Why these powerful muscles matter more than ever

During perimenopause and menopause, declining oestrogen levels can significantly affect the pelvic floor. For many women, this contributes to bladder and bowel symptoms, pelvic discomfort, and changes in sexual function. These symptoms are common — but they are not inevitable, and they are certainly not something you need to “just live with.”

Understanding your pelvic floor

The pelvic floor is a complex, highly responsive group of muscles that support the bladder, bowel and uterus. These muscles play a vital role in:

Core stability and movement

Bladder and bowel control

Vaginal support

Sexual function

As oestrogen levels decline during menopause, changes occur not only in the pelvic floor muscles themselves, but also in the bladder, urethra and vaginal tissues. Reduced blood flow, thinning of tissues and loss of elasticity can all contribute to symptoms.

Common menopausal pelvic floor symptoms include:

• Vaginal dryness or discomfort
• Pain during intercourse
• Increased urgency or frequency of urination
• Getting up at night to pass urine
• Leakage of urine or difficulty controlling wind
• A feeling of heaviness or dragging in the vagina

The evidence is clear: pelvic floor muscle training works

There is strong medical evidence that pelvic floor muscle training (PFMT) is one of the most effective first-line treatments for urinary incontinence and pelvic organ prolapse — including in post-menopausal women.

A well-designed pelvic floor programme improves:

• Muscle strength and endurance
• Coordination and relaxation
• Blood flow to vaginal tissues
• Vaginal lubrication and flexibility
• Bladder, bowel and sexual function

Importantly, clinical trials show it is never too late to start.

Why do symptoms often worsen during menopause?

Menopause brings structural and biological changes:

• Reduced oestrogen affects vaginal and bladder tissues
• Collagen weakens and tissues become less elastic
• Vaginal cells thin and lose glycogen, altering the vaginal microbiome
• Natural lubrication decreases

These changes can contribute to bladder symptoms and recurrent discomfort. Vaginal oestrogen, alongside pelvic floor muscle training, is a safe and effective option for most women and is widely recommended by menopause and pelvic health specialists.

Risk factors you may not expect

Hormones are only part of the picture. Large studies show that factors earlier in life — particularly vaginal birth — influence pelvic floor health decades later. Research demonstrates higher rates of urinary leakage in women who have had vaginal deliveries compared to caesarean sections, regardless of whether the caesarean was planned or emergency.

Lifestyle factors such as:

• Reduced physical activity
• Weight changes
• Smoking
• Chronic cough or constipation

can also increase symptoms during menopause and are modifiable  — making this a critical window for prevention and support.

Why women delay seeking help — and why they shouldn’t

Leakage is a major barrier to exercise, despite physical activity being essential for long-term health. Studies show women who exercise are three times more likely to experience urinary leakage, yet many stop exercising rather than seek help.

When women are given permission to talk about pelvic health, the response is often relief. Simple screening questions and early referral can be life-changing.

The Menopause Movement Pelvic Floor Screening Questions

Want to know whether you should seek help?

Look no further… answer these simple questions to find out what you should do:

Pelvic floor dysfunction is a common — and modifiable — barrier to staying active. If you answer yes to any of the questions below, a pelvic health assessment is recommended:

• Do you leak urine or faeces at any time?
• Do you struggle to control wind, especially during exercise?
• Do you experience urgency or not make it to the toilet in time?
• Do you feel vaginal heaviness or notice a bulge?
• Do you experience pain during sex, tampon use, cycling or daily life?
• Do you experience constipation?
• Do you have a persistent cough, wheeze or frequent sneezing?
• Have you had pelvic surgery or injury?
• Are you breastfeeding?
• Are you perimenopausal or menopausal?
• Is your BMI over 25? (While imperfect, higher BMI is associated with pelvic floor symptoms.)

If any of these resonate, you are not alone — and help is available.

Where to start

• The NHS-endorsed Squeezy App is an excellent first step for guided pelvic floor training.
• If symptoms persist despite consistent training, book an appointment with Dr Morton’s team here, your GP,  or a pelvic health physiotherapist.
• The Pelvic, Obstetric and Gynaecological Physiotherapy (POGP) directory can help you find qualified clinicians across NHS and private services:
  https://thepogp.co.uk/patients/physiotherapists/

Supporting women to stay active through menopause

At Menopause Movement, we train health and fitness professionals to work confidently, safely and effectively with women through perimenopause and menopause — including understanding how to support pelvic floor health.

Our community and training platform ensures women can stay active without fear, shame or unnecessary restriction.

👉 Find a Menopause Movement–trained professional in our directory:
https://www.menopausemovement.co/directory

👉 If you’re a health or fitness professional, we welcome you to join our community and courses. The amazing Dr Karen Morton of www.drmortons.co.uk presents our fantastic gynae module. Pelvic floor symptoms are common. Suffering in silence is not necessary. Support works — and you deserve it.