By Ruth Jenkins, PT, DPT, PWCS, COMT, CMTPT/DN, CLT

“Crossing your legs and hoping for the best” is not a healthcare strategy.

Pelvic floor symptoms are common during and after menopause, but treatment is available. Menopause is often portrayed as a time of hot flashes, mood changes, and suddenly always needing a fan within arm’s reach. While these symptoms certainly deserve attention, another important aspect of women’s health frequently goes undiscussed: pelvic floor health.

For many women, menopause can bring unexpected challenges such as urinary leakage, pelvic pressure, painful intercourse, urinary urgency, and changes in sexual function. The good news? These symptoms are common, but they are not an inevitable part of aging. Pelvic floor physical therapy (PFPT) is an effective, evidence-based approach that may improve quality of life during and after the menopausal transition.^3,4

The pelvic floor consists of several muscles, fascia, and connective tissues that support the bladder, bowel, and reproductive organs. These muscles also contribute to core stability, continence, sexual function, breathing mechanics, and posture. We talk about the 4 S’s.

As estrogen levels decline during menopause, tissues throughout the genitourinary system undergo changes. Reduced collagen content, tissue elasticity, blood flow, and muscle function can contribute to symptoms associated with genitourinary syndrome of menopause (GSM), urinary incontinence, pelvic organ prolapse, and sexual dysfunction.⁴

In other words, the pelvic floor enters menopause right alongside the rest of the body and sometimes protests just as loudly.

Women experiencing menopause may notice:

• Urinary leakage with coughing, laughing, sneezing, or exercise
• Increased urinary urgency and frequency
• Pelvic heaviness or pressure
• Vaginal dryness and discomfort
• Pain during intercourse
• Reduced sexual satisfaction
• Persistent pelvic, hip, or low back pain

These symptoms can affect exercise participation, social engagement, sleep quality, intimate relationships, and overall well-being. Yet many women wait years before seeking help because they assume these changes are simply “normal.”⁴

Let’s be clear: menopause is normal. Suffering in silence is not.

Pelvic floor physical therapists are specially trained to evaluate and treat dysfunction of the pelvic floor muscles and surrounding structures.

A comprehensive assessment may include:

• Pelvic floor muscle strength and coordination
• Breathing patterns
• Core function
• Pelvic alignment and movement
• Bladder and bowel habits
• Lifestyle and exercise factors

Treatment is highly individualized and may include:

• Pelvic floor muscle training
• Manual therapy
• Behavioral and bladder retraining
• Core stabilization exercises
• Postural education
• Relaxation techniques
• Exercise modification
• Sexual health education

Pelvic floor therapy is not just Kegel exercises. Many menopausal women actually have pelvic floor muscles that are overactive, tight, or poorly coordinated rather than weak. In these situations, learning to relax the pelvic floor may be just as important as strengthening it.^4,6

Research supports pelvic floor muscle training as a first-line conservative treatment for urinary incontinence.

A 2025 systematic review and meta-analysis of five randomized controlled trials found that pelvic floor muscle training significantly improved the severity of urinary incontinence, leakage episodes, pelvic floor muscle function, and quality of life in postmenopausal women. The authors estimated a 92% probability of meaningful improvement compared with control groups.²

Additionally, a 2023 systematic review of randomized controlled trials demonstrated that pelvic floor muscle exercises effectively reduced urinary incontinence symptoms and improved pelvic floor function in postmenopausal women.³

Pelvic floor physical therapy may also support sexual wellness for postmenopausal women.

Changes in hormone levels, tissue health, and pelvic floor muscle function can contribute to discomfort during intercourse, reduced arousal, and decreased sexual satisfaction. Pelvic floor therapy can help address muscle tension, improve circulation, enhance body awareness, and support healthy sexual function.

A 2025 systematic review and meta-analysis of five studies found that pelvic floor muscle training improved several aspects of sexual function in postmenopausal women, including arousal, orgasm, and overall satisfaction.⁵

As it turns out, strengthening the pelvic floor can provide benefits well beyond avoiding an awkward sprint to the restroom.

Pelvic floor therapy does not directly moisturize vaginal tissue or replace treatment for the tissue changes of genitourinary syndrome of menopause (GSM). It may help when muscle tension, pain, or coordination problems also contribute to discomfort. Vaginal moisturizers, lubricants, and clinician-recommended medical treatments address different parts of the problem.

Via® is a non-hormonal vaginal moisturizer with hyaluronic acid designed for ongoing moisture support, while a lubricant is used for short-term friction reduction during sexual activity. Some people may use these options alongside pelvic floor therapy because they serve different purposes.

Current menopause guidelines emphasize a multidisciplinary approach to managing genitourinary symptoms. Pelvic floor therapy is increasingly recognized as an important component of conservative care, but optimal menopause wellness may include a combination of:

• Pelvic floor therapy
• Regular strength training
• Cardiovascular exercise
• Good nutrition with whole foods
• Adequate hydration
• Sleep optimization
• Stress management
• Evidence-based medical care for menopausal symptoms, which may include hormone therapy when appropriate
• Non-hormonal vaginal moisturizers or lubricants for vaginal dryness and discomfort
• Supplementation like probiotics for gut, vaginal, and bladder health

Think of menopause as a recalibration. Much like updating your smartphone, your body may require a few adjustments to keep everything functioning optimally. Pelvic floor therapy can complement medical care, exercise, sleep, nutrition, and stress management. The right combination depends on a person’s symptoms, goals, and health history.

Menopause represents a significant transition, but it does not have to mean accepting bladder leakage, pelvic discomfort, or reduced quality of life as the “new normal.”

Pelvic floor therapy offers a safe, effective, and evidence-based pathway to improved continence, pelvic support, sexual health, and overall wellness. By addressing pelvic floor dysfunction early, women can maintain confidence, stay active, and continue doing what they love without constantly mapping the location of the nearest restroom.

If pelvic symptoms affect daily life, exercise, sleep, or sexual health, ask a healthcare professional whether pelvic floor physical therapy is appropriate.

Thriving through menopause should be the goal, not merely surviving it.

1. Piernicka, M., Labun, J., & Szumilewicz, A. (2025). Training interventions used in postmenopausal women to improve pelvic floor muscle function related to urinary continence: A systematic review. Journal of Clinical Medicine, 14(13), 4800.
2. Marcellou, E. G., Stasi, S., Giannopapas, V., Bø, K., Bakalidou, D., Konstadoulakis, M., & Papathanasiou, G. (2025). Effect of pelvic floor muscle training on urinary incontinence symptoms in postmenopausal women: A systematic review and meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology, 304, 134–140.
3. López-Pérez, M. P., Afanador-Restrepo, D. F., Rivas-Campo, Y., Hita-Contreras, F., Carcelén-Fraile, M. D. C., Castellote-Caballero, Y., Rodríguez-López, C., & Aibar-Almazán, A. (2023). Pelvic floor muscle exercises as a treatment for urinary incontinence in postmenopausal women: A systematic review of randomized controlled trials. Healthcare, 11(2), 216.
4. Kaufman, M. R., Ackerman, L. A., Amin, K. A., et al. (2025). The AUA/SUFU/AUGS guideline on genitourinary syndrome of menopause. The Journal of Urology.
5. García-Laria, R., Alonso-Calvete, A., Justo-Cousiño, L., Da Cuña-Carrera, I., & Soto-González, M. (2025). Effects of pelvic floor muscle training on sexual function of postmenopausal women: A systematic review and meta-analysis. Sexual Medicine, 13(4), qfaf067.
6. Walgren, L. A., Wade, C., Dessaulles, M., Martin Ginis, K., & Locke, J. (2024). A review of the role for pelvic floor physiotherapy in postmenopausal women with urinary incontinence. Post Reproductive Health, 30(4), 239–245.