4 Ways Pelvic Floor Therapy Can Help Ease the Most Uncomfortable Menopause Symptoms

When you think of pelvic floor issues, people who’re pregnant or just had a baby might come to mind. After all, the group of muscles that sits at the base of your torso works extra hard to hold up a growing uterus and may need extra care after birth—sometimes in the form of pelvic floor therapy.

But did you know pelvic floor therapy can help during menopause, too?

Here’s how the pelvic floor changes during menopause, how pelvic floor therapy can help ease common symptoms like painful sex and urinary incontinence, and how to find a pelvic floor therapist near you.

What happens to the pelvic floor during menopause

Many of us tend to focus on keeping major muscles and bones healthy—like our hips, knees, and back. But our pelvic floor, which serves as a “hammock” for our urethra, bladder, rectum, and vagina (or prostate) needs attention, too. These muscles can get weak, leaving us with myriad sexual health issues.

Why does this happen? One word: hormones.

“Declining estrogen levels during perimenopause and menopause leave women especially susceptible to pelvic floor weakening,” says Margo Kwiatkowski, PT, DPT, a pelvic health specialist, founder of P4Moms in Ventura County, California, and medical advisory board member for Intimina, an intimate wellness brand.

“Estrogen is responsible for improving blood flow, increasing muscle bulk, helping tissues remain elastic, and providing natural lubrication to the vagina,” says Kwiatkowski. “Without estrogen, our pelvic floor tissues atrophy and retract, we lose our natural lubrication, and our muscle strength declines.”

Because our pelvic floor kind of works “behind the scenes,” we typically don’t think about it until these muscles weaken or tear, causing what’s commonly referred to as pelvic floor disorder, or PFD, which affects 1 in 3 women, according to a June 2022 study in Scientific Reports¹.

Other symptoms of PFD include the following, per Kwiatkowski:

• Pelvic organ prolapse: A condition where the pelvic organs protrude into the vagina
• Pain with intercourse
• Urinary or bowel incontinence
• Constipation
• Vaginal dryness
• Pelvic pain or heaviness
• Vaginal bulges

This is where pelvic floor therapy—a specialized physical therapy that treats pelvic floor dysfunctions—comes in. It’s done by a licensed physical or occupational therapist with special certifications in women’s health, according to Rachelle Larson, PT, MPT, a certified women’s health specialist and senior physical therapist-pelvic health at Corewell Health’s Beaumont Women’s Urology and Pelvic Health Center in Royal Oak, Michigan.

And while it can benefit anyone throughout their lifespan, it’s especially helpful for people with menopausal pelvic pain and other symptoms, says Larson.

“Pelvic floor therapy is highly tailored to the individual. What’s right for you isn’t necessarily right for your friend.”—Rachelle Larson, PT, pelvic floor therapist

4 ways pelvic floor therapy can help with menopause symptoms

While there’s a plethora of Kegel-forward exercise routines online, the best way to reap the benefits of pelvic floor therapy during menopause is by seeing a therapist in person, says Kwiatkowski. They are trained to perform vaginal and/or rectal exams to check your pelvic muscle function and put together a customized treatment plan with a combo of exercises and lifestyle changes.

Pelvic floor therapists can also determine whether you need to focus more on strengthening or relaxing these particular muscles. That’s why it’s highly recommended to see someone before trying to perform pelvic floor exercises on your own, adds Kwiatkowski.

On top of this, pelvic floor therapists can teach you how to manage other menopause symptoms (like vaginal dryness) long after you’ve finished treatment with them.

Pelvic floor therapy is also highly tailored to the individual—what’s right for you isn’t necessarily what’s right for your friend, says Larson.  “It’s often of little help or may even result in worsening of symptoms to treat these conditions on your own,” she adds.

Read on for more on the specific benefits of pelvic floor therapy for menopause symptoms.

1. It can improve urinary incontinence

If you’ve ever laughed or sneezed and felt a leak “down there,” you’ve likely had some degree of urinary incontinence—or loss of bladder control. There are a few different types, but the most common during menopause are stress incontinence and urge incontinence, per the Mayo Clinic.

Stress incontinence happens when pressure is applied on the bladder (from a cough or sneeze), resulting in urine leaks. Urge incontinence is when you have a sudden, intense urge to pee, followed by a loss of urine, per the Mayo Clinic.

Both likely happen from pelvic floor weakness or poor muscle coordination, says Kwiatkowski. In other words, “your muscles and bladder are not communicating well and need retraining.”

No matter the kind you’re dealing with, pelvic floor therapy can help by improving the strength of your pelvic muscles and the speed at which they contract, she adds.

What a therapist might do: If you have stress incontinence, a therapist might teach you “the knack,” aka, how to contract the pelvic floor before a cough, sneeze, or laugh, says Kwiatkowski. They may also practice Kegels with you, and other exercises to strengthen your lower abdomen.

If you’re dealing with urge incontinence, you may need to take a closer look at your bathroom habits, fluid and food intake, and other strategies to retrain your bladder—like diaphragmatic breathing with pelvic floor contractions before heading to the restroom.

2. It can help you have more comfortable sex

There are many factors that can contribute to uncomfortable, or even painful, sex during menopause. The top issue is usually vaginal dryness (caused by hormone changes), which can be remedied with lubricants or estrogen creams. But structural changes could be at play here, too.

During menopause, your pelvic floor muscles shrink and lose elasticity. “When tissues can’t stretch like they once did, it can lead to pain during intercourse,” says Kwiatkowski.

What a therapist might do: If you have pain during sex, stretching your pelvic floor muscles is important. Therapists might show you moves to open a tight pelvic floor, like child’s pose, deep squats, butterfly stretch, and hip stretches. Or, they’ll recommend relaxation methods prior to sex like diaphragmatic breathing, mindfulness, and yoga, according to Larson.

Additionally, your session will include some type of manual therapy to address muscle stiffness, adds Kwiatkowski. This may include an abdominal massage, pressing external trigger points until they relax, or pressing internal points along your vaginal wall (which sits up against your pelvic floor muscles).

3. It can relieve pelvic pain during and after menopause

Menopause can bring about pelvic pain that’s different from period cramps. It’s often due to tension in your pelvic floor, postural changes, or weakness in the muscles surrounding the pelvis and lower back, according to Kwiatkowski. This pain can happen while walking or exercising, or it may remain constant throughout the day.

What a therapist might do: Therapists will likely start with a thorough examination to determine the source of your pain, says Kwiatkowski. Then, you’ll get a customized treatment plan, which often includes manual techniques like massage. They may also suggest exercises to improve your posture.

Other techniques pelvic floor therapists may incorporate to relieve pain include:

• Acupuncture
• Cupping
• A TENS machine—a device that sends small electrical impulses to nearby nerves and muscles, helping relax them, per the Cleveland Clinic. It’s often used in traditional physical therapy and can be applied to your lower abdomen.
• Pressing trigger points outside and/or inside the vaginal wall, with either gloved fingers or a pelvic wand. Therapists may also teach you to do this technique on yourself, so you can get relief at home.

Keep in mind: If you’re feeling pelvic pain after menopause, it could be a sign of an underlying health issue like endometriosis, pelvic adhesions (leftover scar tissue from a previous infection), ovarian cysts, or bowel or bladder disease. If you feel postmenopausal pelvic pain, it’s worth a trip to the doctor just to double check, per The North American Menopause Society.

4. It can reduce pelvic organ prolapse

Up to half of all women will develop pelvic organ prolapse in their lifetimes, according to a November 2022 study in PLOS One.

“Many of these women develop minor prolapse after childbirth yet are asymptomatic until menopause. The loss of estrogen makes prolapse more symptomatic and prominent,” says Kwiatkowski.

Prolapse can feel like a heaviness in your lower abdomen, like you’re sitting on a small ball, or like a dragging feeling inside your vagina, per the U.K.’s National Health Service. It’s not harmful (just uncomfortable at times), but some more serious cases may require surgery.

What a therapist might do: Prolapse is treated by reducing pressure on the pelvic organs, which is greatest when straining to poop or cough, says Kwiatkowski. Methods to reduce pressure often include Kegel exercises and constipation-management strategies, says Larson.

“Some simple techniques involve using a stool under your feet during a bowel movement to reduce straining, or doing a pelvic floor muscle contraction before coughing,” says Kwiatkowski.

She adds that some pelvic floor therapists are also trained at fitting pessaries—a silicone ring device that can be inserted into the vagina to support the pelvic organs and decrease the need for a future surgery, per the Cleveland Clinic.

How to find a pelvic floor therapist

There are several ways to find a pelvic floor therapist to help with menopause symptoms. The Academy of Pelvic Health Physical Therapy (part of the American Physical Therapy Association) and Pelvicrehab.com both offer searches for physical therapists by location.

You can also ask your OB/GYN or primary-care doctor for a recommendation (they may even need to send over a referral), or see if your insurance company has any in-network pelvic floor physical therapists in your area.

When to see a doctor

Pelvic floor dysfunction during menopause is pretty common, but that doesn’t mean you have to resign yourself to a life of leaking a little when you cough or laugh, avoiding sex, or living in pain. Going to a pelvic floor therapist can help you manage and prevent the worsening of your symptoms during menopause (or at any age, really).

That said, if your symptoms are severe and come with new-onset bowel or bladder incontinence (especially with a lower back injury), vaginal bleeding during menopause, or abnormal vaginal discharge, it’s worth a trip to your doctor’s office. They can help treat any underlying conditions you may have.

—medically reviewed by Andrea Braden, MD, OB/GYN