Menopause and Pelvic Health for Women

Did you know that October the 18th is World Menopause Day? But is it a cause for celebration or an accident waiting to happen? Do we need to dive under the kitchen table to take cover or pull ourselves together and learn what we could do to prevent problems further down the line.


Hello, I’m Phillipa Butler a Chartered Physiotherapist and Certified Pilates and Yoga Teacher. I have a special interest in Menopause. This came about because of my own experiences and a general lack of information and guidance for women experiencing symptoms and challenges.

My philosophy in my own life is that prevention is better than cure and I believe that a regular programme of appropriate exercise is the key to a fitter, healthier future.

I love to share sound health information and advice to help you take your health into your own hands.

What Is Menopause?

Menopause is the end of the female reproductive cycle. It happens when your ovaries stop producing as much of the hormone oestrogen and no longer release an egg each month. At the same time there is also a decrease in progesterone and testosterone levels. It is a natural part of ageing that usually occurs between 45 and 55 years of age. Menopause is official when a year has passed without having had a menstrual period and in the UK, the average age for menopause is 51.

Premature Menopause

The exception of course is premature menopause that can occur naturally or can be medically or surgically induced. Premature Menopause means that the time spent with decreased oestrogen is longer.  In the case of medically induced Menopause there is a sudden onset and the symptoms experienced can be more severe and, in some cases, totally unexpected.


The term Perimenopause is used to describe the time approaching menopause before periods have stopped but when the balance of the sex hormones begins to change, and symptoms can begin to appear.

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What are the symptoms of Menopause

The four main symptoms are:

  1. Hot flushes.
  2. Poor sleep.
  3. Genitourinary symptoms and sexual dysfunction.
  4. Mood changes.

These are commonly seen among menopausal women and have been called postmenopausal syndrome.

Is there a light at the end of the tunnel?

Yes, these physical symptoms can reduce after the onset of Menopause. But it is worth remembering that all Women will go on to live the rest of their lives with reduced levels of oestrogen. With life expectancy in the UK  at around 82 years for females (Office for National Statistics UK); this is around 30 years living with lowered oestrogen levels.

How does Menopause affect pelvic health

The hormone oestrogen plays a part in maintaining a healthy genitourinary system. As the oestrogen levels decline around menopause the tissues of the vulva, vagina and urethra can become thinner and more fragile. The pelvic floor muscles become weaker and slower to react and other tissues like fascia offer less support to the pelvic organs.

More than 50% of postmenopausal women will suffer genitourinary symptoms including:

  • Vaginal dryness
  • Frequent urination
  • Urinary incontinence
  • Urgency of urination
  • Recurrent urinary tract infections
  • Discomfort or bleeding with intercourse

The symptoms will vary in severity, and it is possible to experience more than one symptom at once. This Assessment Tool can be used to help you to decide when to seek assistance from a doctor or a Pelvic Health Physiotherapist (also called Women’s Health Physiotherapist)

Vulvovaginal Symptom Questionnaire (Erekson EA et al 2013)

Please Note

If you experience any of the following potentially serious symptoms it would be wise to seek out immediate medical attention.

  • Flow blockage or pain when urinating
  • Blood in urine
  • Frequent and intense need to urinate
  • Burning feeling when urinating
  • The inability to empty or control the bladder
  • Pressure or pain in the pelvic region
  • Unusual or abnormal Vaginal bleeding after menopause.
  • A persistent change in bowel habit sometimes with abdominal pain
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Strengthen the Muscles of the Pelvic Floor

The Good News is Pelvic Floor Muscle Training is an effective treatment for postmenopausal women with genitourinary symptoms. Strengthening the pelvic floor muscles can cure or improve symptoms of stress and all other types of urinary incontinence (Cacciari et al, 2018).

The Right Way to do Pelvic floor exercises!

It is surprisingly common for women to get these exercises wrong! (Bump et al 1991) found that 50% of women couldn’t contract the pelvic floor correctly after brief verbal instruction, and that half of these were instead doing something that could aggravate their symptoms.

Find and Feel the Pelvic Floor Muscles

The first step is to identify the correct muscles. If you know that your pelvic floor is struggling to cope it is important to approach exercise sensibly. NEVER ‘bear down’ when learning to find these muscles and try not to hold your breath.

Try the Cat-Cow

Now try the Cat-Cow exercise to feel your pelvic floor as you move.

If you are in any doubt, get help from a qualified professional. A Pelvic Health Physiotherapist (women’s health Physiotherapist) can perform an assessment and get permission from you doctor before embarking on a new programme of exercise.

Even walking more could be a start

The good news is that doing moderate physical activity such as walking can decrease your risk of urinary incontinence. (K Bo and IE Nygard, 2019)

To Sum Up

I hope you are feeling more confident about the steps you can take to improve your Pelvic health.  Remember movement is medicine for the body and mind and in most cases if you do the work, it will make a difference. Act sooner rather than later to improve your outcome and prevent a worsening of your condition.


Bump RC, Hurt WG, Fantl JA, Wyman JF. Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol. 1991 Aug;165(2):322-7; discussion 327-9. doi: 10.1016/0002-9378(91)90085-6. PMID: 1872333.

Cacciari LP, Dumoulin C, Hay-Smith EJ. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women: a cochrane systematic review abridged republication. Braz J Phys Ther. 2019 Mar-Apr;23(2):93-107. Epub 2019 Jan 22.

Erekson EA, Yip SO, Wedderburn TS, Martin DK, Li FY, Choi JN, Kenton KS, Fried TR. The Vulvovaginal Symptoms Questionnaire: a questionnaire for measuring vulvovaginal symptoms in postmenopausal women. Menopause. 2013 Sep;20(9):973-9. doi: 10.1097/GME.0b013e318282600b. PMID: 23481118; PMCID: PMC3695224.

Gandhi J, Chen A, Dagur G, Suh Y, Smith N, Cali B, Khan SA. Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management. Am J Obstet Gynecol. 2016 Dec;215(6):704-711. doi: 10.1016/j.ajog.2016.07.045. Epub 2016 Jul 26. PMID: 27472999.

Bø, K., Nygaard, I.E. Is Physical Activity Good or Bad for the Female Pelvic Floor? A Narrative Review. Sports Med 50, 471–484 (2020).

Maltais ML, Desroches J, Dionne IJ. Changes in muscle mass and strength after menopause. J Musculoskelet Neuronal Interact. 2009 Oct-Dec;9(4):186-97. PMID: 19949277.

NICE guideline [NG123] Urinary incontinence and pelvic organ prolapse in women: management. Published: 02 April 2019 Last updated: 24 June 2019