Perimenopause, Menopause and Your Pelvic Floor – What Nobody Tells You

Most women in Mid Sussex arrive at perimenopause braced for hot flushes and disrupted sleep. Almost nobody has been warned about the pelvic floor.

And yet, in our clinic in Haywards Heath, it’s one of the most common reasons women in their forties and fifties finally pick up the phone. Not because something dramatic happened, but because of a slow accumulation of small things. The jog to the car that now needs a bit of planning. The trampoline you’ve quietly stopped going on. The extra loo stop before leaving the house. The vague feeling of heaviness by the end of a long day.

If any of that sounds familiar, this article is for you. Here’s what’s actually happening, why it’s so common, and importantly, why it is very treatable.

Why the pelvic floor changes at menopause

Your pelvic floor is a layer of muscle, ligament and connective tissue slung across the base of your pelvis. It supports your bladder, bowel and uterus, contributes to core stability, and helps control when you go to the loo.

Like a lot of tissue in the body, it is sensitive to oestrogen. As oestrogen levels fall through perimenopause and into menopause, several things happen at once:

• Tissue becomes thinner and less elastic. The tissues of the vagina, urethra and pelvic floor lose some of their bulk and stretch, which affects how well they seal and support.
• Muscle mass declines generally. From our forties onwards we lose muscle across the whole body unless we actively work against it. The pelvic floor is no exception.
• Connective tissue support softens. The ligaments and fascia that hold pelvic organs in place become slightly less robust.
• Bladder sensitivity increases. Many women notice urgency, that sudden, insistent “I need to go now”, before they notice any leaking at all.

Layer on top of this the things that came before: pregnancies, births, a C-section, years of high-impact exercise, a persistent cough, constipation, heavy lifting at work or in the garden. Perimenopause doesn’t usually create a new problem out of nowhere. It removes the buffer that was quietly compensating for an old one.

The symptoms women actually describe

In the clinic, women rarely open with “I think I have pelvic floor dysfunction.” They say things like:

• “I leak a bit when I sneeze, cough or laugh, it’s not much, but it’s there.”
• “I’ve stopped doing the class I loved because I don’t trust myself in the jumping bits.”
• “I know where every toilet between here and Burgess Hill is.”
• “I get a dragging or heavy feeling low down, especially by the evening.”
• “Sex is uncomfortable in a way it never used to be.”
• “I have to go twice before I’m confident I’m empty.”
• “My lower back and hips have been niggling and nothing seems to shift it.”

None of these are things you have to accept. All of them are worth assessing.

“Isn’t this just part of getting older?”

This is the single most common thing we hear, and it’s the reason so many women wait years before seeking help.

Very common is not the same as normal, and it certainly isn’t the same as untreatable. Bladder leaking affects a large proportion of women during and after menopause, but the evidence base for supervised pelvic floor muscle training is genuinely strong. UK clinical guidance (NICE) recommends a supervised programme of pelvic floor muscle training, taught properly and continued for at least three months, as a first-line treatment for stress urinary incontinence and for pelvic organ prolapse. Not as a last resort. First.

The catch is in the word supervised. Research has consistently found that a large share of women doing pelvic floor exercises from a leaflet or an app are not performing them correctly; some are bearing down rather than lifting, which can make matters worse. That’s not a failure of effort. It’s a muscle you can’t see, in an area nobody ever taught you to feel.

What a women’s health physiotherapy assessment involves

At The Health Hub in Haywards Heath, a menopause-related pelvic health assessment with Jodie Pargeter typically covers:

A proper conversation first. Your history, births if relevant, bladder and bowel patterns, exercise, work demands, what you’ve already tried, and crucially what you want to get back to. That last one shapes everything.

A functional movement and breathing assessment. The pelvic floor doesn’t work in isolation. It works with your diaphragm, deep abdominals and hips. How you breathe, brace and load through the day matters enormously.

A pelvic floor assessment. This is usually an internal examination, with your consent, and it is the most accurate way to establish what your pelvic floor is actually doing, whether it’s weak, overactive, poorly coordinated, or some combination. Many women are surprised to learn that their pelvic floor is too tight rather than too weak, and that squeezing harder is the last thing they need. You can decline the internal assessment and still be helped; it just gives us more to work with.

Real-time diagnostic ultrasound where useful. We use ultrasound imaging to show deep core and pelvic floor activation on a screen. Being able to see the muscle move is often the moment something clicks after years of guessing.

A written plan. Not a generic sheet. A specific programme, with load and progression, matched to your life, whether that’s getting back on the netball court, walking the South Downs Way, or simply going out for the day without a mental map of the toilets.

What treatment usually looks like

Most women need a course rather than a one-off, and the honest timeline is months, not weeks; muscle adapts on a biological schedule that can’t be rushed. Typical elements include:

• Individually prescribed pelvic floor training, progressed over time in the same way you’d progress any strength programme
• Down-training and release work if the floor is overactive
• Breathing and pressure management – how you exhale on effort, how you lift, how you brace
• Bladder retraining for urgency and frequency
• Load management – reducing straining, addressing constipation, adjusting exercise temporarily rather than abandoning it
• APPI Clinical Pilates to build the surrounding system, available on-site
• Strength training advice for bone health, which becomes a priority in its own right after menopause

Many women also benefit from a conversation with their GP about vaginal oestrogen or HRT. That is a medical decision for you and your GP, but it works alongside physiotherapy rather than instead of it, and the two together often produce a better result than either alone. We’re happy to write to your GP with our findings.

Women’s health physiotherapy in Haywards Heath and across Mid Sussex

The Health Hub is based in Haywards Heath and we see women from across Mid Sussex – Lindfield, Cuckfield, Burgess Hill, Hassocks, Hurstpierpoint, Ansty, Balcombe and Ardingly, for pelvic health, menopause-related symptoms, postnatal recovery and scar therapy.

Our Women’s Health service is led by Jodie Pargeter, a Chartered Physiotherapist with over 20 years of clinical experience, certified Mummy MOT® practitioner, RESTORE Caesarean Scar Specialist and APPI Clinical Pilates trained. Appointments are private, unhurried and held in a private treatment room. We’re recognised by Aviva, Cigna, Simply Health, Westfield, WPA and BHSF.

Initial Women’s Health Assessment · 60 minutes · £94

Follow-up · 30 minutes · £74