Your pelvic floor during perimenopause and menopause
There are moments in a woman’s life when the pelvic floor gets attention. During pregnancy and after birth is one. Perimenopause and menopause should be another. For most women, there is a long gap in between where it is rarely discussed, and if you have never had a baby, it may never have come up at all.
What your pelvic floor actually is
Your pelvic floor is a group of muscles, tendons and connective tissue that supports your bladder, bowel and uterus. It plays a role in your sex life, your bladder and bowel control, and the way you move. Estrogen plays an active role in keeping it strong and functional. As your levels fall during perimenopause and menopause, that changes.
What changes during perimenopause and menopause
You might have noticed leaking when you laugh, cough, sneeze or exercise. Or a sudden urgency to get to the bathroom that was not there before. Some women notice discomfort during sex, or a feeling of heaviness or pressure in the vagina. These experiences can happen during perimenopause and menopause, and they are connected to the same estrogen changes affecting your bones and muscles.
They are not something you have to accept as inevitable.
What helps
Pelvic floor exercises are one of the most effective things you can do, at any age and any stage. Both the lift and the full release matter. A pelvic floor that can fully relax is just as important as one that can contract.
Staying active generally supports pelvic floor health. If you are experiencing symptoms, high impact exercise like jumping and running places more load on your pelvic floor, and it is worth paying attention to how your body responds. If something does not feel right during or after exercise, ease back and seek some support.
If symptoms are affecting your daily life, a women’s health physiotherapist can help, though access and cost are real barriers for many women. The National Continence Helpline on 1800 33 00 66 is a free service that can offer advice and point you in the right direction.
When to get support
If joint pain is affecting your daily life, your sleep, or your confidence to keep moving, it is worth talking to your doctor. There are good treatment options available, and you do not have to manage this alone.
A women’s health physiotherapist or exercise physiologist can also help you find a way to keep moving that works for your joints right now. If cost or access is a barrier, ask your GP about a chronic disease management plan, which can provide subsidised allied health sessions.
References
Bodner-Adler, B., Alarab, M., Ruiz-Zapata, A.M., & Latthe, P. (2020). Effectiveness of hormones in postmenopausal pelvic floor dysfunction. International Urogynecology Journal, 31, 1577-1582.
Robinson, D. (2024). Oestrogens and lower urinary tract dysfunction chronicling a lifetime of research. Continence. https://doi.org/10.1016/j.cont.2024.101720
Pérez-López, F.R., Vieira-Baptista, P., Phillips, N., Cohen-Sacher, B., Fialho, S.C.A.V., & Stockdale, C.K. (2021). Clinical manifestations and evaluation of postmenopausal vulvovaginal atrophy. Gynecological Endocrinology, 37(8), 740-745. https://doi.org/10.1080/09513590.2021.1931100
Wright, V.J., Schwartzman, J.D., Itinoche, R., & Wittstein, J. (2024). The musculoskeletal syndrome of menopause. Climacteric, 27(5), 466-472. https://doi.org/10.1080/13697137.2024.2380363
WHEN Position Statement: Resistance Training Across the Menopausal Transition (April 2026). Women’s Health Education Network. www.when.org.au
Developed by the WHEN Clinical Team
Clinically reviewed by the WHEN Clinical Governance Committee
Last reviewed: July 2026
