Pelvic Floor Health During Perimenopause and Menopause: What Every Woman Should Know

When women experience the physical and hormonal changes of perimenopause and menopause, it’s natural to look for solutions to feel more like themselves again. Hot flushes might prompt changes in diet or discussions about hormone therapy. Vaginal dryness, painful sex, or bladder leaks often lead to exploring options like vaginal oestrogen.

But when symptoms like vaginal discomfort, urinary issues, lower back pain, or even balance problems appear together, there’s often a deeper connection, one that’s frequently overlooked: the pelvic floor.

The pelvic floor is a group of muscles that sit at the base of the pelvis, connecting from the pubic bone in front to the tailbone in the back and side to side. These muscles support the pelvic organs, including the bladder, uterus, and bowels and help manage functions like urination, bowel movements, and sexual activity. They also play a key role in posture, stability, and movement.

Unfortunately, this crucial system can become disrupted over time due to poor posture, long periods of sitting, stress, childbirth, or hormonal changes during menopause. According to some studies, up to half of all women experience pelvic floor dysfunction at some point in their lives.

How Menopause Affects the Pelvic Floor

The drop in oestrogen during menopause causes tissues to become less elastic and resilient. This can lead to dryness, pain during sex, and changes in bladder or bowel habits. Childbirth also places a significant strain on the pelvic floor, and if the muscles don’t fully recover, it can contribute to issues later in life.

Understanding Pelvic Floor Dysfunction: Tight vs. Weak Muscles

Pelvic floor dysfunction can show up in different ways, and the key to treatment lies in identifying whether the muscles are hypertonic (too tight), hypotonic (too weak), or a mix of both.

• Hypertonic pelvic floor: Muscles are too tight, which can make it hard to fully empty the bladder or bowels. Sex may be painful, and tightness can even contribute to lower back pain.

• Hypotonic pelvic floor: Muscles lack tone and strength. This can lead to urine leakage, the sensation of something “falling” in the pelvic area (prolapse), or difficulty controlling bowel movements. Weakness in these muscles can also affect posture and stability.

Some women experience both tightness and weakness at the same time, a combination that makes symptoms and treatment more complex.

What Can Help: Treatment Options

While many people think of Kegels as the go-to solution, they’re not a one-size-fits-all fix. In fact, doing Kegels with a tight pelvic floor may actually worsen the problem. Pelvic floor physiotherapists often take a more tailored approach.

• For tight muscles, the goal is to first relax and release tension. Techniques may include yoga, deep breathing, posture adjustments, and gentle stretching routines focused on the hips and pelvic area.

• Once tension is reduced, strengthening exercises like lunges, squats, and longer-hold Kegels may be introduced.

• For weak muscles, physiotherapists focus on rebuilding coordination, strength, and function through core exercises, mobility work, and breath control.

Over time, usually within six to eight weeks, the brain and body begin to reconnect, allowing these muscles to function properly again.

Some physiotherapists also use tools like red light therapy wands, which have shown promise in improving circulation, reducing inflammation, and aiding tissue recovery. These devices can sometimes be used at home under professional guidance.

Act, Find Support

If you suspect pelvic floor issues may be contributing to your symptoms, speak with your doctor or a women’s health physiotherapist. Many pelvic health professionals offer assessments and personalised plans to help you restore function and reduce discomfort.

You don’t have to suffer in silence, there are effective, evidence-based treatments and supportive practitioners who can help you feel strong, supported, and confident again.

Thanks for reading!

Louise x

To learn more about Louise go here