The menopause pelvic floor connection is real, but not inevitable. Many women notice changes in bladder control, heaviness, or discomfort during perimenopause and beyond. These symptoms stem from hormonal shifts that affect tissue quality, but they do not mean permanent weakness. With the right assessment and treatment, most women see meaningful improvement.
Understanding what happens to your pelvic floor during menopause helps you recognise when to seek support. In clinic, we often see women who have spent months wondering if their symptoms are normal, or whether they should simply accept them as part of ageing. The short answer is no. Pelvic floor changes are common, but they are treatable.
Does Menopause Weaken the Pelvic Floor?
Yes, menopause can weaken the pelvic floor due to declining oestrogen levels. Oestrogen supports collagen production and tissue elasticity throughout the body, including in the pelvic floor muscles, ligaments, and connective tissue. When oestrogen drops, these structures lose some of their strength and flexibility, which can lead to pelvic floor weakness menopause symptoms.
The decline begins during perimenopause, sometimes years before periods stop completely. Tissue becomes thinner and less resilient. Muscles that previously recovered well after strain may now fatigue more easily. Ligaments that once provided stable support may stretch more readily.
It is important to note that pelvic floor weakness is not the only pattern. Some women develop tightness or overactivity instead, particularly if they have been clenching in response to urgency or leakage. Others have a combination of both. This is why generic advice to “just do pelvic floor exercises” does not always help, and can sometimes make symptoms worse.
What Are the Symptoms of Pelvic Floor Changes During Menopause?
Menopause pelvic floor symptoms vary, but some patterns appear frequently. Urinary leakage is one of the most common. This might be stress incontinence (leaking with coughing, sneezing, or exercise) or urgency (a sudden, strong need to urinate that is hard to control). Both can appear together.
Prolapse symptoms include a sensation of heaviness, dragging, or bulging in the vagina. Some women describe it as feeling like something is sitting low or pressing down. Prolapse does not always cause pain, but it can feel uncomfortable after standing for long periods or later in the day.
Vaginal dryness affects many women and can contribute to discomfort during sex or exercise. Less commonly discussed is how dryness and tissue thinning can also affect bladder and bowel function. Constipation becomes more common, partly due to slower gut motility and partly because pelvic floor changes can make it harder to empty the bowel completely.
Pelvic pain is another possible symptom. This might show up as pain during sex, aching in the lower abdomen, or discomfort around the tailbone or hips. Pain often signals overactivity rather than weakness, which is why assessment matters.
One patient recently came to our Bloomsbury clinic describing leakage when running for the bus near Tottenham Court Road. She had assumed her pelvic floor was weak and had been doing hundreds of squeezes daily. Assessment revealed significant overactivity and tension. Once we addressed the tightness first, her symptoms improved within weeks.
Can You Strengthen Your Pelvic Floor After Menopause?
Yes, you can strengthen your pelvic floor after menopause at any age. Muscle tissue remains responsive to targeted exercise, even decades after periods stop. Studies show that pelvic floor muscle training improves symptoms in postmenopausal women, particularly when exercise is tailored and progressive.
The idea that pelvic floor exercises after menopause do not work is a myth. What matters is doing the right exercises in the right way. Many women squeeze too hard, hold for too long, or clench muscles that should stay relaxed. Others perform exercises while their pelvic floor is already overactive, which increases tension without improving function.
Hormone replacement therapy (HRT) can support tissue quality by restoring some oestrogen to the pelvic floor and vaginal tissues. Local oestrogen (applied as a cream or pessary) is particularly effective for dryness and tissue thinning. HRT does not replace the need for pelvic floor rehabilitation, but it can make exercises more effective. Whether to use HRT is a decision for you and your doctor, based on your symptoms and medical history.
Improvement takes time. Expect to notice changes over weeks and months, not days. Realistic expectations matter. Most women will not return to the pelvic floor function they had at 25, but they can regain control, confidence, and comfort.
Is It Worth Seeing a Pelvic Floor Physio in London?
Yes, especially if you are unsure whether your pelvic floor is weak, tight, or both. A women’s health physio menopause assessment gives you accurate information about what is happening and what will help. This is particularly valuable in a city like London, where access to specialist pelvic physiotherapy for menopause in London is available but not always easy to find.
Physiotherapy offers more than exercise instruction. Assessment includes looking at posture, breathing patterns, movement habits, and how your whole body supports pelvic floor function. Treatment might include manual therapy, bladder retraining, bowel management strategies, or advice on pessaries for prolapse.
In Central London, many women balance demanding jobs, commuting, and caring responsibilities. Pelvic floor symptoms can make all of this harder. Specialist physiotherapy gives you practical, evidence-based strategies that fit into your life, rather than generic advice that assumes you have endless time to lie on the floor doing exercises.
The NHS provides guidance on menopause symptoms, including pelvic floor changes. However, waiting times for NHS pelvic health physiotherapy can be long. Private women’s health physiotherapy in London allows you to access specialist assessment and treatment more quickly.
What Happens During a Menopause Pelvic Health Assessment?
A pelvic health assessment for menopause typically lasts 60 minutes. It begins with a detailed discussion of your symptoms, medical history, and what you hope to achieve. We ask about bladder and bowel habits, any pain, and how symptoms affect your daily life.
Physical assessment includes observing your posture, breathing, and movement. Internal examination (vaginal) allows us to assess pelvic floor muscle strength, coordination, and tone. This is always optional and only done with your consent. Some women prefer to wait until a second appointment.
Assessment findings determine your treatment plan. This might include specific exercises, advice on managing urgency or leakage, referral for imaging if prolapse needs further investigation, or discussion about whether local oestrogen could help. We also address any concerns about exercise, lifting, or activities you have been avoiding.
When to Seek Medical Attention
Most pelvic floor changes during menopause are not medically urgent, but some symptoms require prompt assessment. See your GP if you experience:
- Unexplained vaginal bleeding after periods have stopped
- Sudden, severe pelvic pain
- New bowel changes with unexplained weight loss
- Blood in your urine
- Neurological symptoms such as numbness, weakness, or loss of bladder or bowel control
These symptoms may indicate conditions that need investigation beyond pelvic floor physiotherapy.
Book Your Appointment in Central London
Pelvic floor changes during menopause are common, but they are not something you have to accept. Assessment and treatment can make a significant difference to your symptoms, confidence, and quality of life.
PhysioReform is located in Bloomsbury, Central London, close to Tottenham Court Road. We specialise in pelvic health physiotherapy for women at all stages of life, including menopause and perimenopause. Book an appointment online or contact our team to discuss your needs.