Menopause refers to a woman’s final menstrual cycle, most commonly around the age of 50. During perimenopause, hormones wind down and fluctuate for an average of four to eight years, until ovulation, menstruation, and the production of the hormones oestrogen and progesterone have ceased. When menstruation has ceased for an entire year, a woman is considered postmenopausal.

These transitional years can be challenging for some and a breeze for others. For some women, this time is a nightmare of hot flashes, irritability, mood swings, bladder urgency, disturbed sleep, forgetfulness and a dry vagina. For others, it’s a rite of passage to many welcome changes, including increased confidence, enhanced energy, renewed interest in trying new things, greater wisdom, low tolerance for anything second best, liberation from menstrual symptoms and birth control, and the extra bonus of a higher sex drive. Or anything in between. Whatever the case, there are undeniable changes to the female physiology that require attention to comfortably maintain an active quality of life and sparkling self-esteem during the final third of our lives. One area that is universally impacted by menopause is the pelvic floor.


What is the pelvic floor, and what does it do?

The pelvic floor includes a group of muscles, ligaments, and other tissues inside the pelvis. The pelvic floor muscle complex spans from the pubic bone to the tail bone and attaches to the pelvic side walls. The pelvic floor accommodates sex, childbirth, and bladder and bowel emptying, helps you to stay continent, and holds your pelvic organs (bladder, uterus, and bowel) in place.


What affects your pelvic floor at menopause?


Your pelvic floor is oestrogen-dependent for flawless function. So, running low on that stuff after menopause can wreak all sorts of havoc on your pelvic floor, including:

Development or worsening of pelvic floor symptoms due to the changed condition of the pelvic floor muscles and pelvic ligaments, such as bladder control issues, increased night-time visits to the bathroom, bladder urgency, bowel control issues, and prolapse (loss of pelvic organ support, resulting in the descent of the pelvic organ/s, bladder/uterus/rectum via the vagina).

Vaginal dryness, discomfort, and structural changes.

Loss of sexual sensation and orgasmic ability.

Painful intercourse.

Urinary tract and vaginal infections.

Vulvar (the external part of your genitalia) irritation.


Collagen & Elastin

The natural loss of collagen and elastin in your connective tissue (which holds your pelvic floor together) makes things looser and weaker in your pelvic floor. This increases your chances of incontinence and prolapse. Your bladder walls, on the other hand, become less elastic resulting in sudden, strong, hard-to-control urges to pee, as opposed to a gradual increase in needing to go.


Weight Gain

Weight gain is more likely during menopause as part of the natural aging process, as well as lifestyle and genetic factors. If your weight gain becomes significant the pelvic floor can become strained. This is understandable since the heavier your body, the harder your pelvic floor must work to keep you continent and stabilise your pelvic organs and your spine during activities.


The Baggage

You may have been neglecting a childbirth injury, experienced pulmonary disease and constipation for years, or neglected your pelvic floor exercises up until now without any signs of pelvic floor dysfunction. However, at menopause, with further changes to the condition of your pelvic floor muscles and connective tissue, you might notice unwelcome symptoms. If you are diabetic, nerves to the bladder and back passage can be damaged, resulting in poor bladder and bowel emptying, loss of sensation, and constipation.

Working to keep your diabetes and pulmonary disease well controlled is the best way to protect pelvic floor function.


How can you manage your pelvic floor during menopause?

Compensate for Oestrogen Starvation

Localised, topical, low-dose oestrogen treatment is available for the pelvic floor to boost tissue quality and manage problems related to urgency, incontinence, urinary tract infections, discomfort while urinating, and prolapse. Consult your health care provider to see if you’re a suitable candidate for this treatment.

If your vulvar skin becomes bothersome, practice gentle vulvar care by keeping chemicals away from your lady garden, avoiding scratching and rubbing, and wearing loose-fitting, cotton undergarments. If the issue persists, it’s best to consult your physician. Generally, treatment will depend on the cause.


Strengthen & Protect your Pelvic Floor Muscles

With the weakening of other structures, we rely on pelvic floor muscle strength more than ever at menopause. The great news is that pelvic floor muscles at any age respond to exercise with increased strength, just like any other muscle in your body. Invest in learning how to practice urge control and the correct and most effective technique for pelvic floor exercises instead of clenching at the traffic light.

Additionally, sexual stimulation – arousal and orgasm – can keep your pelvic floor young by enhancing blood circulation in the vagina and stimulating natural moisture. Purchase the best organic lubricant you can get your hands on, or use olive, vitamin E or almond oil instead.

Be kind to these muscles by applying good toilet habits and avoid constipation.


Manage Your Weight

Keep moving! In fact, boost your activity level if you are gaining weight, and indulge in a healthy diet. Aim for 150 minutes of sweat-inducing exercise each week, with some resistance training. Choose exercises that make you feel good and don’t exacerbate your pelvic floor symptoms. Remember, you can always vary what you do to suit your pelvic floor. Emptying your bladder before your workout and exercising earlier in the day, when the energy stores of your base are full, can help your pelvic floor better respond to natural changes. Good overall physical condition also has a positive impact on pelvic floor strength.

Pelvic floor issues surrounding menopause should not be ignored as they are not likely to simply disappear. These problems can be remedied or managed, allowing you to maintain your lifestyle and feel youthful about yourself.


If you liked this you might also enjoy:

Why women gain weight in their forties

5 natural ways to tame your hot flushes

Natural help for insomnia in menopause

About the Author

Katalin Janssen is an exercise therapist and women’s health educator who can help you fix bladder control issues, prolapse and sexual insensitivity with her Discreetly Fit program. Her pelvic floor course is available in Sydney or online. Find out more via


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