20/01/2026
Menopause and Your Pelvic Floor
Why these powerful muscles matter more than ever
During perimenopause and menopause, declining oestrogen levels can significantly affect the pelvic floor. For many women, this contributes to bladder and bowel symptoms, pelvic discomfort, and changes in s*xual function. These symptoms are common — but they are not inevitable, and they are certainly not something you need to “just live with.”
Understanding your pelvic floor
The pelvic floor is a highly responsive group of muscles that support the bladder, bowel and uterus. These muscles play a vital role in:
Bladder and bowel control
Vaginal support
Sexual function
Core stability and movement
As oestrogen levels decline during menopause, changes occur not only in the pelvic floor muscles themselves, but also in the bladder, urethra and va**nal tissues. Reduced blood flow, thinning of tissues and loss of elasticity can all contribute to symptoms.
Common menopausal pelvic floor symptoms include:
Vaginal dryness or discomfort
Pain during in*******se
Increased urgency or frequency of urination
Getting up at night to pass urine
Leakage of urine or difficulty controlling wind
A feeling of heaviness or dragging in the va**na
While these symptoms affect over half of women at some point, effective treatments exist — and early intervention can make a profound difference.
Understanding the pelvic floor
To understand the pelvic floor a helpful analogy is the boat in a dock
The ropes holding the boat to the dock are the ligaments and fascia support to supporting the organs above.
The water represents your pelvic floor muscles, absorbing the load
If the water level drops, the boat drops down and puts strain on the ropes. If the water level rises, it takes the strain off the ropes. If the ligaments and connective tissue are overstretched from for instance childbirth, or changes into the MP, the PFM can help to compensate for this by supporting the pelvic organs. If PF muscle training is not enough to help prolapse or continence issues, there are other techniques and devices we can help women with, one example silicone pessaries, like a sports bra for the bladder neck and or va**nal walls. Most important is that you don’t give up and seek help.
The evidence is clear: pelvic floor muscle training works
There is strong medical evidence that pelvic floor muscle training (PFMT) is one of the most effective first-line treatments for urinary incontinence and pelvic organ prolapse — including in post-menopausal women.
A well-designed pelvic floor programme improves:
Muscle strength and endurance
Coordination and relaxation
Blood flow to va**nal tissues
Vaginal lubrication and flexibility
Bladder, bowel and s*xual function
Importantly, clinical trials show it is never too late to start.
Why do symptoms often worsen during menopause?
Menopause brings structural and biological changes:
Reduced oestrogen affects va**nal and bladder tissues
Collagen weakens and tissues become less elastic
Vaginal cells thin and lose glycogen, altering the va**nal microbiome
Natural lubrication decreases
These changes can contribute to bladder symptoms and recurrent discomfort. Vaginal oestrogen, alongside pelvic floor muscle training, is a safe and effective option for most women and is widely recommended by menopause and pelvic health specialists.
Risk factors you may not expect
Hormones are only part of the picture. Large studies show that factors earlier in life — particularly va**nal birth — influence pelvic floor health decades later. Research demonstrates higher rates of urinary leakage in women who have had va**nal deliveries compared to caesarean sections, regardless of whether the caesarean was planned or emergency.
Lifestyle factors such as:
Reduced physical activity
Weight changes
Smoking
Chronic cough or constipation
can also increase symptoms during menopause and are modifiable — making this a critical window for prevention and support.
Why women delay seeking help — and why they shouldn’t
Leakage is a major barrier to exercise, despite physical activity being essential for long-term health. Studies show women who exercise are three times more likely to experience urinary leakage, yet many stop exercising rather than seek help.
When women are given permission to talk about pelvic health, the response is often relief. Simple screening questions and early referral can be life-changing.
The Menopause Movement Pelvic Floor Screening Questions
Pelvic floor dysfunction is a common — and modifiable — barrier to staying active. If you answer yes to any of the questions below, a pelvic health assessment is recommended:
Do you leak urine or faeces at any time?
Do you struggle to control wind, especially during exercise?
Do you experience urgency or not make it to the toilet in time?
Do you feel va**nal heaviness or notice a bulge?
Do you experience pain during s*x, tampon use, cycling or daily life?
Do you experience constipation?
Do you have a persistent cough, wheeze or frequent sneezing?
Have you had pelvic surgery or injury?
Are you breastfeeding?
Are you perimenopausal or menopausal?
Is your BMI over 25? (While imperfect, higher BMI is associated with pelvic floor symptoms.)
If any of these resonate, you are not alone — and help is available.
Where to start
The NHS-endorsed Squeezy App is an excellent first step for guided pelvic floor training.
If symptoms persist despite consistent training, book an appointment your GP, or a pelvic health physiotherapist.
The Pelvic, Obstetric and Gynaecological Physiotherapy (POGP) directory can help you find qualified clinicians across NHS and private services:
https://thepogp.co.uk/patients/physiotherapists/
Find a Menopause Movement–trained professional in our directory:
https://www.menopausemovement.co/directory
· if you need medical advice, Dr Karen Morten and her team offer an accessible, comphensive and specialised service of www.drmortons.co.uk on line
Pelvic floor symptoms are common. Suffering in silence is not necessary. Support works — and you deserve it.
