What happens to your pelvic floor in menopause?

When most people think about menopause, symptoms like hot flashes or mood changes often come up first, but the hormonal shifts during this transition reach much further. Because estrogen receptors exist throughout your entire body, changes in hormonal levels that accompany perimenopause and menopause can affect nearly every system in your body, including your pelvic floor.

In fact, pelvic health symptoms tend to worsen during this phase of life. Our Origin x Ipsos study found that 63% of women in peri/menopause reported bladder leaks and 21% reported pain with sex. Unfortunately, more than a third of those affected aren’t getting the care they need because these symptoms are rarely discussed and often overlooked. 

In this article, we’ll help you understand changes that can occur during peri/menopause and how they may affect your pelvic floor. We’ll also share tips for what you can do. Read on to learn more about menopause and pelvic floor symptoms, and how our team can help support you during this (and any) phase. 

What is the pelvic floor?

The pelvic floor is a group of muscles, ligaments, and connective tissues that forms a hammock-like support system at the base of your pelvis. It has many functions, including helping you control urination and bowel movements, manage abdominal pressure, support your uterus, bladder, and rectum, and enjoy pain-free sex. 

Just like any other muscles in the body, the pelvic floor structures can become tight, weak, or uncoordinated, which can affect the body in various ways. Major physical events like pregnancy, childbirth, and surgery can also impact the pelvic floor. What makes the pelvic floor so interesting is that other factors like lifestyle, hormonal changes, and even mental health can impact it as well.  

Ultimately, a healthy and functional pelvic floor is critical for a vibrant and active life. Understanding the anatomy and knowing your own “normal” is a great place to begin, but it’s also important so you can tell when something is “off.” 

What is perimenopause vs menopause?

We sometimes talk about menopause like it’s the “end” of something, but it is also a beginning, and a very natural and normal part of every woman’s journey. It’s also important to understand that menopause isn’t just a single event that happens and then is over. It’s usually a gradual transition marked by shifting hormone levels over time. 

• Perimenopause: The phase preceding menopause that usually begins in someone’s 40s, but can begin as early as someone’s 30s or as late as their 50s. During this phase, estrogen and progesterone fluctuate (not simply a steady decline) which can set off the start of ‘menopausal’ symptoms. This phase can last from around 4 years to a decade or more for some.
• Menopause: Medically defined as the point in time that a woman has gone 12 consecutive months without a period. The average age of menopause is 51. The ovaries now have stopped producing eggs and estrogen. Though your body still produces some estrogen from fat cells, estrogen levels are largely reduced. 

Estrogen receptors live everywhere in our body so the fluctuating then decreasing estrogen levels during perimenopause and menopause can affect symptoms in our whole body- from urinary leakage to a sore knee to brain fog. This is why there are over 100 symptoms of menopause.

How does menopause impact the pelvic floor?

Hormonal changes in menopause play a huge role in the health of your pelvic floor.  Estrogen helps keep tissues strong and elastic. Its decline can affect the pelvic region leading to tissue thinning, muscle and ligament weakening, and vaginal dryness. This can present as new onset symptoms in the pelvic region such as: 

• Urinary incontinence (UI)
• Urinary Tract Infections (UTIs)
• Increased urinary urgency and frequency
• Pelvic organ prolapse (POP)
• Vaginal dryness and irritation
• Painful sex
• Hip, low back, or other musculoskeletal pain

Many of these symptoms are now acknowledged as the term: genitourinary syndrome of menopause (GSM). This term encompasses the vaginal tissue changes, sexual dysfunction, and urinary changes that often occur together during menopause.  

If you think you may be experiencing any of these symptoms, don’t hesitate to schedule a call with one of our specialists for guidance and support. 

What are symptoms of pelvic floor dysfunction?

If you’re noticing changes or new symptoms in your pelvic region it’s always worth seeing a pelvic floor specialist to get a better sense of what’s going on. Make sure to share what your normal has been, and what has changed, so your physical therapist can get a better sense of the cause of your symptoms. While menopausal symptoms are common, you don’t have to accept them as inevitable. 

Unsure if you should schedule an appointment? Use this symptom checklist to check yourself and decide when to seek help:

• Leaking urine during laughs, coughs, sneezes, exercise, jumping, or really any time
• Urge to urinate more often or difficulty holding it 
• Pain, dryness, or burning with sex 
• Heaviness, bulging, or pressure in the pelvic area
• Pain or discomfort in the hips, back, or abdomen

If you recognize any of the symptoms on this list, know that you’re not alone. Most symptoms can be treated or managed, so there’s no need to put up with discomfort that limits your daily life.

How can symptoms be treated?

Menopause cannot be stopped or ‘cured’ but symptoms can be managed. Treatment for menopausal symptoms in the pelvic region requires a comprehensive team. 

You'll want to maintain care with a primary care provider and/or gynecologist for routine in-person care like vaccinations, Pap smears, and annual exams. For specialized menopause management, providers educated by the Menopause Society (such as those at virtual clinics like Midi) often have advanced expertise in hormone therapy and can help identify the right and safest treatment options for your specific needs, complementing the care you receive from your local providers. Additionally, a pelvic physical therapist should be on the team to address symptoms from the physical side of things. Physical therapy continues to prove effective for symptoms such as pelvic organ prolapse, urinary incontinence, and painful sex. 

Medical Treatment options:

• Systemic hormones: often referred to as hormone replacement therapy (HRT) or menopause hormone therapy (MHT). HRT can provide important protection for bone and cardiovascular health, and many women benefit from starting treatment early in the menopause transition (even before hot flashes begin) to help preserve long-term health.
• Local hormones: creams, suppositories or rings
• Various other medications for specific symptoms such as hot flashes more mental health changes
• Over the counter vaginal moisturizers (our favorites here!)

Physical Therapy Treatment:

• Pelvic floor exercises: from Kegels to pelvic floor relaxation to internal pelvic wand use to stretches, depending on your needs
• Dilator training: for pain with penetration
• Lifestyle adjustments: bladder training, nutrition tips, and stress management techniques
• Whole body resistance training: for addressing musculoskeletal pain and hormone related bone and muscular changes
• And more! Based on your needs

Need to find a medical provider that is a menopause specialist? At Origin we love sending patients to Midi. Midi provides in-network, telehealth appointments for all your menopause and aging needs.

You can also find a certified menopause medical practitioner here thanks to the Menopause Society.

How to take the next step

Listening to your body and acting early can make all the difference. If you’re experiencing symptoms, or just want to figure out what’s going on, start with this:

• Screen for symptoms using the checklist above (but keep in mind there are many other symptoms you may experience!)
• Keep notes of changes and patterns you’ve noticed (nothing is too small or too big to mention)
• Reach out for expert guidance any time. Origin’s clinicians are always ready to support you.

If you think you’re experiencing pelvic floor symptoms related to menopause, know that you’re not alone. 

Ready to take charge of your pelvic health? Book an evaluation with an Origin clinician.

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Sources

Camon C, Garratt M, Correa SM. Exploring the effects of estrogen deficiency and aging on organismal homeostasis during menopause. Nat Aging. 2024;4(12):1731-1744. doi:10.1038/s43587-024-00767-0. (pubmed.ncbi.nlm.nih.gov)

Goldenberg L, et al. Pelvic Floor Overview. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482200/

Angelou K, Grigoriadis T, Diakosavvas M, et al. The genitourinary syndrome of menopause: An overview of the recent data. Cureus. 2020;12(4):e7586. doi:10.7759/cureus.7586. PMID: 32399320; PMCID: PMC7212735. (pubmed.ncbi.nlm.nih.gov)

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Midi Health. 12 Common Symptoms of Menopause Every Woman Should Know. JoinMidi. Published July 12, 2024. Updated December 24, 2024. Accessed November 21, 2025. https://www.joinmidi.com/post/12-common-symptoms-of-menopause-every-woman-should-know