How menopause affects your pelvic floor- and what you can do about it.
Menopause is a natural part of life—but that doesn’t mean you have to suffer through it.
As estrogen levels decline during perimenopause and menopause, a number of physical changes can show up, especially in your pelvic floor. These changes might surprise you—but the good news is, there’s a lot you can do to support your body through them.
We created this guide to help you better understand what’s happening, why it’s happening, and most importantly, what you can do about it
what is the pelvic floor- and why does it matter?
Your pelvic floor is a group of muscles that support your bladder, uterus, and rectum. These muscles work automatically (you don’t have to think about them!) to control continence, support your core, stabilize your pelvis and spine and are vital for sexual function and bowel/bladder function.
During perimenopause and menopause, changes in hormone levels—especially estrogen—can affect how these muscles function, leading to symptoms you may not expect.
common pelvic floor changes during perimenopause and menopause
Here are the most common changes in the pelvic floor that we see:
Decreased Tone and Strength
Estrogen is vital for tendon and muscle strength. When this starts to decline, we can see a weakening of pelvic floor muscles. This can lead to leaking with coughing, sneezing or jumping- also known as stress incontinence
Prolpase Risk
As muscles weaken, the organs they support may begin to change position (especially since gravity can be pulling everything down). You might feel heaviness, pressure or even notice a bulge.
Increased Urinary Frequency or Urgency
Thinning bladder walls and changes in the sensation can make it feel like you need to pee all the time, or that urge comes on really fast and you are unable to control it.
Vaginal Dryness
Estrogen keeps the vaginal tissues elastic and moist, however when it begins to decline it can cause intercourse to become uncomfortable or even painful
Reduced Circulation
Less estrogen means less blood flow to your pelvic tissues. This can slow healing, decrease tissue health and impact sensation. All these changes can impact pain with intercourse as well as elasticity of your pelvic floor
what can you do to support your pelvic floor
You are not powerless here. With the right strategies, you can strengthen and support your pelvic floor to feel confident and comfortable again.
Pelvic floor strengthening (hint: it’s more than kegels)
The pelvic floor needs dynamic strengthening—not just squeezing while you sit. Think of it like building your quads: you wouldn’t just flex your thigh muscle, you’d do squats, lunges, and loaded movements. Your pelvic floor needs the same challenge.
Some of our favorite exercises:
Bear Plank
Kickstand Hip Hinge
Tip: these are best done under guidance to ensure you are engaging the right muscles at the right time.
Bladder health tips
Avoid “just in case” trips to the bathroom
This is teaching the bladder to empty when it is not full. It will adjust to emptying earlier than it should, contributing to frequency.
Stay hydrated
Concentrated urine irritates your bladder, which can make you pee more. Decreasing the amount you drink so that you do not pee does not help.
Watch for irritants
This is very person-specific. Some people are more sensitive to irritants than others; therefore, tracking what you are drinking and its effects can be helpful. Some common irritants include caffeine, alcohol, carbonated beverages, and acidic foods.
Use urge suppression techniques
Urge suppression techniques can be used when you are getting the urge to go to the bathroom too frequently (this happens when you train your bladder to empty when it is not full!). Some helpful techniques are heel raises, distraction and breathing.
Managing painful sex
Discomfort with intimacy is incredibly common but also highly treatable and not something you just need to deal with it.
Focus on relaxation first
Breathwork to help regulate the nervous system as well as mobility/stretches can help release tension in the pelvic floor. Here are some of our favorite mobility exercises:
Adductor Rock Back
Deep Squat Breathing
Use daily vaginal moisturizers
Dryness is not uncommon as we age, and using a moisturizer can help decrease the dryness. We moisturize other parts of our body, and our pelvic floor is no different. Here are a couple of our favorites.
Bionurish Ultra Moisturizing Vaginal Gel with Hyaluronic Acid
Revare by Bonafide by Good Clean Love
Via by SolvWellness
You Deserve More Than "Just Deal With It"
Every woman experiences perimenopause and menopause differently, but one thing we hear over and over again is that symptoms are often brushed off as “just part of aging.” That’s not okay.
There are supportive, effective ways to help you feel strong, confident, and in control of your body again.
let us help
At Empower PT & Wellness, we specialize in helping women navigate pelvic health through every stage of life—including perimenopause and menopause.
Our approach is personalized, movement-based, and rooted in compassion. Whether virtually or in-person, we’re here to help you thrive—not just survive—this phase of life.
Curious if pelvic floor PT is right for you?
Schedule a free 15-minute consultation with one of our expert physical therapists.
Dig Deeper: Uncover More Secrets to Pelvic Floor Health
link blogs
Hi! We are Dr.Aimee and Dr. Lauren
We are the owners of Empower Physical Therapy and Wellness. We are pelvic floor physical therapists who specialize in helping women from pregnancy, into postpartum and through perimenopause, menopause and then beyond! We believe all women deserve to do all of the things they love without symptoms!
You can contact us via our website, email at hello@weempowerpt.com or social media!
The information provided in this blog is for educational and informational purposes only and is not intended as medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or symptoms. Never disregard professional medical advice or delay in seeking it because of something you have read on this blog.
If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately. The opinions expressed in this blog are those of the author and do not necessarily reflect the views of any medical or healthcare institutions.
