Why does your bladder seem to have a mind of its own, or sex feel different than it used to?
If you are in your 40s, 50s, or beyond, hormones may be part of the answer. The link between hormones and pelvic health is well documented, and it often goes unnoticed because many people assume these changes are just part of getting older. They are common, but they are not something you have to put up with.
This guide from Parkway Physiotherapy in Langford explains what hormones do for your pelvic floor, which changes are normal, and when it is worth getting checked.
How Hormones and Pelvic Health Are Connected
Your pelvic floor is a group of muscles, ligaments, and tissue that supports your bladder, bowel, and reproductive organs. It helps you control when you go to the bathroom, supports your core, and plays a role in sex.
Estrogen helps keep the tissue in and around your vagina, urethra, and bladder thick, stretchy, moist, and well supplied with blood. When estrogen levels fall, those tissues can become thinner and drier. That can affect comfort, bladder control, and sex.
Normal Changes in Perimenopause and Menopause
Perimenopause is the stretch of years before your final period, when hormone levels rise and fall unevenly. Menopause is when you have gone 12 months without a period. During this time, many changes are expected:
- periods that become irregular, lighter, heavier, or farther apart
- hot flashes and changes in sleep
- some vaginal dryness or less natural lubrication
- needing the bathroom a little more often
Many of the pelvic changes fall under a pattern called genitourinary syndrome of menopause. It includes dryness, burning, urinary urgency, repeat urinary tract infections, and pain with sex. About 40% to 60% of postmenopausal women have it. In one study it affected 4% of women in perimenopause, 25% one year after menopause, and 47% three years after (Phillips & Bachmann, 2018). It is common, but it also tends to be ongoing and to get worse without treatment. Common does not mean nothing can be done.
Normal Versus Worth Checking
It can be hard to tell what is part of the transition and what needs attention. This table is a general guide:
| Area | Often normal | Worth checking with your doctor |
|---|---|---|
| Periods | Irregular or changing flow in perimenopause | Any bleeding after menopause, very heavy bleeding or large clots, or bleeding after sex |
| Bladder | Needing to go a bit more often, or a small leak with a cough or sneeze | Sudden new leaking, burning or pain when you pee, blood in your urine, repeat infections, or trouble emptying your bladder |
| Vaginal comfort | Some dryness | Pain that stops sex or daily activity, sores, unusual discharge, or burning that does not settle |
| Bowels | Occasional constipation | New, lasting constipation, or blood from the bowel |
| Whole body | Hot flashes and lighter sleep | Unexplained weight change, extreme tiredness, feeling too hot or too cold all the time, or a racing heart |
| Pelvic pressure | Not expected | A feeling of heaviness or a bulge in the vagina |
If something in the right-hand column sounds familiar, speak with your doctor. We are happy to work alongside them.
What About Thyroid and Other Hormone Conditions?
Some perimenopause symptoms, like tiredness, mood and sleep changes, and weight changes, can overlap with thyroid problems. A blood test can check this. Some clinicians believe an underactive thyroid can slow the bladder and bowel and add constipation and pelvic pressure, but research on a direct link to pelvic floor problems is limited. If your symptoms feel bigger than menopause alone would explain, ask your doctor whether a thyroid check makes sense.
Physiotherapists do not diagnose hormone conditions or prescribe hormones. Our role is to assess how your pelvic floor is working, treat what we can, and point you to the right medical care when needed.
Practical Ways to Support Your Pelvic Health
There is a lot you can do, and the steps below work well together:
- Train your pelvic floor, because in a Cochrane review of 31 trials, 56% of women with stress urinary incontinence reported being cured after pelvic floor muscle training, compared with 6% who had no treatment (Dumoulin et al., 2018).
- Learn to relax your pelvic floor as well as strengthen it, because a pelvic floor that is too tight can cause pain and urgency, and a physiotherapist can tell which you need.
- Support your bladder and bowel with regular fluids, fiber, and unhurried bathroom trips without straining.
- Ask about vaginal moisturizers and low-dose vaginal estrogen, which are options your doctor can discuss if dryness or urinary symptoms continue (Phillips & Bachmann, 2018).
- Stay active with walking and strength training, which support muscle and bone health.
How Pelvic Floor Physiotherapy Can Help
Pelvic floor physiotherapy starts with a private, one-on-one assessment. We ask about your symptoms, history, and goals, and we look at how your pelvic floor, core, hips, and breathing work together. An internal exam is optional and only done with your consent. Depending on what we find, treatment may include:
- strengthening exercises for leaking or pelvic pressure
- relaxation and breathing techniques for a pelvic floor that is too tight
- manual therapy to ease tense or sore muscles and tissue
- coaching on bladder and bowel habits
- a gradual return to exercise and the activities you enjoy
- education about what is normal and when to see your doctor
This kind of care can help with leaking, urgency, pelvic pain or heaviness, and painful sex. For example, it can help when painful sex has led to involuntary muscle tightening (Phillips & Bachmann, 2018). It works well alongside medical care, such as moisturizers or local estrogen, not in place of it.
A Quick Note for Men
Hormones matter for men too. Urinary leaking and pelvic pain affect men, and changes in testosterone and age may play a role, although this is less well studied. Pelvic floor physiotherapy can help men as well.
Take the Next Step
At Parkway Physiotherapy in Langford, we help people across Victoria and Greater Victoria with pelvic floor concerns at every stage of life. We will listen, assess how your pelvic floor is working, and build a plan of exercise, manual therapy, and education that fits you. If your symptoms need medical attention, we will tell you and work with your doctor. Reach out to book an assessment whenever you are ready.
References
Dumoulin, C., Cacciari, L. P., & Hay-Smith, E. J. C. (2018). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews, 2018(10), Article CD005654. https://www.cochrane.org/evidence/CD005654_pelvic-floor-muscle-training-treating-urinary-incontinence-women
Phillips, N. A., & Bachmann, G. A. (2018). Genitourinary syndrome of menopause: Common problem, effective treatments. Cleveland Clinic Journal of Medicine, 85(5), 390-398. https://www.ccjm.org/content/85/5/390
