Preparing Your Pelvic Floor for Menopause

Supporting your bladder, bowel, sexual health and confidence through midlife.

Menopause is a time of significant change. We often talk about hot flushes, sleep, mood and changing periods, but there is another area of women's health that deserves much more attention: the pelvic floor.

Your pelvic floor works quietly in the background every day. It helps support your bladder, bowel and pelvic organs, contributes to sexual function and helps you control when you pass urine and bowel movements.

As oestrogen levels change during perimenopause and menopause, the tissues of the vagina, vulva, bladder and urethra can also change. Some women notice increased urinary urgency, leaking, recurrent urinary tract infections, vaginal dryness or discomfort during sex.

Others notice changes in pelvic pressure or bowel function.

These symptoms are common—but they are not something you simply have to put up with because you're getting older.

The good news is that there is a lot you can do to support your pelvic health before, during and after menopause.

What happens to the pelvic floor around menopause?

The pelvic floor is made up of layers of muscles and connective tissue at the base of the pelvis. It works together with the diaphragm, abdominal muscles and other muscles around the pelvis and spine.

Oestrogen also plays an important role in the health of the tissues around the vagina, bladder and urethra.

As oestrogen levels fluctuate and eventually decline, some women experience changes in these tissues. This is often referred to as genitourinary syndrome of menopause (GSM).

Symptoms can include:

• Vaginal dryness or irritation

• Burning or discomfort

• Pain or discomfort with sex

• Urinary urgency or frequency

• Getting up more often during the night to pass urine

• Leaking urine when coughing, sneezing, exercising or jumping

• A sudden need to get to the toilet

• Recurrent urinary tract infections

• Changes in sexual function

• A feeling of heaviness or pressure in the pelvis

The British Menopause Society describes GSM as a chronic and progressive condition related to oestrogen deficiency which can affect the vulva, vagina, bladder and urethra.

Importantly, symptoms may not appear immediately around the menopause, so women may not always realise that their symptoms are hormone-related.

So, should every woman start doing pelvic floor exercises?

Not necessarily.

This is an important point.

We sometimes think of the pelvic floor as a muscle that simply needs to be stronger. But your pelvic floor needs to be able to do several things:

Contract when you need support.Relax when you need to empty your bladder or bowel.Lengthen when appropriate.React quickly to coughing, sneezing or movement.Work with your breathing and the rest of your body.

A pelvic floor that is already very tense may not benefit from simply doing more squeezing exercises.

This is why an individual assessment can be so useful.

A pelvic health physiotherapist can assess how your pelvic floor is working and help you understand whether you need more strength, more relaxation, better coordination—or a combination of these.

Think beyond the pelvic floor

Your pelvic floor doesn't work in isolation.

Breathing, posture, abdominal pressure, hip strength, spinal movement, bowel habits and general fitness can all influence how your pelvic floor functions.

This is one reason why strength and movement become particularly important during midlife.

Walking, resistance exercise, Pilates and other forms of exercise can all contribute to maintaining strength, bone health, balance and confidence as we age.

And this is where physiotherapy-led Pilates can be particularly useful.

Rather than focusing on the pelvic floor alone, we can work on breathing, mobility, core control, strength, balance and whole-body movement.

Don't ignore changes in your bladder

Many women start noticing small changes and simply adapt their lives around them.

"I don't drink before I go out."

"I always use the toilet before leaving the house."

"I know where every toilet is."

"I don't jump anymore because I might leak."

"I get up twice a night anyway."

These adaptations can become so normal that we don't recognise them as symptoms.

But urinary leakage and urgency are not an inevitable part of menopause.

Pelvic floor muscle training is an established treatment for urinary incontinence, and a recent systematic review and meta-analysis found that pelvic floor muscle training can significantly improve urinary incontinence symptoms in postmenopausal women.

The important thing is getting the right programme for you, rather than simply doing hundreds of pelvic floor squeezes.

And don't forget your bladder and vaginal tissues

Sometimes urinary symptoms during menopause aren't purely a muscle problem.

Declining oestrogen can affect the tissues around the bladder, urethra and vagina. This can contribute to symptoms such as urgency, frequency, discomfort when passing urine and recurrent UTIs.

This is one reason it is important to look at the whole picture.

For women experiencing genitourinary symptoms of menopause, NICE recommends considering vaginal oestrogen, including for women who are already using systemic HRT.

Non-hormonal vaginal moisturisers and lubricants are alternatives for women who cannot or do not wish to use vaginal oestrogen.

Your GP or menopause specialist can discuss whether this is appropriate for you.

And if you have a history of breast cancer, particularly if you are taking an aromatase inhibitor, treatment decisions should be made with the appropriate healthcare professional.

NICE provides specific guidance for these circumstances.

What about prolapse?

Menopause doesn't automatically mean you will develop a prolapse.

However, changes in the pelvic floor and connective tissues, combined with factors such as previous pregnancy and childbirth, constipation, chronic coughing, heavy lifting and changes in muscle strength, can contribute to pelvic organ prolapse.

Some women describe:

"A dragging feeling."

"Something feels heavy down below."

"I feel pressure after a long day."

"I feel something isn't quite right."

These symptoms deserve to be assessed rather than ignored.

For women with symptomatic early-stage pelvic organ prolapse, NICE recommends considering a supervised programme of pelvic floor muscle training.

Again, the emphasis is on supervised and individualised exercise, rather than a one-size-fits-all approach.

Your bowel matters too

Your pelvic floor also plays an important role in bowel function.

Constipation and straining can place additional pressure on the pelvic floor. Equally, a pelvic floor that struggles to relax can make it more difficult to empty the bowel comfortably.

This is why we often talk about:

• Adequate fluids

• Fibre

• Regular movement

• Avoiding prolonged straining

• Responding to your body's urge to go

• Sitting comfortably on the toilet

• Learning to relax the pelvic floor

Pelvic health is about much more than bladder control.

Sex shouldn't become uncomfortable just because you're menopausal

Pain or discomfort during sex is another symptom that women can feel reluctant to discuss.

Dryness, reduced lubrication and changes to the vaginal tissues can contribute to discomfort, but so can pelvic floor muscle tension.

Sometimes women respond to discomfort by subconsciously tightening their pelvic floor.

Over time, this can become part of a cycle:

Dryness or irritation → discomfort → pelvic floor tightening → more discomfort → avoidance → increased anxiety around sex.

There are treatments and strategies that can help break this cycle.

Lubricants, vaginal moisturisers, appropriate medical treatment and pelvic floor physiotherapy may all have a role depending on the individual woman and her symptoms.

Most importantly, pain with sex is not something you simply have to accept as part of menopause.

Preparing your pelvic floor: where to start

You don't have to wait until you develop symptoms.

A few simple habits can help you look after your pelvic health as you move through midlife.

1. Keep moving

Walking, strength training, Pilates, swimming, cycling and other activities all help maintain general physical fitness.

Your pelvic floor is part of your whole body, so keeping the rest of your body strong matters too.

2. Build strength—not just pelvic floor strength

Resistance exercise becomes increasingly important as we move through midlife for maintaining muscle mass, bone health and physical independence.

Squats, lunges, lifting, carrying and appropriately progressed resistance exercises can all be part of a healthy exercise routine.

3. Learn how to breathe and relax

A pelvic floor that can contract and relax is a functional pelvic floor.

Your breathing and diaphragm are closely linked with pelvic floor movement, which is one reason breathing exercises can be incorporated into pelvic health physiotherapy and Pilates.

4. Don't train your bladder to live in fear of toilets

Going to the toilet just in case all the time can become a habit.

If urgency is an issue, bladder retraining and behavioural strategies can sometimes help—but persistent urgency should be assessed, particularly if there are other urinary symptoms.

5. Look after your bowel

Avoiding constipation and prolonged straining is an important part of pelvic health.

If you regularly feel that you haven't emptied properly, strain to pass stool or experience bowel leakage or urgency, pelvic health physiotherapy may be able to help identify what is happening.

6. Don't ignore leaking

A little leak when you sneeze, run or jump might seem harmless.

But it is worth addressing early.

The same applies to urinary urgency, waking several times at night to urinate or constantly planning your day around bathrooms.

These are symptoms—not something you have to organise your life around.

7. Get assessed if you're unsure

Perhaps the most important piece of advice is this:

You don't need to know exactly what is wrong before asking for help.

A pelvic health physiotherapist can assess your symptoms, movement, breathing, abdominal pressure and pelvic floor function and help you understand what may be contributing.

Sometimes the answer is strengthening.

Sometimes it is relaxation.

Sometimes it is bladder or bowel retraining.

Sometimes it is addressing pain, scar tissue, breathing patterns or movement.

And sometimes it is recognising that medical assessment or menopause treatment is needed alongside physiotherapy.

Your pelvic floor doesn't have to be an afterthought

Menopause is not the end of your active years. In many ways, it can be an opportunity to become more aware of your body and what it needs.

Looking after your pelvic floor is not about becoming obsessed with exercises or worrying about every symptom.

It's about maintaining strength, function, comfort and confidence.

Whether you're approaching perimenopause, noticing changes in your 40s or 50s, or are already postmenopausal, it is never too early—or too late—to start looking after your pelvic health.

And if something has changed, you don't have to simply put it down to "the menopause."

There may be something that can be done.

How BodyRight Physiotherapy can help

At BodyRight Physiotherapy in Drogheda, our pelvic health physiotherapy team can assess and treat a wide range of pelvic floor and women's health concerns.

We can help with:

• Pelvic floor weakness

• Urinary leakage

• Urinary urgency and frequency

• Pelvic organ prolapse

• Pelvic pain

• Pain during sex

• Postnatal pelvic floor problems

• Bowel and constipation-related pelvic floor dysfunction

• Menopause-related pelvic health concerns

• Exercise and strength programmes through midlife

If you're experiencing symptoms or simply want to understand how your pelvic floor is functioning, you don't have to wait until the problem becomes significant.

A pelvic health assessment can be a positive first step towards understanding your body and feeling confident about your pelvic health through menopause and beyond.

BodyRight Physiotherapy Drogheda – helping you move, exercise and live well through every stage of life.