Most women arrive at perimenopause expecting hot flushes and broken sleep. Far fewer have been warned about the pelvic floor. It tends to creep up: the run that now needs planning, the extra visit to the loo before leaving the house, a feeling of heaviness by the end of a long day.
These changes are common in your forties and fifties, and they are not something you simply have to put up with. Pelvic health physiotherapy can help at any stage, including years after your periods have stopped.
Why things change around the menopause
The pelvic floor is a layer of muscle and connective tissue across the base of the pelvis. It supports the bladder, bowel and womb and helps control when you go to the toilet. Like much of the body, it responds to oestrogen. As oestrogen falls:
- The tissues of the vagina, urethra and pelvic floor become thinner and less elastic
- Muscle is lost more easily, in the pelvic floor as elsewhere, unless you work against it
- The ligaments and fascia that support the pelvic organs become less firm
- The bladder can become more sensitive, bringing urgency and more frequent trips
If you had a difficult birth or a long-standing weakness years ago, this is often when it starts to show.
What women tell us
- Leaking with a cough, sneeze, laugh or run
- A sudden, urgent need to go, or getting up more than once in the night
- A feeling of heaviness, dragging or a bulge in the vagina
- Giving up exercise they enjoyed because of leaking or discomfort
- New aches in the lower back, hips or pelvis
Read more about bladder leaks and prolapse, or our article on the pelvic floor at perimenopause and menopause.
What can help
- Pelvic floor muscle training, taught properly and progressed over time. National guidance recommends it as a first treatment for stress incontinence and for prolapse symptoms.
- Bladder training for urgency and frequency.
- General strength work. Keeping the hips, trunk and legs strong matters more at this stage of life, for the pelvic floor and for bone and joint health.
- Advice on impact exercise, so that you can keep running, lifting or playing sport, or get back to it.
Physiotherapy works alongside medical treatment. Decisions about HRT or vaginal oestrogen are for you and your GP, and we’ll suggest speaking to them where we think it could help.
Your first appointment
Your first appointment lasts 60 minutes, in a private room. We’ll ask about your symptoms, your bladder and bowel habits, any pregnancies and births, and what you’d like to get back to. We’ll look at your posture, breathing and tummy muscles.
With your consent, an internal examination is the most accurate way to assess the pelvic floor. It is always your choice, and there are other ways to assess and treat you if you’d prefer not to. You’ll leave knowing what we found and with a plan to start straight away.
When to see your GP first
- Any bleeding after the menopause, which should always be checked
- Blood in your urine, or pain or burning when you pass urine
- A new lump or bulge with pain
- A sudden loss of bladder or bowel control with numbness around your back passage or genitals, which can be a sign of pressure on the nerves at the base of the spine and needs urgent medical assessment
The NHS explains more about bleeding after the menopause.
Who you'll see
Pelvic health around the menopause is seen here by our women’s health physiotherapist.
Jodie Pargeter is our women’s health physiotherapist and co-founder of The Health Hub, with over 20 years’ experience in NHS and private practice. She is a certified Mummy MOT® practitioner and is trained in APPI Clinical Pilates.
Jodie Pargeter
Physiotherapist,
Acupuncture Physiotherapist,
Women’s Health Specialist,
Restore C-section Scar Specialist
APPI Pilates trained
Jodie is co-founder of The Health Hub and a chartered physiotherapist with over 20 years’ experience in NHS and private practice. She leads our women’s health physiotherapy service, supporting women through pregnancy, recovery after birth and long-term pelvic health.
She is a certified Mummy MOT® practitioner, trained in RESTORE C-section scar therapy and APPI Clinical Pilates, and uses real-time ultrasound to help you see and learn how your deep core muscles are working.
Prices and insurance
- Women’s health initial consultation (60 minutes): £94
- Follow-up treatment (30 minutes): £74
No GP referral is needed. You pay at your appointment and we’ll give you an invoice to claim back from your insurer if you’re covered. Insurer recognition varies by clinician, so ask us when you book. See our full price list
Frequently asked questions
If you have a question that isn’t answered here, call us and we’ll be glad to help.
- Isn't this just part of getting older?
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These symptoms become more common with age, but they are not inevitable and they are not something you have to accept. Most women can improve them with the right help.
- Is it too late to start pelvic floor exercises?
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No. Muscle responds to training at any age. We see women in their fifties, sixties and beyond who have never been shown how to do the exercises properly.
- Do I need to be on HRT for physiotherapy to help?
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No. Physiotherapy can help whether or not you take HRT. Some women find that vaginal oestrogen helps alongside it, and that is a conversation to have with your GP.
- Do I have to have an internal examination?
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No. It is the most accurate way to assess the pelvic floor, and we will explain why, but it is always your choice.
- How many sessions will I need?
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It varies. Guidance recommends at least three months of supervised pelvic floor training, usually spread over a small number of appointments, and we review your progress as you go.
- Do I need a GP referral?
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No, you can book directly. If you’re claiming on private health insurance, check whether your insurer needs a referral first.
Based in Haywards Heath, we see patients from:
You’ll find us at Unit 3, 2-8 Sussex Road, Haywards Heath, RH16 4EA. There’s free on-street parking on Sussex Road and two pay and display car parks a short walk away, and our entrance, treatment rooms and toilets are wheelchair accessible. We’re open Monday to Friday 8am to 7pm, and Saturday 8am to 1pm.
Book an appointment
If these symptoms sound familiar, an assessment will tell you what is going on and what can be done. Book online or call us on 01444 817851.
Reviewed by Jodie Pargeter, women’s health physiotherapist, registered with the Health and Care Professions Council. Last reviewed November 2026.
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