Menopause: What you need to know from a pelvic health specialist
Key Takeaways:
Menopause often brings changes in pelvic floor function — from bladder leakage to pain, prolapse, and dryness.
These symptoms are common, but not inevitable — pelvic floor therapy can help.
La Hoya Health offers elevated, holistic pelvic PT for women navigating perimenopause, menopause, and beyond.
Hot flashes and mood swings tend to steal the spotlight when it comes to menopause. But ask anyone going through it, and they’ll tell you: the pelvic floor is screaming for a headline.
Menopause brings profound changes to muscle tone, tissue elasticity, and hormone balance. For many women, this means new or worsening bladder issues, vaginal dryness, painful intercourse, or even a feeling of heaviness from pelvic organ prolapse.
The good news? These symptoms are not something you “just have to live with.” With the right care, you can move through menopause feeling supported, empowered, and even more connected to your body.
That’s where pelvic floor physical therapy comes in.
The pelvic floor & menopause: what’s really happening?
Hot flashes and mood swings often steal the spotlight when it comes to menopause. But for many, the pelvic floor deserves equal attention. Menopause brings profound changes to muscle tone, tissue elasticity, and hormone balance. For some women, this can mean new or worsening bladder issues, vaginal dryness, painful intercourse, or even a sensation of heaviness from pelvic organ prolapse.
Recent data show that perimenopause symptoms are becoming increasingly common in women as young as 30. Around 55–64% of women aged 30–40 report moderate to severe symptoms such as anxiety, irritability, sexual dysfunction, and bladder changes, yet most do not seek treatment until their mid-50s. Globally, earlier menopause onset is linked to socioeconomic and health factors, with women in high-vulnerability neighborhoods experiencing menopause up to two years earlier than average.
During perimenopause and menopause, estrogen levels drop. Estrogen is essential for keeping pelvic floor muscles strong, tissues elastic, and bladder function smooth. Without it, many women notice symptoms such as urinary urgency, discomfort with intimacy, pelvic heaviness, or leaking.
Here’s what often shifts during this transition:
Muscle strength & tone → The pelvic floor muscles may weaken, reducing bladder and organ support.
Vaginal & urethral tissues → Thinning and dryness can contribute to pain, irritation, or urinary frequency.
Collagen & elasticity → Less tissue resilience can lead to prolapse (often sensed as a feeling of heaviness or bulging).
Nerve sensitivity → Changes in sensation may contribute to pain or reduced arousal/sensation.
Understanding that these changes are physiological — not just a normal part of “getting older” — is key to reclaiming control over your pelvic health. Despite the prevalence of symptoms, treatment is often delayed: in the U.S., most women don’t seek menopause-related care until age 56 or older, and only 1.8% of women over 40 use menopausal hormone therapy.
With nearly 6,000 U.S. women reaching menopause each day and projections estimating that nearly 500 million women worldwide will be postmenopausal by 2030, pelvic floor health is more important than ever. Early intervention, including pelvic floor physical therapy, can help women move through this transition feeling supported, empowered, and more connected to their bodies.
How pelvic floor PT helps during menopause
Pelvic floor physical therapy during menopause isn’t just about addressing one symptom — it’s about restoring strength, flexibility, and function so your entire system works more effectively.
Pelvic floor PT typically begins with a comprehensive evaluation to assess how the pelvic floor muscles interact with the rest of your body. From there, a combination of gentle, targeted techniques can help retrain and re-educate muscles for better function and comfort.
Common approaches include:
Muscle retraining: Teaching pelvic floor muscles how to contract, relax, and coordinate effectively.
Manual therapy: Gentle internal and external techniques to reduce pain, improve blood flow, and restore tissue mobility.
Breathwork & core integration: Linking the pelvic floor with the diaphragm and deep core for better stability and continence.
Movement & posture training: Supporting daily activities and exercise with optimal pelvic and postural alignment.
Education on lifestyle strategies: Hydration, nutrition, bladder retraining, tools and tricks of the trade, and mindful practices to ease symptoms.
Collaboration with your healthcare team: Coordinating closely with gynecologists, urologists, or hormone specialists when needed.
The goal of pelvic floor PT during menopause is to help people feel supported, connected, and capable in their bodies again. Many find that it not only improves physical symptoms but also enhances confidence, intimacy, and overall quality of life — transforming this stage of life from one of decline into one of empowerment.
A client story
EB came to me in her late 30s, sharing that sex had become so painful she “no longer wanted to have sex” with her husband. The pain — and the days of discomfort that followed — simply “weren’t worth it.”
What made her story even more heartbreaking was how long she had been living this way. For over three years, EB had pushed through the discomfort, carrying shame and quietly accepting this as her “new normal” — until the pain became impossible to ignore.
Her story is far from unique. Pelvic floor symptoms rarely appear all at once. Instead, they tend to creep in slowly, one by one, until the sum of their effects finally forces you to stop and pay attention.
When EB arrived at physical therapy, she was exhausted and defeated. But after a thorough evaluation, education about what was really happening in her body, and a clear, compassionate plan forward, she left feeling hopeful for the first time in years. Together — with support not only for her pelvic floor but also for her mental, emotional, and nutritional needs — she rebuilt trust in her body.
Today, EB and her husband are back to enjoying a healthy, pain-free sex life without the anxiety and fear that had been holding them back.
Community & conversation: breaking the silence
Menopause has long been a topic shrouded in silence. Historically, discussions about women’s reproductive and pelvic health were often taboo, leaving many to navigate symptoms like bladder leakage, painful sex, or pelvic heaviness in isolation. For centuries, these experiences were minimized or dismissed as simply “part of getting older,” reinforcing stigma and shame.
Breaking this silence is crucial. Open conversation normalizes the changes of menopause, helps women understand their bodies, and fosters a sense of empowerment rather than isolation. Sharing experiences also highlights that these symptoms are not inevitable or something to simply endure — they are signals that support and intervention can help.
Supportive communities play a huge role in this process. Connecting with others who are navigating similar challenges can provide both practical guidance and emotional support. Examples of these community spaces include educational workshops on pelvic health, menopause-focused support groups, women’s wellness circles, and yoga or movement classes designed for pelvic floor awareness. These settings allow women to learn, ask questions, and practice strategies in a safe, judgment-free environment.
By weaving education with communal connection, these conversations help dismantle long-standing taboos, turning menopause from a private struggle into a shared journey — one where women can support, learn from, and empower each other.
When to seek help
Many people wait until symptoms feel unbearable before seeking care, but pelvic floor PT can be helpful much earlier. Consider booking an appointment if you notice:
Bladder leakage (with coughing, sneezing, exercise, or urgency)
Pain with intimacy or vaginal dryness
Pelvic heaviness, bulging, or prolapse symptoms
Constipation, straining, or bowel dysfunction
Core weakness, back pain, or loss of strength and stability
Even if your symptoms are mild or just starting, getting ahead of changes during menopause can make a huge difference in how your body feels over the long term. Early intervention often means faster results and fewer disruptions to your daily life. Think of it like strength training for your pelvic floor — the sooner you start, the stronger your foundation will be for the years ahead.
Curious if you’re going through menopause? Take this quiz
How La Hoya Health takes a different approach
Pelvic floor PT doesn’t have to feel clinical, rushed, or uncomfortable. At La Hoya Health, the experience is designed to feel like self-care while still delivering clinical results.
Founder Katie Dewar, PT, DPT, PRPC blends evidence-based practice with a holistic, intuitive style. Sessions take place in a calming, thoughtfully curated environment — because the how of healing matters just as much as the what.
By combining science with sanctuary, La Hoya Health creates an elevated experience where menopause care feels like an empowering investment in your wellness.
Reclaim your confidence — and your comfort
Menopause is a natural stage of life — but it doesn’t have to mean living with pain, leakage, or discomfort. With the right support, you can move through this transition feeling empowered, resilient, and at home in your body.
At La Hoya Health, we specialize in pelvic floor physical therapy for every body, at every stage of life — including menopause and beyond. Our approach is elevated, holistic, and tailored to you.
🌿 Ready to feel supported during menopause?
Schedule your complimentary consult today
And if you’d like to explore this topic in a supportive community setting, join us for one of our Pelvic Floor & Menopause Workshops in Santa Fe.
