The Pelvic Floor During Perimenopause and Menopause

As women approach perimenopause and menopause, they experience a wide range of physical and hormonal changes. Among the most significant, yet often overlooked, is the impact these life stages have on the pelvic floor. The pelvic floor, a network of muscles that support the bladder, uterus, and rectum, undergoes gradual shifts that can affect a woman’s quality of life.

During perimenopause, typically starting in a woman’s late 30s or early 40s, the body begins to experience hormonal fluctuations, particularly a decrease in estrogen. This hormone, essential for maintaining pelvic muscle strength and tone, diminishes as the transition to menopause occurs.

As estrogen declines, many women report changes within the pelvic floor including:

Urinary Incontinence

As estrogen levels decrease, the muscles of the pelvic floor weaken, which can lead to a loss of bladder control. This may manifest as stress incontinence (leakage when coughing, sneezing, or laughing) or urge incontinence (a sudden, intense need to urinate). Weakened pelvic muscles struggle to support the bladder effectively, making incontinence more common during perimenopause and menopause.

Vaginal Dryness

Decreased estrogen can lead to thinning of vaginal tissues and reduced lubrication, causing vaginal dryness. This not only affects sexual comfort and pleasure but can also contribute to irritation, itching, and discomfort during daily activities. Vaginal dryness is a common issue for women going through perimenopause and menopause, significantly impacting pelvic floor health and quality of life.

Pelvic Organ Prolapse

Pelvic organ prolapse occurs when the pelvic floor muscles become too weak to support the bladder, uterus, or rectum, causing these organs to shift down or “prolapse.” This can lead to a sensation of heaviness, pelvic pressure, and even urinary or bowel issues. The loss of estrogen accelerates muscle weakening, making prolapse more likely during menopause.

Decreased Sexual Function

The pelvic floor muscles play a vital role in sexual health. As estrogen levels drop, vaginal tissues lose elasticity and lubrication, which can lead to discomfort or pain during sex. Additionally, weakened pelvic muscles can affect sensation and arousal, making sexual intercourse less enjoyable or even difficult.

Pelvic Pain or Discomfort

Many women experience a sense of pelvic heaviness, pressure, or pain during perimenopause and menopause due to weakened pelvic floor muscles and changes in the position of pelvic organs. This discomfort may be linked to conditions like prolapse or changes in hormone levels that affect the tissues and muscles in the pelvic region.

We’re Here to Help

However, it’s important to note that these changes are not inevitable. Pelvic floor exercises, such as Kegels, can strengthen the muscles and help mitigate some of these symptoms. Consulting with a healthcare provider or pelvic floor physical therapist can guide women through effective strategies to maintain pelvic health and ensure a smoother transition through perimenopause and menopause. Our licensed pelvic health physical therapists spend up to one hour with each patient in private treatment rooms. Call us to schedule an appointment or to schedule a complimentary phone consultation with one of our skilled physical therapists.