Menopause is one of those life transitions that everyone talks about in whispers,but it’s time we started speaking about it out loud. From hot flushes and sleep struggles to changes in mood, energy, and body composition, menopause can feel like a storm. But there’s one topic that still gets pushed into the shadows: pelvic floor health.
And yet, the pelvic floor is at the heart of so many aspects of women’s wellbeing,from bladder control and core strength to sexual health and even confidence in everyday life. The truth is, menopause and pelvic floor health are deeply connected, and understanding that connection is key to feeling strong, capable, and in control during midlife and beyond.
Let’s break it down.
What Happens to the Pelvic Floor During Menopause?
When estrogen levels drop during menopause, the tissues of the vagina, bladder, and pelvic floor lose some elasticity and blood supply. That means the muscles that were once springy and supportive can weaken, leaving women more vulnerable to issues like:
- Urinary incontinence (that frustrating leakage when you cough, sneeze, or exercise)
- Pelvic organ prolapse (where the bladder, uterus, or rectum bulges into the vaginal wall)
- Genitourinary syndrome of menopause (GSM) (vaginal dryness, irritation, pain during sex)
- Sexual dysfunction (lower arousal, discomfort, or difficulty reaching orgasm)
Research suggests urinary incontinence affects up to 56% of postmenopausal women, and pelvic organ prolapse occurs in around 14–52%,numbers that are too high to ignore.
So while menopause doesn’t cause pelvic floor dysfunction outright, the hormonal changes magnify existing risk factors like pregnancy, childbirth, aging, or heavy lifting.
Why Pelvic Floor Dysfunction Matters Beyond “Leaks”
Here’s the real talk: pelvic floor problems aren’t just a nuisance. They can hit every corner of your life.
- Physical wellbeing – Worrying about leakage can stop you from exercising or doing activities you love.
- Mental health – Women with pelvic floor dysfunction are more likely to experience depression and social isolation.
- Sexual health – Over half of menopausal women with pelvic floor issues report sexual dysfunction, from discomfort to a complete loss of desire.
And yet, many women never get help. Why? Because we’ve been conditioned to accept pelvic floor symptoms as “normal” after a certain age. But common is not the same as normal,and there are things you can do about it.
The Gold Standard: Pelvic Floor Muscle Training (PFMT)
If you’ve heard of “Kegels,” you’ve already come across PFMT. But here’s the thing: most women aren’t doing them correctly,or consistently enough,to get results. Done right, PFMT strengthens the muscles that support your bladder, bowel, and sexual function. There are physios that specialise in women’s health that can prescribe exercises catered to you that will make a huge difference to your pelvic floor health.
What the research says:
- Urinary incontinence – PFMT significantly reduces leakage episodes and can even cure symptoms in some women.
- Pelvic organ prolapse – Improves both symptoms and severity in mild to moderate cases, often delaying or avoiding surgery.
- Sexual function – PFMT improves arousal, orgasm, satisfaction, and reduces pain for many women.
- Quality of life – From feeling more confident in movement to improved intimacy, the benefits go beyond the physical.
Supervised programs with a physio tend to work best, but digital platforms and apps are showing real promise, too,especially for women who want privacy and flexibility.
Barriers: Why Aren’t More Women Doing PFMT?
This is where the gap lies. Studies show many women don’t know enough about their pelvic floor or how to exercise it effectively. Others feel embarrassed to seek help. And some simply believe symptoms are “part of getting older.”
But let me be clear: it is never too late to start strengthening your pelvic floor.
Lifestyle Habits That Support Pelvic Floor Health
PFMT is the cornerstone, but it’s not the only tool. Supporting your pelvic floor during menopause also means looking at your whole lifestyle.
- Stay Active – Regular strength training (done safely) keeps your core and pelvic floor engaged.
- Watch Heavy Lifting Technique – Poor lifting can strain the pelvic floor. Breath control and posture matter.
- Nutrition Matters – Adequate protein supports muscle tissue, and fibre helps prevent constipation (a big strain on the pelvic floor).
- Weight Management – Extra weight increases downward pressure on the pelvic organs.
- Address Menopause Symptoms – Vaginal estrogen therapy, prescribed by your doctor, can help restore tissue health.
It’s a multi-pronged approach: exercise, lifestyle, and (when needed) medical support.
Busting the Myths
Let’s clear up a few common misconceptions:
- “Pelvic floor problems only happen to women who’ve had kids.”
Not true,menopause, aging, and genetics also play big roles. - “If I just do Kegels, I’ll be fine.”
Not always. Many women need guided programs to ensure they’re activating the right muscles. - “It’s too late to start after menopause.”
Absolutely not. Research shows PFMT improves outcomes even decades after menopause.
The Bottom Line
Menopause is not the end of your story,it’s the start of a new chapter. And just like strength training helps preserve your muscles and bones, pelvic floor training protects your core, bladder, and sexual health.
The science is clear: conservative, non-invasive strategies like pelvic floor muscle training work. They improve function, boost confidence, and give women back control over their bodies. It is important you visit a women’s health physio to establish the best exercises for your situation.
What we need now is awareness, education, and support. Too many women are struggling in silence. You deserve better,and you deserve to feel strong at every stage of life.
Final Word
If you’re reading this and nodding along, here’s your reminder: you don’t have to accept pelvic floor problems as your “new normal.” Start small, seek guidance if you need it, and know that change is possible.
I’ll be sharing more evidence-based, practical advice for women navigating fitness, menopause, and pelvic healthover on Instagram. Come join me at @sarahcurranfitpro—let’s break the stigma and build strength from the inside out.
The bodybuilding aesthetician 
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