Whoever said women should age with grace clearly did not understand all the complexities and frustrations of losing your estrogen stores. Yes, hot flashes are annoying and sleeping less takes getting used to, but saggy pelvic organs are an entirely different beast.
The unglamorous truth is that as we age, our vaginas and uteri can fall out, well sort of. Estrogen, a hormone that aids in several important physiologic functions in the female body including bone building and temperature maintenance, also plays an important role in vaginal elasticity and pelvic muscle tone.
Low estrogen and a number of other risk factors like increasing age, obesity, chronic cough, heavy lifting and one or more vaginal births can increase the chances of uterine prolapse, or the sinking of the uterus from its normal position high in the pelvis down into the vagina.
Degrees of uterine prolapse can vary and so can the treatment options. For severe prolapse where the uterus descends all the way down to the bottom of the vagina, surgery might be a first choice treatment. For milder cases however, it's common for doctors to recommend pessary devices (imagine a diaphragm like plug high up in the vagina that holds everything in place) or do-it-yourself kegel exercises.
Made infamous by the schoolyard talk or whispers of its existence during middle school sex-ed courses, kegels are, in fact, a legitimate and well-supported approach to treating and preventing prolapse.
If performed correctly, kegels can tone and tighten the group of muscles (levator ani) that help keep the uterus, vagina, bladder and even lower rectum in place. The key to perfecting this exercise is to first recognize and isolate the right muscle group.
Most physicians recommend the "stop-peeing" technique where the same muscles used to stop the flow of urine are the ones to target. Then it's a matter of spending enough time on the exercise. The Mayo Clinic recommends starting at reps of three seconds each and eventually moving up to ten, ten-second kegels, three times a day.
Perhaps what's most interesting about kegels is that despite a good percentage of women already knowing about their existence, not enough women perform them. In a 2007 study from the Journal of Pelvic Medicine and Surgery, researchers found that only 28-percent of women surveyed admitted to doing kegels regularly and that only 36-percent had been instructed by their doctors to perform them.
Clearly, women are knowledgeable about pelvic floor exercises, even if they aren't all the way sure of their purpose or if their physicians aren't bringing it up. And while not every woman's uterus will "fall out" or sag as she ages, it's important to recognize that for a very common problem amongst aging women overall, there is an equally common and easy potential solution.
Moen, M. et al. Knowledge and performance of pelvic muscle exercises in women. Journal of Pelvic Medicine and Surgery. 2007;13:113-7.