How the Menopause Can Impact Women with Perineal Tears

Published: 26th October 2020

Dr Louise Newson, a GP and menopause specialist, recently hosted an informative discussion on birth injury, subsequent incontinence, and how these issues can worsen during the perimenopause and menopause. The event was held as part of Leigh Day’s weekly webinars for Women’s Rights in Healthcare series that covers important topics that have low public awareness, variable quality of care and treatment, and often devastating effects on women’s lives.

Louise was joined by consultant urogynaecologist, Miss Ranee Thakar, Dr Radhika Vohra, a GP with special interest in women’s health, and Joanna Prance, ambassador for the MASIC charity who has lived experience of birth injury.

As an ambassador for the MASIC Foundation (Mothers with Anal Sphincter Injuries in Childbirth), and with full endorsement from the other speakers during the webinar, Joanna clarified areas for focus as the Three Ps:

• Promotion – improving awareness of risk of perineal injury in childbirth

All speakers agreed there needs to be an open and honest conversation about the risk of perineal tears and incontinence. Healthcare professionals, as well as women, need to realise that problems can surface years down the line, along any point in a woman’s life, but especially around menopause. Far more education is also needed for girls and young women on the importance of the pelvic floor muscle, how childbirth and menopause can affect it, and how to look after your pelvic floor for the rest of your life.

• Prevention – reducing occurrence of anal sphincter injuries

Third and fourth-degree tears of the perineum shouldn’t be regarded as merely an unfortunate consequence of childbirth. While it may not be possible to eradicate their occurrence entirely, much can be done to reduce the frequency and severity of them and minimise the potential impact on women throughout the rest of their lives.

• Protection – providing the best care possible

Ranee Thakar believes care after perineal injury is everybody’s business:

“We must not compartmentalise care for these women into what is obstetric, what’s for the midwife, for the nurse or GP – it is everyone’s responsibility with the patient at the heart of it. We all have a duty to ask about the perineum and incontinence when we follow women up, to normalise talking about it, and provide that space freely – women are suffering with incontinence for far too long before getting the help they deserve.”

One treatment that can be helpful to women, both after childbirth and around the perimenopause and menopause, is vaginal estrogen. This acts by boosting low levels of estrogen directly to the genital areas that need it, which in turn helps stop thinning of tissue, helps lubricate the vagina, eases discomfort, and helps fight off infection. Vaginal estrogen can be taken safely, and indefinitely by most women, under the advice of a doctor.

Listeners were reminded that women can seek out a GP who has a special interest in women’s health, and that they also have the right to ask for a second opinion from a hospital doctor, even if that means going outside the local NHS Trust.

Dr Newson and The MASIC Foundation have produced a booklet about menopause and perineal injury which contains more information about treatments.