How Menopause Affects Your Pelvic Floor
When we think about menopause, we often focus on hot flashes, mood swings, or the end of periods. But one of the most overlooked areas menopause affects is the pelvic floor—and trust us, it deserves more attention.
Whether you’re leaking when you laugh, noticing pressure “down there,” or struggling with intimacy, these symptoms are common—but they’re not normal. And you don’t have to just live with them.
First, What Is the Pelvic Floor?
Think of your pelvic floor like a hammock of muscles at the base of your pelvis. It supports your bladder, uterus, rectum, and other pelvic organs. It also plays a role in:
Peeing and pooping
Sexual function and sensation
Core stability and posture
Pressure management when lifting or moving
During menopause, this system can get thrown off—sometimes dramatically.
How Menopause Impacts Your Pelvic Floor
1. Estrogen Decline = Tissue Changes
Estrogen helps keep pelvic tissues plump, elastic, and well-lubricated. When levels drop, those tissues can become thinner, drier, and more fragile. This can lead to:
Pain with intercourse
Vaginal dryness or irritation
Increased risk of UTIs
A 2023 study in Climacteric found that up to 80% of postmenopausal women experience vulvovaginal atrophy, yet fewer than half seek treatment.
2. Muscle Coordination Shifts
The pelvic floor doesn’t work in isolation—it’s part of a larger pressure system involving your breath, diaphragm, core, and hips. Hormonal changes can alter how your muscles recruit, often leading to:
Leaking with sneezing, lifting, or running
Constipation or incomplete emptying
Heaviness or bulging (a sign of prolapse)
Pelvic organ prolapse affects an estimated 1 in 2 postmenopausal women, and while it’s common, it’s not inevitable.
3. Posture and Movement Patterns Change
Many women unconsciously grip their glutes, clench their jaw, or tuck their pelvis more during midlife—especially in response to body image concerns, discomfort, or stiffness. These patterns can contribute to:
Overactive (tight) pelvic floors that don’t relax well
Hip and low back pain
Difficulty activating core muscles properly
So, What Can You Actually Do?
Hint: It’s Not Just Kegels
Kegels have been the go-to prescription for decades. But here’s the problem: if your pelvic floor is already tight, over-recruited, or out of sync, doing more Kegels may actually worsen your symptoms.
At South Texas Pelvic Health, we take a different approach—because healing the pelvic floor isn’t about isolating a muscle group. It’s about understanding how your entire system is working together.
We Start With Assessment
We look at how your body moves as a whole—from your breath to your feet. We assess posture, ribcage mobility, glute strength, and how your pelvic floor responds to pressure and movement.
We Address the Why, Not Just the Symptoms
The body is smart—it creates compensations to keep you moving. But over time, these workarounds (like breath-holding, gripping, or poor pressure management) lead to dysfunction.
We help you:
Unwind those compensatory patterns
Release trigger points in deep pelvic, hip, and abdominal muscles
Restore mobility and optimal alignment so your system can actually function efficiently
We Support the Organs
Your pelvic organs don’t float in isolation—they’re suspended in fascia and surrounded by muscle, connective tissue, and pressure systems. Through visceral manual therapy, we gently work with the mobility and position of organs like the bladder, uterus, and rectum.
This can:
Improve organ mobility and reduce adhesions
Support lymphatic and blood flow
Ease feelings of “heaviness” or restriction from scar tissue or hormonal changes
Research in Journal of Bodywork & Movement Therapies shows that visceral mobilization can significantly reduce pelvic pain, improve organ function, and restore dynamic movement in the core.
We Build Strength Functionally (Not Randomly)
Once we’ve restored mobility and coordination, we introduce load and movement in a way that supports your lifestyle. This isn’t just about lifting weights—it’s about training your system to manage pressure, breath, and movement together, so strength gains are reproducible and sustainable.
Whether you’re picking up groceries, hiking with your family, or getting back into exercise, or have a goal to complete a triathlon, our approach helps your body handle real life—without setbacks or symptoms.
A 2021 study in The Journal of Women’s Health Physical Therapy found that functional movement training combined with manual therapy significantly improved pelvic floor symptoms in perimenopausal women—more so than Kegels alone.
Meet “Lisa”
Lisa came to us at age 52 after months of leaking during exercise and a growing feeling of heaviness in her pelvis. She thought it was just “normal aging” and even tried Kegels—but the symptoms got worse. Through a combination of breathwork, hands-on release, visceral work, myofascial release techniques, posture retraining, and functional strength work, Lisa was able to stop leaking and return to movement she loves—without fear or embarrassment.
“I didn’t realize how much tension I was carrying. Once I learned how to relax my body and move differently, everything started to click. I feel like myself again, but better – stronger, more confident, and more free.” - Lisa
Your Pelvic Floor Deserves More Attention
Whether you’re leaking, feeling disconnected from your core, or noticing pelvic heaviness after workouts—these are not just “normal parts of aging.” They’re signs that your body is asking for support.
And the good news? With the right care, things can improve. You can feel strong, confident, and in control again.
Ready to Feel like yourself.. but better?
At South Texas Pelvic Health, we offer pelvic floor therapy that goes beyond Kegels, integrating manual therapy, functional movement, and nervous system support to help you feel like yourself again.
Let’s create a plan that honors your body in this season—and supports your strength in the next.