4 Tips To Keep Your Pelvic Floor Healthy Through Menopause

(Editor’s note: this is a special guest blog post by Liz Miracle, MSPT, WCS. She is a pelvic floor physical therapist who is also an Assistant Clinical Professor at the University of California-San Francisco and the Bay Area Clinical Director for Origin Physical Therapy).

Menopause is a time of many changes. And that goes double for the pelvic floor. It is closely intertwined with the body’s urinary and sexual function in ways that make it part of menopause ground zero, so to speak. But there are many things you can do to keep your pelvic floor fit as a fiddle throughout the process -- this article covers 4 tips to get started.

What Exactly Does Menopause Mean For Your Pelvic Floor?

You may already know that the body undergoes significant hormonal changes during menopause, in particular reducing the amount of estrogen and progesterone that it produces. These hormonal changes, and some of the other consequences of menopause, are closely wrapped up with a number of the roles that the pelvic floor plays.

Common symptoms of menopause that can be connected to pelvic floor function include:

  • Urinary urgency (needing to pee more often)
  • Discomfort during sex
  • Weight gain in the absence of of regular exercise

Menopause can also correspond with weakening of the pelvic floor muscles, which can again impact bladder control and sexual function. Overall, pelvic floor disorders become considerably more common once you hit menopause, with nearly half of postmenopausal women having to deal with one

But, the good news is that your hands are not tied! There are a number of steps that you can take to manage the impact of menopause on your pelvic floor and keep it healthy. Here are four tips to keep in mind.

#1 Continue to participate in vaginal penetration

As with many other aspects of the body, the situation with the pelvic floor becomes increasingly “use it or lose it” as you get older. It is normal for the tissue at the opening of the vagina to narrow and/or atrophy somewhat as part of menopause. This can make insertion more painful, whether it’s in the context of sex or a gynecological exam. This can be exacerbated by increased vaginal dryness, which is another common effect of menopause. 

On top of this, the reduction in estrogen that is at the heart of the changes of menopause can also cause discomfort with vaginal insertion. 

To mitigate this problem, continuing regular vaginal penetration (whether it’s staying sexually active, using an intravaginal pelvic floor trainer, or whatever other approach suits you) throughout menopause can really help. It’s like exercise -- if you don’t do it for a while, it can be hard to get back up to speed. You can also talk to your doctor to see if vaginal estrogen or a vaginal moisturizer is right for you. 

#2 Strengthen your pelvic floor (aka Kegels)

It shouldn’t really come as too big of a surprise that when the question is “how do I keep certain muscles in my body healthy?”, part of the answer is “exercise!”. And the pelvic floor muscles are no exception. 

One of the common side effects of menopause is a weakening of the muscles and ligaments in your pelvic floor that support the pelvic organs. If you aren’t exercising regularly, weight gain as a result of menopause can exacerbate this issue. Overall, strengthening the pelvic floor can help these muscles and ligaments continue to effectively support the pelvic organs and also help with their other functions, such as bladder control. The hormonal and other changes that normally occur during menopause make that a particularly important time of life to be intentional about maintaining pelvic floor fitness. 

With that said, however, it’s also important to note that pelvic floor strengthening is not right for everyone. If your pelvic floor muscles are what’s called hypertonic (or overly tight), Kegels can be ineffective or even counterproductive. A pelvic floor physical therapist is a great resource to talk with to make sure you’re taking the right approach to managing your pelvic floor health through menopause.

#3 Watch out for UTIs

Urinary Tract Infections (UTIs) are the most common bacterial infections for women in general, and unfortunately they become even more common after menopause. Keeping the pelvic floor strong can help close the opening of the urethra so that it can be harder for bacteria to get in and cause an infection. If you are having repeat infections, make sure you are getting them cultured. A tight pelvic floor can sometimes mimic the symptoms of a urinary tract infection and result in unnecessary antibiotics.

There are a number of potential steps you can take to reduce the risk of contracting either recurring or one-off UTIs. Of course, your doctor will be able to provide access to the full arsenal of modern medicine in terms of antimicrobial prophylaxis, topical or oral estrogens, and other options. But there are also a few steps you can consider on your own to try to prevent UTIs (to be clear, once you actually have a UTI, you should definitely see your doctor about treating it):

  1. Probiotics: the Lactobacillus species of bacteria is a type of probiotic that is commonly found in your digestive and urinary tracts. Preliminary research suggests that they can help prevent recurring UTIs.
  1. D-mannose: D-mannose is a simple sugar that can be purchased at most supplement stores and some pharmacies and grocery stores. Initial research has suggested that D-mannose can be an effective prophylactic agent (i.e. that it can help prevent UTIs).
  2. Vaginal hygiene: make sure to pee after vaginal penetration of any kind and always make sure that objects being inserted vaginally (e.g. pessaries, pelvic floor trainer, etc) are cleaned thoroughly before insertion.

#4 Watch your posture

This is perhaps the least intuitive of these four tips, but maintaining good posture can have a surprisingly strong impact on your pelvic floor health. When your pelvis is too far forward (this is called forward pelvis tilt), it constricts the range of motion for your pelvic floor and can contribute to the pelvic floor muscles and ligaments becoming weaker and tighter (i.e. “hypertonic”). It also keeps your hamstrings overly tight and weakens your glutes. Put it together and you’re not putting your pelvic floor in position to stay fit and healthy (and effective).

There is also some evidence that postural balance can be affected by changing hormones. Maintaining pelvic floor strength helps keep your core strong and can contribute to improved balance.

Whether you’re sitting or standing, practicing being more aware of your body is the start to improving your posture. And better yet, improved posture can have benefits far beyond the pelvic floor, including lower risk of joint or muscle pain and even improved energy levels.

The Takeaway

Menopause can bring a lot of changes to get used to. And the pelvic floor in particular is one of the parts of your body that can be most heavily impacted. But having pelvic floor problems during menopause is not inevitable! Incorporating the tips above into your lifestyle can help keep your pelvic floor (and you) running smoothly for the long haul.