suggested I was perimenopausal and I go on HRT. I was in such a stage of anxiety, all I could think about was getting breast cancer. She gave me a couple of websites and forums to visit to go away and think about it. I decided to leave it. Not long after that an incidence at work left me totally flawed. I just couldn’t recover from it and handed in my notice. I felt unable to share anything that was going on in my head or body with the founders who were male and the team who were twenty years younger than me. Then I started questioning my burn out. Surely it couldn’t be hormones. I went for a walk with a good friend who suggested I go on anti-depressants. I returned to the GP and saw a different person and begged for a prescription. I couldn’t stop crying, I felt my marriage was in tatters, I was a terrible mother, and I was unemployable.

I have always worked taking short maternity breaks and setting up a business with my third child. I knew stopping work and not having structure was going to be difficult, so luckily I had in place a volunteering role with Alzheimer’s Society at a local Dementia Café. This was my lifeline. I would walk to venue with wet eyes, arrive a little early to sit on a bench and practice some paced breathing and somehow managed to pull it together so when I walked in I looked composed. Being part of a team of volunteers and getting to know the carers and those living with Dementia was so fulfilling. It gave me a sense of purpose and my mood was transformed in just two hours.


After a month of being on sertraline at the full dose, I started to feel drugged. Although previously, I felt like I was hidden behind a haze, this was different. I felt like my emotions were being blocked and that I was totally disconnected to my body and mind. This was briefly stopped with morning exercise at the gym with endorphins that made me feel happy and strong. One day when I was running late for class, I took the car and managed to drive into a bus coming out of a side road. I was so shocked that my reactions had been slowed and was convinced this was due to the anti-depressants. I decided to wean myself off them, starting the next day. Within 4 weeks I was off them and as part of the process upped my exercise, cut out alcohol and caffeine and changed my diet, so I was eating healthier.