In fact, pelvic health symptoms tend to worsen during this stage of life. Our Origin x Ipsos study found that 63% of peri/menopausal women reported bladder leaks and 21% reported pain with sex. Unfortunately, more than a third of those affected do not receive the care they need as these symptoms are rarely discussed and often overlooked.
In this article, we will help you understand the changes that can occur during peri/menopause and how they can affect your pelvic floor. We also share tips on what you can do. Read on for more information about menopause and pelvic floor complaints, and how our team can help you during this (and any) phase.
What is the pelvic floor?
The pelvic floor is a group of muscles, ligaments, and connective tissues that form a hammock-like support system at the base of your pelvis. It has many functionsincluding helping to control urination and bowel movements, managing abdominal pressure, supporting your uterus, bladder and rectum, and enjoying pain-free sex.
Like all other muscles in the body, the pelvic floor structures can become tight, weak, or uncoordinated, which can affect the body in a variety of ways. Major physical events such as pregnancy, childbirth and surgery can also affect the pelvic floor. What makes the pelvic floor so interesting is that other factors, such as lifestyle, hormonal changes and even mental health, can also influence it.
Ultimately, a healthy and functional pelvic floor is crucial for a vibrant and active life. Understanding the anatomy and knowing your own “normal” is a good start, but it’s also important so you can tell when something is “off.”
What is perimenopause vs menopause?
We sometimes talk about menopause as if it’s the “end” of something, but it’s also a beginning, and a very natural and normal part of every woman’s journey. It is also important to understand that menopause is not just a one-time event that happens and then is over. It is usually a gradual transition characterized by changing hormone levels over time.
- Perimenopause: The phase before menopause that usually begins around age 40, but can begin as early as age 30 or as late as age 50. During this phase, estrogen and progesterone fluctuate (and not simply experience a steady decline), which can trigger the onset of ‘menopausal’ symptoms. This phase can last about four years to ten years or more for some.
- Menopause: Medically defined as the time at which a woman has gone without menstruation for twelve consecutive months. The average age of menopause is 51 years. The ovaries now no longer produce eggs and estrogen. Although your body still produces some estrogen from fat cells, estrogen levels are largely reduced.
Estrogen receptors live all over our bodies, so the fluctuating and then declining estrogen levels during perimenopause and menopause can affect symptoms throughout our bodies — from urine leakage to a sore knee to brain fog. This is why there are over 100 symptoms of menopause.
How does menopause affect the pelvic floor?
Hormonal changes during menopause play a big role in the health of your pelvic floor. Estrogen helps keep tissues strong and elastic. Its deterioration can affect the pelvic area, leading to tissue thinning, weakening of muscles and ligaments, and vaginal dryness. This may present as new symptoms in the pelvic area, such as:
Many of these symptoms are now recognized as the term: genitourinary syndrome of menopause (GSM). This term includes the changes in vaginal tissue, sexual dysfunction, and changes in the urinary tract that often occur together during menopause.
If you think you are experiencing any of these symptoms, do not hesitate to do so schedule a conversation with one of our specialists for guidance and support.
What are symptoms of pelvic floor dysfunction?
If you notice changes or new symptoms in your pelvic area, it’s always worth seeing a pelvic floor specialist to better understand what’s going on. Be sure to share what your normal situation has been and what has changed so that your physical therapist can get a better idea of the cause of your symptoms. Although menopause symptoms are common, you don’t have to accept them as inevitable.
Are you unsure whether you should schedule an appointment? Use this symptom checklist to monitor yourself and decide when to seek help:
- Leaking urine while laughing, coughing, sneezing, exercising, jumping or basically anytime
- Urge to urinate more often or difficulty holding it in
- Pain, dryness or burning sensation during sex
- Heaviness, bulging, or pressure in the pelvic area
- Pain or discomfort in the hips, back or abdomen
If you recognize any of the symptoms on this list, know that you are not alone. Most symptoms can be treated or controlled, so you don’t have to endure discomfort that limits your daily life.
How can symptoms be treated?
Menopause cannot be stopped or ‘cured’, but symptoms can be managed. An extensive team is required to treat menopausal complaints in the pelvic area.
You will want to maintain care with a primary care provider and/or gynecologist for routine personal care such as vaccinations, pap smears, and annual exams. For specialized menopause management, providers trained by the Menopause Society (such as those from virtual clinics such as Midi) often have advanced expertise in hormone therapy and can help you identify the appropriate and safest treatment options for your specific needs, to complement the care you receive from your local health care providers. In addition, a pelvic physiotherapist must be present in the team to address the symptoms on the physical side. Physiotherapy continues to prove effective for symptoms such as pelvic organ prolapse, urinary incontinence and painful sex.
Medical Treatment Options:
- Systemic hormones: often called hormone replacement therapy (HRT) or menopausal hormone therapy (MHT). HRT can provide important protection for bone and cardiovascular health, and many women benefit from starting treatment early in menopause (even before hot flashes begin) to help maintain long-term health.
- Local hormones: creams, suppositories or rings
- Various other medications for specific symptoms such as hot flashes and changes in mental health
- Over-the-counter vaginal moisturizers (our favorites here!)
Physiotherapy Treatment:
- Pelvic floor exercises: from Kegels to pelvic floor relaxation to using the internal pelvic wall to stretching exercises, depending on your needs
- Dilator training: for pain during penetration
- Lifestyle adjustments: bladder training, nutritional tips and stress management techniques
- Full-body resistance training: for addressing musculoskeletal pain and hormone-related bone and muscle changes
- And more! Based on your needs
Do you want to find a medical provider who specializes in menopause? At Origin we like to send patients to Midi. Midi offers in-network telehealth appointments for all your menopause and aging needs.
You can also find a certified menopause doctor here courtesy of the Menopause Association.
How to take the next step
Listening to your body and acting early can make all the difference. If you’re experiencing symptoms, or just want to know what’s going on, start with this:
- Screen for symptoms using the checklist above (but keep in mind there are many more symptoms you may experience!)
- Keep notes of changes and patterns you’ve noticed (nothing is too small or too big to mention)
- Request expert guidance at any time. Origin’s doctors are always ready to support you.
If you think you’re experiencing pelvic floor symptoms related to menopause, know that you’re not alone.
Ready to take charge of your pelvic health? Book an evaluation with an Origin doctor.
Sources
Camon C, Garratt M, Correa SM. Investigation of the effects of estrogen deficiency and aging on the homeostasis of the organism during menopause. Wet aging. 2024;4(12):1731-1744. doi:10.1038/s43587-024-00767-0. (pubmed.ncbi.nlm.nih.gov)
Goldenberg L, et al. Overview of the pelvic floor. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482200/
Angelou K, Grigoriadis T, Diakosavvas M, et al. The urogenital syndrome of menopause: a review of recent data. Cureus. 2020;12(4):e7586. doi:10.7759/cureus.7586. PMID: 32399320; PMCID: PMC7212735. (pubmed.ncbi.nlm.nih.gov)
Midi health. 12 Common Symptoms of Menopause Every Woman Should Know. Join Midi. Published on July 12, 2024. Updated on December 24, 2024. Accessed on November 21, 2025. https://www.joinmidi.com/post/12-common-symptoms-of-menopause-every-woman-should-know
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