Menopause and the Pelvic Floor: What Changes and How to Support It

Menopause is a major transition in a woman’s life — physically, hormonally, and emotionally. While it’s a natural stage, changes in your body can sometimes feel unexpected, especially when it comes to your pelvic health.

Understanding the Pelvic Floor

Your pelvic floor is a group of muscles, ligaments, and connective tissue that form a supportive base for your bladder, uterus, and rectum. A healthy pelvic floor:

• ✓  Supports bladder, bowel, and sexual function

• ✓  Helps stabilize your core, hips, and spine

• ✓  Promotes lymphatic drainage

• ✓  Maintains pelvic organ positioning

When these muscles are strong and coordinated, everything works smoothly. When they weaken, tighten, or lose coordination, issues like urinary incontinence, pelvic pressure, or pain with intimacy can appear — common challenges during menopause.

How Menopause Affects the Pelvic Floor

Menopause occurs when you’ve gone 12 consecutive months without a menstrual period, typically between ages 45–55. The hormonal changes that come with it, particularly declining estrogen, can affect the pelvic region in several ways:

1. Decreased Tissue Elasticity

Lower estrogen can cause the tissues in your pelvic area to become thinner and less flexible, which may lead to vaginal dryness, irritation, or a sense of pelvic heaviness.

2. Weakened Muscle Strength and Coordination

A decline in estrogen may reduce muscle tone and coordination in the pelvic floor, contributing to:

• ✓  Urinary incontinence in menopause (leakage, urgency, frequency)
• ✓  Pelvic organ prolapse (bladder, uterus, or rectum dropping slightly)
• ✓  Difficulty emptying bladder or bowels completely

3. Changes in Sexual Function

Lower estrogen can affect vaginal lubrication, elasticity, and comfort during intimacy. Overactive or tense pelvic floor muscles can also create pain during penetration.

4. Postural and Core Changes

Shifts in core strength, posture, and weight distribution can further impact pelvic floor function. Your pelvic floor works with your diaphragm, deep abdominals, and back muscles — any change in this system can make your pelvic floor less effective.

Common Pelvic Floor Symptoms During and After Menopause

You don’t need to experience all symptoms to benefit from pelvic floor therapy. Common issues include:

• ✓  Urinary leakage with coughing, sneezing, or exercise
• ✓   Urge incontinence (feeling like you can’t make it to the bathroom in time)
• ✓   Vaginal dryness or irritation
• ✓   Painful intercourse
• ✓   Pelvic pressure or heaviness
• ✓  Constipation or straining with bowel movements
• ✓  Low back, hip, or pelvic pain
• ✓  Changes in posture or core strength

Even mild symptoms are worth addressing early. Proactive care can prevent worsening or additional pelvic floor dysfunction.

How to Support Your Pelvic Floor During Menopause

1. Targeted Pelvic Floor Exercises

Not every woman needs more contraction work; some may have a tight pelvic floor that needs relaxation and coordination. A pelvic floor physical therapist can determine what’s best for you. Recommended strategies may include:

• ✓  Gentle contractions: Engage muscles as if stopping urine flow, hold 3–5 seconds, then relax fully
• ✓  Consistency: 2–3 sets daily, focusing on quality, not quantity
• ✓  Breath integration: Exhale gently when contracting, inhale to relax

2. Stay Active

Movement supports muscle strength, pelvic floor function, and overall health. Activities like:

• ✓  Core, hip, and glute strength training
• ✓  Mobility and stretching for pelvis and spine
• ✓  Low-impact cardio (walking, swimming, cycling)

3. Support Tissue Health

Maintaining tissue health can reduce discomfort:

• ✓  Hydrate throughout the day
• ✓  Use water- or silicone-based lubricants during intimacy
• ✓  Avoid harsh soaps, fragrances, and synthetic products on sensitive areas
• ✓  Discuss topical estrogen with your physician if appropriate

4. Mindful Breathing

Your pelvic floor works with your diaphragm:

• ✓  Inhale to relax and lengthen the pelvic floor
• ✓  Exhale to gently contract and lift
• ✓  Practice daily to improve coordination and release tension

5. Daily Habits and Posture

Small adjustments can protect your pelvic floor:

• ✓  Take breaks from prolonged sitting
• ✓  Maintain neutral spine posture
• ✓  Lift with core engagement
• ✓  Avoid straining during bathroom use or exercise

When to Seek Professional Help

Persistent symptoms like leakage, pelvic pressure, or pain are signals to consult a pelvic health physical therapist. At Breakaway Physical Therapy, we:

• ✓  Assess pelvic floor strength, coordination, and relaxation

• ✓  Evaluate posture, core stability, and movement patterns

• ✓  Identify contributing factors (tight hips, weak glutes, breathing mechanics)

• ✓  Create a personalized program to restore function and confidence

With hands-on techniques, guided exercises, and education, we empower you to take control of your pelvic health.

The Bottom Line

Menopause doesn’t have to mean pelvic discomfort or loss of confidence. With proper guidance, pelvic floor therapy and pelvic floor exercises can:

• ✓  Prevent leakage and incontinence after menopause

• ✓  Support tissue health and sexual function

• ✓  Improve core stability and overall pelvic strength

At Breakaway Physical Therapy in Crofton, MD, we combine expertise, compassion, and personalized care to help you navigate menopause with confidence. Don’t wait until discomfort worsens — your pelvic health matters.

Ready to reclaim your strength and comfort?[Schedule a consultation with our pelvic floor specialists today]