Why Menopause Matters for your Pelvic Floor
If you have (or had) ovaries, or know someone with them, then menopause is relevant to you, and I can pretty much guarantee that you should know more about it. Menopause is defined as the point in time when a person has gone 12 consecutive months without a menstrual period, signaling the end of their reproductive years. Menopause is a natural part of life, but it’s often something that doesn’t get the attention it deserves. It’s a major life transition that brings a lot of changes—some subtle, some not so much—and one area that can be significantly impacted during this time is your pelvic floor. The good news is that understanding menopause and its effects on your pelvic health can help you manage any challenges that arise, and pelvic floor physiotherapy is one tool that can make a big difference. I really want to go on a tangent here about the implications of menopause on society as a whole and why every single person needs to understand it better- but I’ll save that for another post.
What Happens to the Pelvic Floor During Menopause?
If you’ve hung out with me in a session…or anywhere really- you’ve heard me talk about this but in case you’re new here: the pelvic floor is a group of muscles, ligaments, and tissues that support your bladder, bowel, and uterus. These muscles play a big role—they help control your bladder, keep everything in place, and contribute to sexual function along with several other things. During menopause, when estrogen levels declines, the pelvic floor can feel the effects. And if you're in perimenopause (the years leading up to menopause), you might start noticing these changes even earlier.
Perimenopause usually kicks off in your 40s, but for some, it starts in the 30s and can last for several years. During this time, your hormones fluctuate, and that can lead to a few changes in your pelvic floor. Here's what you might expect:
Weakening Muscles: As estrogen levels drop, your pelvic floor muscles may weaken, leading to issues like urinary incontinence (leaking when you cough, laugh, or sneeze), pelvic organ prolapse (when organs like the bladder or uterus move lower), and vaginal dryness.
Bladder Problems: A common issue during menopause is stress urinary incontinence (SUI)—when you leak urine during activities like coughing, laughing, or exercising. About 30-50% of people in perimenopause and menopause will experience bladder issues, whether that’s SUI or urgency (a sudden, strong urge to pee) (Chiarelli et al., 2017).
Pelvic Organ Prolapse: As your pelvic muscles weaken, pelvic organ prolapse can happen, which is when your bladder, uterus, or other organs drop lower than usual. This is more common for those who have given birth, and about 50% of people will experience some form of prolapse as they age, especially during menopause.
Estrogen’s Role in Pelvic Floor Health
Estrogen isn’t just about regulating your menstrual cycle—it’s also a key player in maintaining pelvic floor health. Estrogen supports muscle tone, tissue elasticity, and moisture in the vaginal area. The vagina, bladder, and urethra are full of estrogen receptors, which means they’re especially sensitive to estrogen changes. When estrogen levels decline during menopause, the pelvic floor can feel the effects.
Weakened Muscles: Estrogen helps keep the pelvic floor muscles strong. Without it, those muscles may weaken, making it harder to control your bladder and bowels.
Vaginal Dryness: As estrogen levels decline, vaginal tissues can lose moisture and elasticity, leading to dryness and discomfort, especially during sex.
Reduced Collagen: Estrogen also helps produce collagen, which strengthens pelvic tissues. As estrogen decreases, collagen production slows, which can cause your pelvic floor to feel less supported.
One option that may help with symptoms like vaginal dryness is topical estrogen. This can come in the form of creams, tablets, or rings that are inserted directly into the vagina. Topical estrogen works locally to improve vaginal health, helping to restore moisture and elasticity without affecting the rest of the body. It’s a safe and effective option that many people find helpful in managing discomfort during menopause.
Bladder Issues and Menopause
Let’s talk about bladder health, because this is a big issue for a lot of people going through menopause. Stress urinary incontinence (SUI) is common—about 30% of people experience it as they age. This is when you leak urine during activities like coughing, laughing, or exercising, and it can be super frustrating. You may also experience urge incontinence, where you feel an uncontrollable need to pee suddenly.
Bladder issues often come with other discomforts like pelvic pain or frequent urination. These symptoms are all related to the hormonal changes that happen during menopause, and they can significantly affect your quality of life.
The Genitourinary Syndrome of Menopause (GSM)
There’s also something called the Genitourinary Syndrome of Menopause (GSM), which refers to the changes that happen in the genital and urinary areas due to the decline in estrogen levels during menopause. This can result in a variety of symptoms, including:
Vaginal dryness and irritation
Painful intercourse
Frequent urinary tract infections (UTIs)
Urinary urgency and frequency
Incontinence
Vaginal or pelvic discomfort
GSM can significantly impact a person's quality of life, but it is treatable. Solutions like vaginal estrogen therapy, pelvic floor exercises, and other treatments can help manage symptoms. You can read more about GSM and its treatment in detail through resources such as the North American Menopause Society.
Why Menopause is Important to Understand
Menopause will affect everyone who has ovaries, but it’s often not well understood, especially by those who haven’t yet gone through it. Understanding what happens during this time—especially when it comes to pelvic floor health—can help you navigate the changes and feel more confident. It’s also a great way to reduce the stigma surrounding menopause and empower people to seek help when they need it.
One of my personal favorite experts on menopause is Dr. Jen Gunter. She’s a gynecologist, pain management specialist, and the author of The Menopause Manifesto: Own Your Health with Facts and Feminism. Dr. Gunter is a leading voice in the conversation around menopause, breaking down myths and providing evidence-based advice. Her book is an incredible resource, full of practical and scientifically-backed information for anyone navigating menopause. I highly recommend giving it a read! You can find her book here: The Menopause Manifesto.
As Dr. Gunter puts it, “Menopause is not a disease, but a natural transition.” The more we understand it, the better we can manage the physical changes and make informed decisions about our health and well-being.
Final Thoughts
Menopause may be a challenging time, but it doesn’t have to mean a decline in pelvic health. By understanding what’s happening with your body and seeking the right support, you can manage many of the changes that come with menopause and maintain a good quality of life. If you're feeling unsure about anything related to menopause, you should feel comfortable talking through these things with your GP or a pelvic floor physiotherapist. They can provide you with the guidance and resources you need to make the best decisions for your health.
If you've been dealing with any of this, I guarantee you're not alone. People walk into my office every day with these symptoms, and there is help. You deserve to be taken seriously, and you deserve support. And no, you don't have to just deal with it.
Whether through exercise, lifestyle adjustments, treatments like hormone therapy, and/or topical estrogen, pelvic floor physiotherapy can all be helpful.
References
Gunter, J. (2021). The Menopause Manifesto: Own Your Health with Facts and Feminism. Hachette Books. Find the book here: The Menopause Manifesto.
Chiarelli, P., et al. (2017). Prevalence and Impact of Urinary Incontinence in Women in the Journal of Urology, 198(5), 1041-1047. Link to study.
National Institutes of Health (2023). Pelvic Floor Health and Menopause. U.S. Department of Health & Human Services. Link.
International Urogynecological Association (2020). Bladder Control and Incontinence: Menopause and Beyond. IUGA. Link.
The North American Menopause Society (2023). Genitourinary Syndrome of Menopause (GSM). Link.
