How Menopause Affects the Pelvic Floor

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older patient lays on treatment table while PT stands next to her speaking

You probably know that menopause presents a whole new set of changes in someone’s life. We talk about hot flashes, sleep issues, and mood swings, but did you know that the health of your pelvic floor and menopause are absolutely connected? Changes in hormones can lead to symptoms such as pain with sex, prolapse, leakage, and more. The good news is that there ARE things you can do to help alleviate these symptoms! 

What is the average age when menopause starts? 

Menopause definitively starts when 12 consecutive months have passed since your menstrual cycle. Most women experience menopause between the ages of 40-60, but changes during the transitional phase into menopause, called perimenopause, can start years earlier. 

How do hormone changes lead to pelvic floor issues?

During perimenopause and menopause, an individual will experience a decrease in estrogen. Decreased estrogen levels are what causes menstrual cycles to become inconsistent and less frequent. It also affects both blood flow and lubrication of the muscles and tissues of the pelvic floor. Changes in your pelvic health include:

Treatment options 

Many individuals experience these symptoms and do not realize they are related to perimenopause or menopause. Being aware that these symptoms are due to hormonal fluctuations can help you take proactive steps to ease the transition.

Regular exercise and relaxation habits, including meditation and yoga, help decrease stress and improve sleep. Working with your medical provider on ways to balance or manage your hormones is also extremely important to alleviate certain symptoms.

Common symptoms

  • Changes in pelvic floor muscle strength
  • Vaginal dryness
  • A decrease in sexual desire
  • Incontinence
  • Dramatic mood swings
  • Difficulty sleeping
  • Hair loss
  • Weight gain
  • Depression and anxiety

Urinary incontinence

Many going through perimenopause or menopause experience incontinence due to a weakened pelvic floor. If you have incontinence, try these bladder tips:

  • Stop drinking two hours before bed
  • Do 5 kegels while in bed and perform 5 deep breaths to distract yourself 
  • Avoid bladder irritants at night (alcohol, coffee, caffeine) 
  • Pee before getting into bed 

Sexual function

Decreased estrogen levels, along with increased stress and lack of sleep, can decrease one’s sexual desire. This is totally normal. And as you now know, low estrogen levels cause vaginal tissues to be thin and dry, which can lead to pain, a raw sensation or even mild bleeding with intercourse. 

Water-soluble lubricants are recommended for sexual activity and intercourse to minimize friction and improve pleasure. Your medical provider may also recommend a topical hormone replacement to “plump” up the vaginal tissues to improve moisture and comfort. Increased pleasure may also help increase sexual desire. 

How estrogen affects the pelvic floor

You may experience cold sweats and chills due to your drop in estrogen levels during menopause. Low estrogen levels also mean a dry vagina. When vaginal tissue is thin and dry, it is more prone to tearing which is why you may experience mild bleeding with intercourse. Lower estrogen levels are also linked to a lower libido which means you may have a low sex drive. 

  • Decreased estrogen levels during perimenopause and menopause contributes to:
    • Decreased lubrication
    • Less vaginal discharge
    • Dryness of vulvar and vaginal tissues
    • All of the above contribute to painful sexual intercourse, bleeding during intercourse, itching or irritation of vulvo-vaginal tissues, and increased bacterial infections (fun, right?).

Our number one tip to combat this is to moisturize. Using an all-natural and hormone free moisturizer, such as Coconut oil, Vitamin E oil, or all-natural balms can help manage symptoms related to dryness if you feel dry throughout the day.

You should also look for a water-soluble lubricant for intercourse (slippery stuff is my fave). These all-natural moisturizers can be used inside your labia, at your vaginal opening, and inside the vaginal canal. Use nightly (or as often as you like) to help soothe sensitive tissues.

What are the symptoms of prolapse?

Your pelvic floor muscles help support your pelvic organs (uterus, bladder, and rectum) and help keep the sphincters closed that hold in pee and poop. As perimenopause progresses, you may experience increased leaks of urine with coughing, sneezing, laughing or exercise, as decreased estrogen levels contribute to thinning and weakness of your pelvic floor muscles and vaginal tissues.

Weakness of these muscles may contribute to pelvic organ prolapse, when your pelvic floor muscles and ligaments stop supporting your organs like they should. Your bladder, uterus, or rectum may drop down or press into the walls of the vagina. This can feel like:

  • Pressure or heaviness in your pelvis
  • The sensation of something “falling out” of your vagina
  • A bulge at the vaginal opening
  • Rubbing on the inside of your vaginal canal
  • General discomfort down there
  • Incomplete emptying when you use the bathroom that is worse with standing or at the end of the day

Working with a pelvic floor physical therapist is key to managing prolapse to learn how to minimize straining, strengthen your pelvic floor muscles, and modify exercise and activity. A medical provider, such as a urogynecologist, can recommend supportive devices like a pessary or perform surgery if needed. 

Pelvic floor exercises for menopause

If you have pelvic pain or pressure during perimenopause or menopause, you should start an exercise routine. Movement will help. If you aren’t active already, start simple with a walk, jog or yoga class.

That being said, the number one pelvic floor exercise prescribed for menopause is likely kegels. Check with a pelvic floor PT to be sure kegels and pelvic floor strengthening is what you need. 

Quick tips on relieving pelvic pain during menopause

To recap, below are my top tips to relieve pelvic pain during menopause. Reach out or schedule an online consult if you have any questions.

  • Perform pelvic floor strengthening exercises such as kegels
  • Work to “train” your bladder
  • Avoid bladder irritants and take care not to drink too much water (but stay hydrated)
  • Start an exercise routine

Is pelvic floor PT needed for menopause?

Pelvic floor physical therapists specialize in treating the muscles and tissue in the pelvic region, which affect bowel, bladder, and sexual health.

We also specialize in treating women experiencing the symptoms of perimenopause or menopause by working to strengthen the pelvic floor muscles, improve the elasticity of the vagina to minimize pain and tearing with intercourse, and help prevent those bladder leaks that increase with aging. Working with a pelvic floor physical therapist can be extremely beneficial in alleviating symptoms. 

We often do not discuss the very intimate pelvic floor changes we experience with menopause. Know you are not alone, and there is help and hope available! If you are already experiencing any of these symptoms, it’s never too late to talk with your medical provider or to work with a pelvic floor physical therapist.


Interested in more tips on how to prevent or overcome Pelvic Floor Problems?
Download this free guide for some simple, do-able, totally-not-weird tips to take better care of your down there.

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