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

When Sensitivity Isn’t a Weakness: Connective Tissue Disorders, Hormones, and Midlife Women

By Anna Harrelson • September 29, 2025
Many of the women who find their way to me share a common story: They’ve seen multiple specialists. Their labs are “normal.” Their symptoms are scattered across systems—joints, gut, mood, hormones, skin—and yet every provider focuses on one piece at a time, never the whole picture. They’ve often been told they’re anxious, dramatic, or “too sensitive.” And yet, they’re also some of the most intuitive, self-aware, and relentlessly curious patients I’ve ever met. They know their bodies. They know something isn’t right. And they won’t stop searching until someone finally sits down and helps them connect the dots. That’s where connective tissue disorders come in. What Do We Mean by “Connective Tissue Disorders”? When I talk about this group of conditions, I’m referring to women who often fall somewhere on the spectrum of: Hypermobility spectrum disorder (HSD) Ehlers-Danlos features Mast cell activation (MCAS) Endometriosis PMDD and other hormone sensitivities POTS or other dysautonomias The common thread? Their connective tissue is different—looser, more fragile, more reactive. And when the scaffolding of the body isn’t as stable, symptoms spill over into every system: joints, vessels, immune response, mood, hormones, digestion, even the brain. Why Midlife Feels Like a Breaking Point Estrogen has always been a stabilizer. It strengthens collagen, calms mast cells, and helps buffer the nervous system. So, it’s no surprise that perimenopause—when estrogen begins to fluctuate dramatically—can feel like the rug is being pulled out. I see women who: Once held things together with sheer willpower Managed PMDD, migraines, or endometriosis in their younger years Suddenly feel like everything has intensified: joint pain, bloating, histamine reactions, mood shifts, insomnia, brain fog For women with sensitive connective tissue and sensitive nervous systems, hormonal shifts don’t just cause hot flashes—they destabilize the entire body. Hormone Therapy for the Orchid Patient Many of my patients have tried hormones before. Sometimes birth control left them moody, swollen, or miserable. Sometimes a patch or pill was prescribed quickly, with no attention to how sensitive their system might be. So when they hear “hormone therapy,” they’re understandably hesitant. This is where my orchid theory comes in. Orchids are not weak flowers—they’re strong, beautiful, and resilient. But they need careful tending. They don’t thrive when thrown into the same soil or light as every other plant. They require patience, precision, and a slower hand. My connective tissue–sensitive patients are orchids. Their bodies respond to hormone therapy, but they need a methodical, gentle approach: Always bioidentical hormones Introduced slowly, step by step Carefully monitored, with adjustments made gradually Combined with lifestyle strategies to support the nervous system and reduce inflammation This is not a “one patch fits all” process. It’s a partnership. And when done thoughtfully, hormone therapy can bring profound relief and stability. Why Sensitivity Is a Strength The women I see are often neurodivergent—ADHD, autistic traits, or simply highly perceptive. They’re often told their sensitivity is a liability, but I see it differently. That very sensitivity is what helps them notice patterns others miss. It’s what fuels their curiosity to keep searching, even after being dismissed. Their intuition about their own bodies is spot on. Yes, their connective tissue is different. Yes, their mast cells fire more easily. Yes, their hormones seem to create more chaos. But these women are also some of the most resilient, resourceful, and insightful people I know. Moving Forward If you see yourself in this description, please know: You’re not “too sensitive.” You don’t have 27 different diagnoses—you have a pattern that makes sense. Hormones are not off the table for you—they may just need to be approached differently. Your lived experience matters as much as your lab results. This isn’t about fixing you—you are not broken. It’s about giving your body the tailored support it’s been asking for all along. This is just the beginning of a series I’ll be writing on connective tissue–related conditions: MCAS, PMDD, endometriosis, and more. Each deserves its own spotlight. But the first step is recognition. You deserve to be seen in your wholeness—not dismissed as “normal” when everything in your body is telling you otherwise.

Magnesium in Midlife: The Unsung Hero of Women’s Health

By Anna Harrelson • July 12, 2025
You know how people say, "Just drink some water and take a magnesium supplement" like it’s the answer to everything? Well… they’re not totally wrong. But like most good advice, the devil is in the details. Magnesium is one of the most essential minerals in the body, involved in over 300 enzymatic reactions , yet it remains one of the most commonly overlooked deficiencies in midlife women. And no, your annual bloodwork probably didn’t catch it. So What Does Magnesium Actually Do? Think of magnesium as a multitasking background assistant—it keeps the lights on and the gears turning across nearly every body system: Brain & Mood: Regulates GABA and NMDA receptors, supporting calm, focus, and resilience against anxiety and overstimulation. Muscles: Prevents cramping and twitching, supports strength and recovery, and reduces restless legs. Sleep: Plays a role in melatonin production and nervous system regulation. Bowel Function: Helps pull water into the colon to prevent constipation. Cardiovascular Health: Regulates blood pressure and helps with vasodilation. Hormone Balance: Assists in estrogen metabolism and combats insulin resistance. In short: if you’re exhausted, bloated, moody, foggy, tense, or irregular in your gut or cycle—magnesium deserves a spot on your radar. Why Is Magnesium So Important in Midlife? Estrogen and progesterone both influence magnesium levels. As hormone levels decline or fluctuate during perimenopause and menopause, so does your ability to retain and utilize magnesium. Add to that: Chronic stress (which depletes magnesium) Modern diets (often low in magnesium-rich whole foods) Medications like PPIs, diuretics, or certain antibiotics High caffeine, sugar, or alcohol intake (all increase magnesium excretion) And suddenly, a " borderline magnesium issue " becomes a perfect storm. Why Your Blood Test Might Not Show It Serum magnesium tests only reflect ~1% of total body magnesium. Most magnesium is stored in bone and tissue. So it’s very possible to have "normal labs" and still be clinically deficient. In practice, we go by symptoms, risk factors, and therapeutic response. Common Signs of Suboptimal Magnesium Trouble falling or staying asleep Anxiety or nervous system overactivation Fatigue or burnout that doesn’t resolve with rest Muscle cramps, spasms, or eye twitches Constipation Menstrual migraines or tension headaches Joint stiffness or tightness Sugar cravings or blood sugar crashes Best Food Sources of Magnesium Magnesium-rich foods include: Dark leafy greens (spinach, chard) Nuts and seeds (especially pumpkin seeds and almonds) Avocados Legumes Dark chocolate (yes, really!) Whole grains like quinoa and oats That said, many of us still fall short even with a healthy diet, especially during high-stress seasons or if absorption is impaired. Supplements: Which Type of Magnesium Is Best? Not all magnesium is created equal. Here are the forms we most often recommend: Magnesium Glycinate: Best for sleep, anxiety, and muscle relaxation. Gentle on the stomach.** Magnesium Citrate: Useful for constipation, but can cause loose stools at higher doses. Magnesium Threonate: May support cognitive function and brain health. Magnesium Malate: Good for energy and muscle pain, often used in fibromyalgia. We generally avoid magnesium oxide unless constipation is the only concern, as it’s poorly absorbed. **Mag Glycinate is generally my go to recommendation and what we take at our house Also, BLENDS can be good- but generally more expensive Dosing & Timing Most women benefit from 200–400 mg daily, depending on needs. Take it in the evening if you're targeting sleep or relaxation. Divide doses if taking more than 300 mg (e.g. AM + PM). Always start low and go slow, especially with citrate forms to avoid urgent bathroom visits. Final Thoughts If magnesium had better marketing, it would be a top-tier wellness darling. But because it’s quiet, essential, and boring on paper, we tend to overlook it. Yet for so many midlife women, magnesium is the missing link that helps all the other systems and strategies finally click. So if you're doing "everything right" and still feel off? It might be time to start taking magnesium!