How Menopause Impacts the Pelvic Floor (and What You Can Do About It)

Menopause isn’t just about hot flashes and night sweats. The drop in estrogen that happens during this phase, whether it’s natural or caused by surgery, medication, or cancer treatment, can also change the way your pelvic floor and surrounding tissues feel and function.

These changes can be frustrating, even surprising.

But here’s the empowering truth: with the right care and knowledge, you can stay strong, comfortable, and confident through menopause and beyond.

Understanding the Pelvic Floor

Your pelvic floor is a team of muscles and connective tissues that sit at the base of your pelvis. They:

• Support your bladder, uterus, and rectum

• Help control when you pee and poop

• Play a role in sexual comfort and pleasure

• Work with your core to stabilize your body

  
  

When hormones shift during menopause, these muscles and tissues can weaken, tighten, or lose coordination, leading to new or worsening symptoms.

Menopause & the Pelvic Floor: What Changes Happen

Estrogen plays a major role in keeping the vaginal and pelvic tissues healthy. When levels drop, several things can happen:

🔹 Genitourinary Syndrome of Menopause (GSM)

GSM is the medical term for the collection of symptoms that can affect the vagina, vulva, and urinary tract during and after menopause.

You may notice:

• Vaginal dryness or irritation

• Pain or tightness with intimacy

• Increased urinary urgency or frequency

• Burning or discomfort when urinating

These symptoms happen because tissues lose elasticity, blood flow, and natural moisture, but that doesn’t mean you have to live with them.

🔹 Pelvic Muscle Changes

Without the same hormonal support, the pelvic floor can lose tone and flexibility. Some women experience weakness (leading to leakage or heaviness), while others develop tension or tightness (causing pain or pressure).

🔹 Bladder & Bowel Shifts

You might find yourself running to the bathroom more often or dealing with constipation. These can both be signs that the pelvic floor and surrounding structures need some attention.

What You Can Do to Support Your Pelvic Floor

The good news? You have options; many of them safe, holistic, and effective.

1. See a Pelvic Floor Physical Therapist

A pelvic floor PT can assess your muscle coordination, teach you how to relax or strengthen effectively, and help with:

• Urinary leakage or urgency

• Painful sex

• Pelvic pressure or prolapse

• Constipation

• Core stability after menopause or cancer treatment

This isn’t just about doing Kegels. It’s about learning what your pelvic floor actually needs.

2. Restore Vaginal & Tissue Health

Vaginal moisturizers, lubricants, and local vaginal estrogen can make a world of difference.

If you’ve had cancer or are in medically-induced menopause, talk with your oncologist or gynecologist about what’s safe for you. Many survivors use localized treatments that stay mostly in the tissue and don’t affect the rest of the body.

3. Move, Breathe, & Hydrate

Movement keeps blood flowing to the pelvic region. Strength training, yoga, walking, or mobility work all help your pelvic floor function better. Deep breathing and relaxation techniques can ease tension and support core balance.

And, don’t forget hydration: your tissues love water!

4. Support Your Whole Self

Sleep, stress, and self-care matter. Chronic tension or fatigue can directly affect the pelvic floor. Small changes, like setting boundaries, gentle stretching, or mindfulness, can help you feel more grounded in your body.

Conversations to Start with Your Provider

At your next visit, consider asking:

• “Could my symptoms be part of Genitourinary Syndrome of Menopause?”

• “Would you provide me with a referral to pelvic floor physical therapy?”

• “What local, hormonal or non-hormonal options are safe for me?”

• “How can I support my tissue and muscle health long-term?”

  
  

You deserve more than “that’s just menopause.” You deserve answers, comfort, and care that fits your body and your story.

The Bottom Line

Menopause - natural or medically induced - can bring changes, but it doesn’t have to bring misery. Your pelvic floor can stay strong, responsive, and resilient with the right care, education, and support team.

This chapter of life isn’t about shrinking or enduring. I’s about thriving, feeling connected to your body, and living Fempowered.