Pelvic Floor Health and its Link With Menopause

Pelvic Floor Health and its Link With Menopause

We hear from Miss Rhiannon Bray of New Victoria Hospital

Over 60% of UK women have at least one symptom of poor pelvic health, and of those, 69% of sufferers have not spoken to anyone in the NHS about the issue either due to embarrassment or the assumption that their symptoms are normal. Whilst the menopause can bring on a whole host of symptoms such as hot flashes, mood swings, and sleepless nights around the ages of 40s and 50s, its effects can dramatically range from person to person and whilst at least 1 in 2 women will be impacted by this little known symptom, it remains largely under discussed in the public realm today.

As part of New Victoria Hospital’s Women’s Health focus, the hospital took part in the latest Breaking the Silence panel discussion series based at Allbright in Mayfair to offer real insight into some conditions women face but may have barriers to getting accurate information or diagnosis. In one of the panel discussions, Urogynaecologist and Pelvic Floor specialist Miss Rhiannon Bray got together with writer and menopause advocate (Elizabeth Joseph also known on social media as @TheMenopauseGuineaPig) to discuss the little known common change of pelvic floor health and how it can have an impact on your life.

The pelvic floor might not be something you think about every day, but it plays a big role in your overall health and wellbeing. This undervalued group of muscles and tissues form a hammock-like structure at the bottom of your pelvis, providing a supportive foundation that holds up the bladder, uterus and rectum.

Wondering what perimenopause has to do with all of this? Well, the female sex hormone oestrogen can hugely influence the strength of your pelvic floor, and as levels tend to decline during these years, it can weaken its function – bringing on a whole host of new health issues.

The panel discussion delved into some of the surprising symptoms a weak pelvic floor can cause during the perimenopausal years:

It can be harder to achieve an orgasm

Perimenopause can last anywhere from 2 to 10 years, and although every woman’s symptoms are different, it can have a big effect on our ability to find sex pleasurable during that time.

When perimenopause hits, the body is working through major hormonal changes – particularly a decline in oestrogen levels – which can have a numbing effect on our natural arousal.

Leading Consultant Urogynaecologist Miss Rhiannon Bray from New Victoria Hospital explains: “Oestrogen influences the delicate epithelial tissue in the vagina. So when there are lower levels of this hormone in the body during the perimenopause, the tissues can become thinner and more delicate, leading to dryness, soreness and discomfort during sex.”

Bray further elaborates on why exactly this happens: “Oestrogen affects blood flow to the vulva, vagina, and pelvic floor, so when perimenopause is in flow, women can find their orgasmic potential is suddenly reduced.”

If that wasn’t frustrating enough to deal with, there can be additional symptoms that can compound the issue further. “We know that perimenopause can cause heightened stress, poor sleep, dryness and soreness,” says Bray. “So if these symptoms are going on at the same time as a natural decline in our libido, it can further reduce our enjoyment of sex.”

It can fuel bladder incontinence issues

Ever been midway through a yoga class and struggled to hold in your pee? It’s a common issue in midlife, yet many women don’t realise that the perimenopausal weakening of the pelvic floor could be fuelling this new issue.

“Oestrogen helps maintain the strength and elasticity of the muscles and tissues that support the bladder and urethra,” explains Bray. “But as oestrogen levels drop off naturally, these tissues may weaken, increasing the risk of urinary incontinence.”

When our pelvic floor strength isn’t working at its maximum capacity, the bladder sphincter has less support, leading to stress incontinence issues. When this happens, urine can leak out under pressure, such as when you’re coughing, laughing or exercising.

It can cause a higher chance of UTIs

It can be frustrating to feel a burning sensation when you pee, and as UTIs tend to happen more often during perimenopause, women can struggle to keep this health issue at bay.

UTIs are uncomfortable bacterial infections that occur anywhere within the urinary tract, which includes the kidneys, ureters, bladder and urethra.

So why exactly does it happen more during perimenopause? “Because lower oestrogen levels cause a thinning of the skin in the vulva and vagina, it can leave us wide open for recurrent UTIs,” says Bray.

“Suddenly, it’s easier for bacteria to then travel into the bladder. And as UTIs will appear quite early in the perimenopausal journey, lots of women might not necessarily relate the two issues together.”

What can women do to find relief from perimenopause pelvic floor issues?

Miss Rhiannon Bray says, “Pelvic floor issues are typically diagnosed with a vaginal examination to get a good understanding of what’s happening day-to-day,” explains Bray. “In women who are premenopausal, symptoms can often be worse in the second half of their cycle when oestrogen is rising, so we’ll tend to see what’s going on during that time.”

Treating a weak pelvic floor typically involves a combination of lifestyle changes, exercises, and in some cases, medical interventions. “For prolapse, where organs bulge or protrude into the vaginal canal, there’s really good evidence that four months of pelvic floor exercises with a physiotherapist can improve the symptoms,” notes Bray. “There are also pessaries available that can lift and support the vagina, and help with prolapse issues too.”

Maintaining a healthy weight, avoiding constipation (which can strain pelvic floor muscles), and practising good posture can all help support pelvic floor health. So too can bladder training, which involves gradually increasing the time between bathroom trips to improve bladder control and reduce urinary urgency.

Bray adds that monitoring your liquid intake can have a huge impact on how the bladder functions too. “A higher concentrated urine can irritate the bladder more,” reveals Bray. “Women often decrease the amount they are drinking so they can reduce the risk of incontinence, but ironically that can make the issue worse.”

In more severe cases, surgery can help to restore function, but Bray stresses this is a last resort and is only recommended if the pelvic floor doesn’t respond to lifestyle interventions and other treatments.

Women can struggle with a variety of symptoms during perimenopause, but Bray stresses that help is always available. “Speaking to a qualified health professional with specialist knowledge in menopause can be a helpful first step in exploring treatment options,” she says.

“The idea that incontinence is normal is a misconception. It’s common, but it’s not normal. So if women are suffering with this or any other issues, they should know that there are options and help available.”


Miss Rhiannon Bray recently appeared on a ‘Breaking The Silence Panel Discussion: Menopause and Pelvic Health’ alongside writer and menopause advocate Elizabeth Joseph. To watch the full discussion, hosted by New Victoria Hospital, an independent hospital based in Surrey, visit link here.