Ever wonder what menopause does to your pelvic floor? As estrogen levels drop, those muscles can weaken, which may lead to things like leaks or vaginal dryness. Not exactly fun—but you're not alone, and there are ways to feel better. In this article, we’ll break down what’s really going on down there and share some simple, effective ways to manage the changes.

Pelvic Floor 101: What Every Woman Over 40 Should Know

Menopause is a big transition in a woman’s life, and it brings a whole mix of changes—including some that affect your pelvic floor. This group of muscles and connective tissues helps support your bladder, bowel, and uterus, and plays a key role in things like continence and pelvic stability. But as hormone levels shift during menopause, especially with the drop in estrogen and collagen, the pelvic floor can take a bit of a hit.

Estrogen is super important for keeping the pelvic floor muscles and nearby tissues strong and flexible. When those hormone levels dip, the muscles can become thinner and less able to support and relax around your pelvic organs. Everything feels a bit less elastic, and the pelvic floor just doesn’t work quite like it used to.

Think of your pelvic floor like a trapdoor that keeps everything up and in place. When estrogen drops, that “trapdoor” can start to sag, making it harder to keep things where they belong. While the average age for menopause is around 51, these changes can actually start earlier—during perimenopause—and may stick around well into post-menopause.

Noticing these changes is the first step in taking care of your pelvic health. If you're experiencing any of the symptoms below, it might be a sign your pelvic floor needs a little extra support.

Common Pelvic Floor Symptoms During Menopause

• Urinary incontinence
• Vaginal dryness
• Vaginal irritation or itching
• Pain during intercourse
• Decreased vaginal sensation
• Pelvic pressure or heaviness
• Constipation
• Recurrent urinary tract infections (UTIs)
• Vaginal laxity or looseness
• Mild prolapse

As menopause kicks in, it’s totally normal to notice some changes in how your body feels—especially when it comes to your pelvic floor. One of the most common issues is urinary incontinence—that unexpected little leak when you laugh, cough, or exercise. Yep, stress incontinence is super common during menopause and can be really annoying to deal with.

Another thing many women experience is vaginal dryness, which can make intimacy uncomfortable or even painful. This often comes down to vaginal atrophy—basically, the tissues become thinner and less stretchy, thanks to lower estrogen levels. When the pelvic floor muscles weaken too, it can reduce sensation and make sex feel painful, especially around the vaginal opening.

Pelvic pain and dysfunction are also part of the picture for many women—around 57% going through menopause deal with these kinds of symptoms. For some, it's an ongoing struggle, while others might have occasional flare-ups. The tricky part? These issues often get worse if they’re not addressed. So, if you’ve been dealing with pelvic pain for six months or more, it’s definitely time to seek some support. You don’t have to push through it alone.

Genitourinary Syndrome of Menopause (GSM)

Let’s talk about something called Genitourinary Syndrome of Menopause—or GSM for short. It’s a bit of a mouthful, but it basically covers all the changes that can happen to your vagina, vulva, pelvic floor, urinary tract, and even your sex life during menopause. You might’ve heard it called vulvovaginal atrophy before, but GSM is a more accurate way to describe the full picture of what’s going on.

The symptoms of GSM can be really uncomfortable—things like dryness, irritation, lack of natural lubrication, and even bladder issues like urgency or recurring infections. These changes happen because estrogen levels drop, which causes the tissues in your vagina, bladder, and urethra to thin and weaken. That makes everything more sensitive, less protected, and can also lead to weaker pelvic floor muscles and a higher risk of urinary infections.

And here’s the thing—these symptoms tend to become more common with age. Studies show that up to 72% of women over 70 experience them. That’s because hormone receptor cells in your vagina, vulva, and urinary tract are particularly affected by those hormonal shifts. So, understanding what GSM is all about can really help when it comes to managing symptoms and looking after your pelvic health as you move through menopause.

Why Pelvic Floor Muscles Weaken in Menopause

Estrogen plays a significant role in maintaining muscle function and elasticity, and its decrease during menopause can lead to muscle weakness. This is a major factor in the development of urinary incontinence among postmenopausal women.

Aging naturally causes muscle deterioration, but the hormonal changes during menopause significantly exacerbate pelvic floor issues. After menopause, the connective tissues of the pelvic floor have less collagen and become less elastic, leading to weakened support for the pelvic organs. This combination of hormonal changes and natural aging makes it crucial to focus on pelvic floor health during and after menopause.

Understanding why pelvic floor muscles weaken allows you to take proactive measures to strengthen them. Here are some signs indicating your pelvic floor might need extra support.

Signs Your Pelvic Floor Needs Support

Pelvic organ prolapse is a clear sign that your pelvic floor needs support. This condition occurs when weakened muscles allow pelvic organs to descend, leading to a noticeable bulge in the vagina. Prolapse can contribute to urinary symptoms like urge incontinence and painful urination during menopause.

Another sign is an increase in urinary frequency, including nocturia, which is waking up multiple times at night to pass urine. Sudden leaks of urine or faecal incontinence, vaginal pain, and discomfort can also arise from a weakened pelvic floor, potentially indicating an overactive bladder.

Collagen loss in the connective tissues after menopause results in decreased elasticity, which is crucial for maintaining pelvic support. Chronic cough and constipation can exacerbate pelvic floor weakness by increasing pressure on the pelvic region. Early recognition and action can prevent further complications and enhance your quality of life.

Nutrition & Lifestyle Tips

Maintaining a healthy pelvic floor involves more than just exercises; nutrition and lifestyle play a crucial role. Key factors include:

• Staying hydrated
• Consuming a diet rich in fiber to prevent constipation, which strains the pelvic floor
• Including estrogen-supportive nutrients, such as soy products, to help mitigate hormonal changes during menopause

Managing weight is essential, as excess weight puts additional pressure on the pelvic floor. Regular physical activity and stress reduction techniques, like yoga or meditation, can improve overall pelvic health. Incorporating these lifestyle changes can make a significant difference in maintaining a strong pelvic floor and core strength:

• Manage weight to reduce pressure on the pelvic floor
• Engage in regular physical activity
• Practice stress reduction techniques such as yoga or meditation

Seeking personalised advice and treatment options from health professionals is beneficial. They can guide you on the best practices for your needs and help you stay on track with your pelvic health goals.

Effective Pelvic Floor Exercises

Kegel exercises are one of the best ways to give your pelvic floor muscles a boost. These muscles help support your pelvic organs, so keeping them strong can make a big difference—especially when it comes to things like bladder control and overall pelvic health. The trick? Finding the right muscles to work with, which is key to getting the most out of your pelvic floor workouts.

Here's 6 great pelvic exercises you can do just about anywhere!

It might take a few weeks—or even a couple of months—to notice real changes, but stick with it. Strengthening your pelvic floor through Kegels can make a huge difference to how you feel during and after menopause. It’s a small daily effort that can lead to a big boost in confidence and comfort.

Pelvic Floor Strength = Confidence

Looking after your pelvic floor isn’t just about avoiding leaks or discomfort—it’s a key part of self-care. A strong pelvic floor helps you feel more confident, supported, and in control. By understanding how menopause affects these muscles and taking some simple, proactive steps, you can stay on top of your pelvic health and overall wellbeing.

Let’s be honest—pelvic floor issues are common, and there’s no need to feel embarrassed. This is a natural part of being a woman, and taking care of it is just as important as any other part of your health. So don’t let shame or outdated ideas stop you from getting the support you deserve. When you take charge of your pelvic health, you’re really backing yourself—and that’s powerful.