Pelvic Floor Therapy for Menopause Relief

Pelvic floor health is an important factor for overall well-being, particularly during menopause. The pelvic floor muscles support the bladder, uterus, and rectum, contributing to core stability and proper organ function. However, pregnancy, childbirth, and menopause all bring hormonal shifts that affect these muscles, leading to discomfort and dysfunction.⁽¹⁾⁽²⁾

Common symptoms include pelvic pain, frequent urination, incontinence, and pelvic organ prolapse. These issues can significantly impact daily life, but maintaining pelvic floor strength through targeted therapy can help counteract symptoms. Below, learn about the biological changes affecting pelvic floor health and practical strategies to maintain muscle strength and function.⁽³⁾

The Pelvic Floor and Menopause

The pelvic floor consists of a group of superficial and deep-layer muscles, including the pubococcygeus, iliococcygeus, coccygeus, and puborectalis muscles. Estrogen helps maintain muscle tone, tissue elasticity, and blood flow, all of which support pelvic structures. As estrogen levels decline, these muscles begin to weaken, vaginal tissues can thin, and ligaments may lose their elasticity.⁽¹⁾⁽⁷⁾

These changes increase the risk of pelvic floor dysfunction, leading to discomfort and even organs shifting from their proper place. Reduced estrogen also affects the urethral sphincter, contributing to incontinence and bladder control issues. These biological shifts highlight the importance of proactive pelvic floor care.⁽¹⁾

Common Pelvic Floor Issues

Several pelvic floor-related problems can arise during menopause:^(1)(2)(3)(4)

• Pelvic Pain: Menopausal changes can lead to lower abdominal, groin, or ovarian pain due to muscle weakness and reduced blood flow.

• Pelvic Pressure and Discomfort: Weakened pelvic floor muscles may cause a sensation of heaviness or pressure in the lower abdomen.

• Pelvic Floor Incontinence: Urinary and fecal incontinence are common as weakened muscles struggle to maintain control.

• Pelvic Organ Prolapse: The uterus, bladder, or rectum may descend due to insufficient muscle support, causing discomfort and potential complications.

These symptoms can affect mobility, confidence, and emotional well-being, making pelvic floor therapy an essential consideration for menopausal health.

How Pelvic Floor Therapy Can Help

Pelvic floor therapy strengthens and rehabilitates the pelvic muscles, restoring function and alleviating discomfort. Research supports its effectiveness in improving bladder control, reducing pain, and lowering the risk of prolapse. Pelvic floor exercises, particularly Kegels, have been widely studied and recommended for managing menopausal symptoms.⁽²⁾⁽³⁾

Therapy options range from self-guided exercises to professional treatments that incorporate multiple methods, including physical therapy. Consistently practicing pelvic floor therapy can enhance quality of life and prevent further complications.

Pelvic Floor Therapy Options

Maintaining pelvic floor health can be approached in different ways:

Professional Care:

• Pelvic Floor Physical Therapy – This is a tailored approach that includes exercises, manual techniques, and education to improve pelvic floor function and alleviate symptoms.⁽³⁾

• Personalized Treatment – A comprehensive plan can be designed to address individual needs, which may include different treatment options such as physical therapy, lifestyle modifications, and medical interventions like hormone therapy.

• Biofeedback – A sensor is inserted into the vagina to detect muscle contractions and measure their strength. This technique helps individuals who have difficulty isolating pelvic floor muscles and provides a way to track progress over time.⁽²⁾⁽³⁾

• Electrical Stimulation – This method involves inserting a device into the vagina or anus to send a gentle electrical current, stimulating pelvic floor muscle contractions. It’s often combined with biofeedback for enhanced effectiveness.⁽³⁾

• Pelvic Floor Trainers or Weights - Weighted inserts, placed in the vagina, engage the pelvic floor muscles to help maintain their position during daily activities. While evidence supporting their effectiveness is limited, some individuals find them beneficial for strengthening these muscles.⁽³⁾

Pelvic Floor Therapy at Home:

• Kegel exercises to strengthen pelvic muscles

• Squats to improve strength in the pelvis and surrounding muscles 

• Pelvic tilts for core engagement

• Bridge pose to support muscle coordination

Home exercises can be effective for mild symptoms, but professional guidance from a physical therapist is recommended for persistent issues.

Pelvic Floor Strengthening Practices During Menopause

Identifying the correct muscles is essential for effective pelvic floor exercises. The muscles used to stop the flow of urine or prevent passing gas are the pelvic floor muscles. However, it’s not recommended to routinely stop the flow of urine, as this may lead to urinary tract infections.^(3)(5)(6)

Basic Pelvic Floor Exercise Routine

1. Comfortable Positioning – Start in a relaxed position, such as sitting or lying down. As strength improves, try standing or walking while performing the exercises.

2. Activation of Pelvic Floor Muscles –

   • Tighten the internal muscles of the rectum as if preventing gas from passing, but avoid clenching the buttocks.

   • Squeeze the vaginal muscles inward without pulling in the stomach.

3. Long and Short Squeezes – A combination of both is necessary for strengthening the pelvic floor.

   • Long Squeezes: Contract and hold for up to 10 seconds, then relax for 5 seconds. Repeat 10 times.

   • Short Squeezes: Contract for 1 second, then relax. Repeat 10 times.

Frequency and Progression

• Perform 10 long squeezes and 10 short squeezes three times per day.

• Avoid engaging the abdominal, buttock, or thigh muscles.

• Relaxing between repetitions ensures muscle recovery and prevents fatigue.

• Gradually increase the duration of holds as strength improves.

• Long-term commitment is needed as progress may take several weeks to months.

Pelvic floor exercises can be integrated into daily routines and offer significant benefits when done correctly and consistently. Consulting a healthcare provider is recommended if experiencing pelvic pain, difficulty identifying the correct muscles, or worsening symptoms. If incontinence or prolapse symptoms continue despite consistent exercise, professional guidance from a physical therapist can help ensure optimal technique and better results.^(3)(5)(6)

Managing Pelvic Discomfort with Hormonal Support

Hormonal changes play a significant role in pelvic floor health. Both systemic hormone replacement therapy (HRT) and localized treatments, such as vaginal estrogen cream, can help alleviate discomfort. HRT has been shown to improve reproductive tissue elasticity and muscle tone, reducing symptoms like pain and urinary urgency.⁽¹⁾

However, it’s always important to address individual considerations. Consulting a physician who specializes in HRT ensures that hormonal interventions align with personal health needs and provides the best treatment plan.

Lifestyle Tips for Pelvic Health During Menopause

Adopting healthy habits supports pelvic floor function:

• Hydration: Drinking enough water helps prevent bladder irritation and relieve constipation.

• Stress Management: Reducing tension supports overall muscle function.

• Weight Management: Managing body fat, especially around the abdomen, reduces pressure on pelvic organs.

• Constipation Prevention: Eating a fiber-rich diet promotes digestive health.

• Mindful Bladder Habits: Avoiding straining or pushing when urinating or during bowel movements helps prevent unnecessary pressure on the pelvic muscles. Minimizing frequent urination also helps improve bladder control.

Incorporating these habits can improve symptoms and overall well-being.

Essential Menopause Therapy 

Pelvic floor exercises offer a simple yet effective way to support bladder control, sexual health, and core stability during menopause. Consistency in these exercises can help reduce discomfort and improve overall quality of life. Those experiencing persistent symptoms may benefit from working with a pelvic health specialist for personalized guidance. Strengthening the pelvic floor is an investment in long-term well-being — small daily efforts can lead to lasting benefits.

Experiencing pelvic floor issues? Discover if HRT is right for you.

If you’ve entered the menopause transition and are struggling with pelvic pain or discomfort, you don’t have to suffer in silence. Take our brief menopause quiz to see if you’re an eligible candidate for HRT. Get started with Winona to take the first step toward feeling better.