How does perimenopause impact your pelvic floor health? During perimenopause, hormonal changes can weaken the pelvic floor muscles, leading to issues like incontinence (i.e. leaking & urges) and discomfort. Here we share four podcast recommendations on pelvic floor health and perimenopause so you can get started listening and learning. In the rest of this blog, we explore the connection between pelvic floor health and perimenopause, offering insights into trying to effectively manage your pelvic health.
But before we dive in, here are 4 podcast recommendations:
Key takeaways
- The pelvic floor supports vital organs and its health can decline during perimenopause due to decreased estrogen, leading to issues like urinary incontinence and pelvic pain.
- Addressing pelvic health during perimenopause through exercises, like kegels, medical interventions, and consulting specialists is crucial for maintaining overall well-being and sexual health.
Understanding your pelvic floor
The pelvic floor is a group of muscles and connective tissue at the base of the pelvic region, forming a hammock-like structure that supports your pelvic organs. This crucial support system includes:
- The bladder
- The bowel
- The uterus, which plays a vital role in functions such as urination, defecation, bladder function, sexual activity, and pelvic floor function.
- The pelvic floor muscles, including the puborectalis muscle, are essential for: maintaining the angle of the anal canal and controlling bowel movements.
Pelvic floor muscles include both superficial and deep layers, each with specialized muscles. These muscles can contract, changing the female pelvic floor from a basin shape to a dome shape, which is crucial for supporting pelvic organs and maintaining health. Aging, childbirth, and hormonal changes can affect their strength and elasticity, leading to pelvic floor dysfunction. Additionally, pelvic floor muscles contain receptors for estrogen, which research indicates they respond to changes in estrogen levels.
Did you know? Advancements in imaging techniques, such as MRI and 3D ultrasound, have significantly enhanced our understanding of pelvic floor anatomy and dynamics during contraction, including aspects related to blood flow. These insights are vital for diagnosing and treating pelvic floor disorders, ensuring women receive optimal care for their pelvic health.
How perimenopause affects pelvic floor health
Perimenopause is a time of big hormonal shifts – and your pelvic floor feels it too. According to research, as estrogen levels start to dip, the pelvic floor muscles can lose some of their natural elasticity and strength. This means they may not support your bladder, bowel, and reproductive organs as effectively as before. The result? You might notice changes like bladder leaks, discomfort during sex (eek!), or a sense of pressure in the pelvis. After menopause, lower collagen levels can further reduce tissue elasticity, compounding these symptoms. These hormonal changes can also contribute to ongoing pelvic pain and discomfort, impacting overall pelvic and sexual health. That’s why maintaining pelvic floor strength during this transition is so important.
Below we’ll talk about how perimenopause affects key areas – from urinary incontinence and vaginal dryness to pelvic organ prolapse – and share practical tips to support your pelvic health through it all.
Urinary incontinence during perimenopause
Urinary incontinence – including bladder leaks and urges – is one of the most common pelvic floor issues during perimenopause. It happens when weakened muscles can’t fully support the bladder, leading to symptoms like sudden urges to urinate, stress incontinence (leaks when you cough, sneeze, or exercise), and general bladder leakage. While it can feel frustrating or even embarrassing, the good news is there’s a lot you can do. Pelvic floor exercises (kegels) are one of the most effective ways to rebuild strength and regain control. These exercises involve tightening and relaxing the pelvic muscles, much like stopping the flow of urine midstream (though you shouldn’t actually do them while peeing).
You can also manage bladder symptoms by:
- Scheduling regular bathroom breaks
- Avoiding bladder irritants (like caffeine or alcohol)
- Working with a pelvic floor physical therapist who can tailor exercises to your body and ensure you’re doing them correctly.
Vaginal dryness and discomfort
Research tells us that as our estrogen levels decline, the vaginal lining can become thinner and drier – leading to irritation, discomfort during sex, and sometimes even spotting. These changes can have a real impact on one’s intimacy and quality of life. If dryness starts affecting your comfort or daily activities, don’t hesitate to speak with your general practitioner. There are several effective treatments available, including:
- Vaginal moisturizers for daily comfort
- Lubricants for sexual activity
- Vaginal estrogen therapy to restore tissue health and elasticity
Addressing vaginal dryness early helps maintain both pelvic health and sexual well-being during perimenopause.
The risk of pelvic organ prolapse
Pelvic organ prolapse occurs when weakened pelvic floor muscles allow organs (like the bladder, uterus, or rectum) to shift downward into the vaginal space. It may feel like heaviness, pressure, or a bulge in the pelvis, and can interfere with exercise, comfort, and sexual activity. Treatment depends on severity, but common options include:
- Pelvic floor exercises to strengthen support structures, like kegels or several you may do in yoga or pilates
- Hormone replacement therapy (HRT) to restore tissue elasticity
- Medical assessment to explore further options if symptoms are severe
Your healthcare provider can guide you toward the best plan for your individual needs.
Maintaining pelvic floor health in perimenopause
A strong pelvic floor supports bladder and bowel function, sexual health, and overall comfort. Here are some foundational habits to protect and strengthen it:
Exercise regularly — gentle movement like walking or yoga helps maintain circulation and reduce strain.
Eat a high-fiber diet — preventing constipation means less pressure on your pelvic organs.
Maintain a healthy weight — even a few extra pounds can increase pressure on the pelvic floor.
If you experience chronic pelvic pain, over-the-counter pain relief or hormonal treatments may help, depending on your doctor’s advice.
Pelvic floor exercises (aka kegels)
Kegels are small but mighty. These simple contractions of your pelvic muscles can:
- Improve bladder control
- Prevent or ease prolapse
- Increase blood flow to pelvic tissues
- Enhance sexual pleasure
Learning the correct technique is key, and that’s where a pelvic physical therapist can help. They’ll teach you proper muscle engagement and create a personalized plan that fits your lifestyle.
Medical interventions for your pelvic floor
For some, lifestyle changes and exercise aren’t enough. For others, HRT can ease perimenopausal symptoms and strengthen pelvic tissues. Vaginal estrogen treatments can reduce urinary tract infection (UTI) risk by over 75% and relieve genitourinary symptoms, while nonhormonal lubricants and moisturizers offer comfort for those who prefer nonhormonal options. Your healthcare provider can help you decide which treatment best suits your needs.
Also, if you’re unsure whether you’re doing pelvic floor exercises correctly or are experiencing symptoms like pain, leakage, or prolapse, a pelvic floor physical therapist is a great ally. They can:
- Assess your pelvic floor strength
- Guide you through tailored exercises
- Provide hands-on therapy to improve function
- Your doctor or healthcare provider can refer you to a trusted therapist and help coordinate a holistic care plan.
Sexual health and perimenopause
Changes in estrogen levels don’t just affect your body; they can impact desire, arousal, and pleasure too. Many women experience reduced libido or discomfort during intimacy in perimenopause. Hormone therapy and pelvic floor strengthening can make a big difference. Stronger pelvic muscles may also enhance sensation and sexual responsiveness, helping you reconnect with your body and intimacy on your terms. Just remember, you are not alone!! Share these podcasts with your partner so they can also understand you better.
Summary
Perimenopause may bring big changes, but it doesn’t have to mean discomfort or loss of control. Understanding how hormonal shifts affect your pelvic floor, and taking proactive steps through exercise, therapy, and treatment, can help you feel strong, confident, and comfortable in your body. By staying informed and seeking support when needed, you can navigate this menopausing journey with confidence and protect your pelvic health for years to come!
Frequently Asked Questions on pelvic floor health & perimenopause
1. What are the common symptoms of perimenopause?
Perimenopause often brings hot flashes, night sweats, mood swings, irregular periods, and shifts in sexual desire. If you notice these symptoms, you’re not alone; many women experience them. Your pelvic floor is also affected by perimenopause as explored in this article.
2. How can I manage urinary incontinence during perimenopause?
To manage urinary incontinence during perimenopause, try pelvic floor exercises like kegels to strengthen your muscles. Several yoga and pilates exercises may help. A pelvic floor physical therapist can offer tailored advice to suit your needs.
3. What treatments are available for vaginal dryness during perimenopause?
Vaginal dryness during perimenopause can be effectively treated with nonhormonal lubricants, moisturizers, or vaginal estrogen therapy. It’s best to chat with your doctor to find the right option for you.
4. When should I seek medical attention for pelvic pain?
You should definitely seek medical attention for pelvic pain if it’s severe or if you experience vaginal bleeding or fever. It’s better to be safe and get checked out!
Sources:
https://menopause.org/patient-education/menopause-topics/symptoms The Menopause Society
https://womenshealth.gov/menopause/menopause-and-sexuality Office on Women’s Health
https://cdn.ymaws.com/abdominalradiology.site-ym.com/resource/resmgr/education_dfp/pelvicfloor/anatomy/pelvic_floor_imaging_and_ana.pdf YMAWS
https://pmc.ncbi.nlm.nih.gov/articles/PMC6769195/ PMC
https://academic.oup.com/smoa/article/12/2/qfae024/7667260 OUP Academic
https://www.auanet.org/documents/Guidelines/PDF/2025%20Guidelines/GSM%20Unabridged%202025.pdf American Unaccompanied Minor Association
https://menopause.org/wp-content/uploads/press-release/sexual-health-concerns-june-video-release.pdf
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