Pelvic Floor Changes During Perimenopause & Menopause

During perimenopause and menopause, reduced oestrogen and changes in tissue health can contribute to pelvic floor symptoms such as leaking urine, vaginal dryness, pain during sex and prolapse symptoms. Pelvic floor physiotherapy can help manage these changes through targeted exercises, relaxation strategies, pressure management and education - including via online consultations without internal examination.

If this sounds familiar

During perimenopause or menopause, you may notice:

• Leaking urine when coughing, sneezing or exercising
• A feeling of heaviness or pressure in the pelvis
• Pain during sex or painful intercourse
• Vaginal dryness, irritation or sensitivity
• Pelvic discomfort or aching
• Symptoms appearing years after childbirth
• Pelvic floor exercises no longer “working” the way they used to

These changes are common - but they are not inevitable or untreatable.

Why menopause affects the pelvic floor

Hormonal changes play a key role.

Reduced oestrogen can lead to:

• Thinning and reduced elasticity of vaginal and pelvic tissues
• Changes in muscle strength and recovery
• Increased sensitivity or irritation
• Altered bladder control and urgency
• Reduced tolerance to load and pressure

At the same time, lifestyle, stress, sleep disruption and past pregnancy or birth history all influence pelvic floor function.

Common menopause-related pelvic floor symptoms physio can help with

Pelvic floor physiotherapy during menopause commonly supports:

• Stress urinary incontinence (leaking with movement)
• Urge incontinence (sudden need to urinate)
• Pelvic organ prolapse symptoms
• Pain during sex or penetration
• Vaginal dryness–related discomfort
• Pelvic floor tightness or difficulty relaxing
• Fear of exercise due to symptoms

Pelvic floor, vaginal dryness and painful sex

Vaginal dryness and pain during sex are common during menopause, but they are rarely due to dryness alone.

Contributing factors often include:

• Pelvic floor muscle tension or guarding
• Reduced tissue tolerance
• Pain-protective movement and breathing patterns
• Anxiety around pain or discomfort

Pelvic floor physiotherapy addresses these factors alongside education about hormonal and non-hormonal support options (in collaboration with your GP or specialist if needed).

Can pelvic floor physiotherapy be done online during menopause?

Yes - very often.

Online pelvic floor physiotherapy is appropriate if:

• Symptoms are mild to moderate
• You want conservative, non-invasive care
• You prefer privacy and flexibility
• You want clear guidance before symptoms worsen
• You are unsure whether strengthening or relaxation is appropriate

Online care focuses on assessment, education, movement, breathing and symptom-specific strategies - without internal examination.

What happens in an online menopause pelvic floor consultation?

Your pelvic health physiotherapist will:

• Take a detailed symptom, hormonal and medical history
• Discuss bladder, bowel and sexual health changes
• Assess breathing, posture and movement patterns
• Identify whether symptoms relate to weakness, tension or coordination
• Create a personalised plan, which may include:
  • Pelvic floor strengthening or relaxation strategies
  • Bladder retraining or urgency management
  • Pain-reducing and tissue-friendly approaches
  • Exercise guidance tailored to menopausal changes
  • Education on lifestyle and load management

You’ll leave with a clear plan and realistic expectations.

When should you book an assessment?

Book an online consultation if:

• Pelvic floor symptoms are new or worsening around menopause
• Leaking, pain or dryness is affecting confidence or intimacy
• You’ve been told symptoms are “just menopause”
• Pelvic floor exercises no longer feel helpful
• You want expert guidance without invasive assessment

Early support can significantly improve quality of life.

When online care may not be appropriate

You should seek in-person or urgent care if you have:

• Unexplained vaginal bleeding
• Severe pelvic pain
• Signs of infection
• Rapid or severe prolapse symptoms
• New neurological symptoms

Your physiotherapist will advise if escalation is needed.

Why Mothercore

• Specialist pelvic health physiotherapists who truly understand what you’re going through
• UK-registered clinicians you can feel confident and safe with
• Evidence-based, personalised care - built around your body, your symptoms, and your life
• Clear, supportive explanations (no shame, no guesswork, no “just live with it”)
• Flexible online appointments that fit around work, pregnancy, and childcare

Frequently Asked Questions

Do I need hormone therapy for pelvic floor symptoms?

Not always. Many symptoms improve with physiotherapy and conservative management, though some people benefit from combined approaches.

Is leaking urine normal during menopause?

It is common, but not inevitable. Pelvic floor physiotherapy can often improve bladder control during menopause.

Can pelvic floor physio help vaginal dryness?

Physiotherapy can help address muscle tension, pain and sensitivity that often coexist with dryness, alongside appropriate medical guidance.

Is it too late to seek help if I’m post-menopausal?

No. Pelvic floor symptoms can improve at any stage with appropriate assessment and treatment.

Book your online pelvic floor consultation

Useful links:

Tight Pelvic Floor

Weak Pelvic Floor

Pain during sex

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