Pelvic Health and Perimenopause

February 01, 2025 Kate Hines

This week we talk with Kate Hines about pelvic health and perimenopause (You First Physio, Femhealth).

A pelvic and musculoskeletal physiotherapist based in Ōtautahi, Christchurch, Kate is passionate about helping women through all stages of life — from pregnancy and postnatal recovery to peri- and post-menopause. She finds supporting women with pelvic pain especially rewarding, as even small improvements can make a significant difference to quality of life.

During Perimenopause, You Might Notice:

Aches and pains in muscles and joints, particularly the hips, lower back, and pelvis
Changes in bladder and bowel function, such as struggling to “hold on” or not making it to the toilet in time
Leaking when coughing, sneezing, or laughing
A feeling of heaviness or bulging in the vaginal area
A decrease in libido or discomfort during intercourse
Vaginal dryness

If you’re experiencing any of these symptoms, read on for Kate’s expert advice.

The advice below is general advice. For any specific or tailored advice relevant to your health conditions, please talk to your health professional.

Why Do We Experience Changes in Pelvic Health During Perimenopause?

This is largely due to declining levels of oestrogen and progesterone. Oestrogen supports the growth, development, and strength of tissues throughout the body, while progesterone helps regulate that growth.

As these hormones decline, women may experience increased joint pain, stiffness, reduced muscle strength, and higher risk of musculoskeletal issues. The pelvic floor muscles and their connective tissues may thin or weaken, losing responsiveness and strength, which can lead to new or worsening pelvic health concerns.

What Pelvic Health Treatments or Exercises Are Commonly Recommended?

Treatment depends on your individual symptoms, but pelvic floor exercises (Kegels) are often a cornerstone of care.

To perform an effective pelvic floor contraction:

Imagine stopping yourself from passing wind and urine at the same time.
Hold the contraction for a few seconds, then fully relax.
Aim for 10 repetitions of 10-second holds and 10 quick contractions.

If you’re new to pelvic floor exercises, start where you are — even 5 reps of 2-second holds is a great beginning.

A pelvic health physiotherapist can ensure you’re engaging the correct muscles without compensating elsewhere.

Other treatments may include:

Stretching or breathing exercises to release tension
Strengthening exercises for hips, glutes, and core

Can Lifestyle Changes Support Pelvic Health During Perimenopause?

Absolutely. Helpful strategies include:

Diet: Adequate hydration and fibre intake to support bowel health, which in turn supports bladder function.
Hydration: Sip water throughout the day. Pale straw-coloured urine is a good hydration indicator.
Exercise: Resistance training is essential to counter muscle and bone loss associated with hormonal change.

When Should Someone See a Pelvic Health Physiotherapist?

If you experience heaviness, bulging, pelvic pain, bladder or bowel changes, leaking, or discomfort during intercourse — or if you’re simply curious about pelvic health changes — it’s a good idea to seek professional support.

What Happens During a Pelvic Health Assessment?

Your first session begins with a detailed discussion of symptoms, medical history, pregnancies, deliveries, surgeries, and bladder, bowel, and sexual function.

If appropriate and with your consent, assessment may include:

A vaginal examination (gold standard for pelvic floor assessment)
Or a trans-abdominal ultrasound to assess muscle function externally

This allows your physiotherapist to create a tailored treatment plan, which may include exercises, education, lifestyle changes, and referrals if required.

Advice for Women Hesitant to Seek Pelvic Health Support

Reach out for a conversation. Pelvic health issues are common, treatable, and nothing to be embarrassed about. Talking openly helps break down stigma and empowers women to get the care they deserve.