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How Does Menopause Affect My Pelvic Floor?

Hello friends! Let’s talk about the dreaded “M” word—menopaus or “the change.” While menopause often gets a bad reputation because of the many symptoms it can cause it’s a natural part of the aging cycle for those born with ovaries. Addressing some of the symptoms can improve quality of life while transitioning to menopause, and of course one of the treatment options is pelvic floor physical therapy!

Let’s start with what exactly is menopause? The World Health Organization defines menopause as 12 full months without a menstrual period. It is typically a gradual transition which starts with an average of 3.8 years of irregular bleeding (Mastrangelo, 2010). However, menopause can also start suddenly and cause symptoms like when an oophorectomy (surgery to remove the ovaries) is done (Bo, 2015). During the transition to menopause, the levels of the hormones estrogen and progesterone in the body slowly decrease which can cause a wide array of symptoms (Mastrangelo, 2010).

Symptoms of Menopause (Mastrangelo, 2010; Palombaro KM, 2008))

  • Hot flashes and night sweats

  • Mood changes

  • Depression

  • Decreased cognitive function (thinking)

  • Frequent urination

  • Joint pain

  • Vaginal dryness

  • Lower sexual drive

  • Osteoporosis

  • Lower muscle mass/strength

How Does Menopause Affect My Pelvic Floor?

The decreased production of the hormone estrogen can lead to urinary incontinence and a need to go to the bathroom more often (Knorst, 2011). There is also a higher risk of urinary tract infections (UTIs) associated with menopause.

Menopause can impact the pelvic floor tissues and sexual function. Not only can the change in hormones cause sex drive to decrease but it can also cause pain with intercourse. The hormone changes cause the vaginal tissue to become less lubricated and the tissues become thinner and more fragile. Vaginal moisturizers like VMagic are essentially non-hormonal lotions for the vaginal tissue. If vaginal dryness is causing pain with intercourse, water-based lubricants like Slippery Stuff can decrease pain and increase pleasure.

Below is an interview with Dr. Staci Tanouya MD, FACOF/GYN on low sex drive.

What Are My Treatment Options?

The are so many different treatment options depending on what symptoms you are experiencing. Your physician may recommend hormonal replacement therapies. These can be either systemic (a pill that will impact the entire body) or local (like a vaginal estrogen cream). Since systemic hormonal replacement affects the entire body there can be negative side effects, but like with any medication, sometimes the benefits outweigh the negative effects. Talk with your provider about what the best options are for you.

Last but definitely not least, pelvic floor physical therapy is a great option for treating incontinence, frequent urination, and pain with sex. Plus, physical therapists are not only trained to help with your pelvic floor symptoms, but they can help you develop a safe exercise routine. Exercise, specifically circuit training, has been shown in research to improve the symptoms of frequent urination and joint pain (Mastrangelo, 2010). Exercise can also help to maintain a healthy and active lifestyle as we age.

While menopause may be inevitable with age, there are so many options to help treat the many symptoms that may come along with it. Have a discussion with your providers about any symptoms you may be experiencing so that you can create a treatment plan.

Here are some great resources to learn more about your pelvic floor and menopause:

  • Ask your healthcare provider for a referral to a pelvic therapist.

  • Find a pelvic therapist on your own at We have links to 4 free searchable databases under Find a PT.

  • Check out tabu and use the code MYPFM for 15% off!

  • Learn more about the pelvic floor muscles with our book: My Pelvic Floor Muscles The Basics

  • Sign up for our email newsletter!

  • Visit our Amazon store for items to like vaginal moisturizers and lubricants

For providers, check our online courses to help your clients experiencing pelvic floor dysfunction. Consider joining our Ambassador Program and most of our courses are included with your membership!

What experiences or tips do you have that can help others? We’d love to hear them. Please join the conversation in the comments section below.  

Written by Emily Reul, PT, DPT


1. Knorst M, Resende T, Goldim J. Clinical profile, quality of life and depressive symptoms of women with urinary incontinence attending a university hospital. Rev Bras Fisioter. 2011;15(2):109–116. doi:10.1590/s1413-35552011000200005.

2. Mastrangelo MA et al. Effect of circuit training on menopausal symptoms and quality of life. J Womens Health Phys Therap. 2010;34(2):58-63.

3. Bo K, Berghmans B, Morkved S, Van Kampen M. Evidenced-based physical therapy for the pelvic floor bridging science and clinical practice. 2nd edition. 2015.

4. Palombaro KM et al. Osteopenia and sarcopenia: factors related to physical frailty in women. J Womens Health Phys Therap. 2008;32(2):13-16.

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