Pelvic Floor, Pilates & Menopause: Let’s Talk About What No One Warned Us About

Pelvic Floor, Pilates & Menopause: Let’s Talk About What No One Warned Us About

If you’re in your 40s or 50s and thinking, “Why does my body feel so different lately?” you are definitely not alone.

Maybe you’re noticing bladder leaks, pelvic heaviness, discomfort during sex, or that your core just doesn’t feel as supportive as it used to. And no one really mentioned that this might happen during perimenopause or menopause, did they?

Let’s talk about it — without shame, without scary language, and with a lot of hope.

I have lived with pelvic organ prolapse myself for 7 years. When I was diagnosed, I felt confused, scared, and honestly a bit betrayed by my body. I kept thinking, - how has this happened? Can I still move? Did I cause this?

As a result I ended up retraining as a Pilates teacher & Reiki therapist, currently also training as a Menopause Movement Coach, and I’ve been down a long rabbit hole of research, pelvic floor training courses for movement professionals, and pelvic-floor podcasts. And what I’ve learned is this: pelvic floor problems are common in midlife, but they are not something you just have to put up with.

Why Do Pelvic Floor Problems Show Up Around Menopause?

Short answer? Hormones — plus life.

Oestrogen helps keep our pelvic tissues healthy, springy, and well hydrated. It supports the bladder, vaginal tissue, muscles, and connective tissue. As oestrogen starts to decline during perimenopause and menopause, those tissues can become thinner and less resilient.

So if you’ve had:

• pregnancies or births

• tearing or episiotomies

• years of heavy lifting

• constipation or IBS

• chronic coughing

• high stress (and honestly, who hasn’t?)

…menopause can be the point where your body says, “Hey, I need a bit more support down here.”

And you know what? That’s not a failure — it’s information.

First Things First: What Even Is the Pelvic Floor?

Despite the name, it’s not really a “floor” or an it! The pelvic floor is a dynamic hammock of muscles, fascia, and nerves, much like a soft, stretchy trampoline inside your pelvis.

It supports your bladder, bowel, and uterus, and we want it to move spontaneously every time you breathe, laugh, lift, sneeze or walk. It also works closely with the rest of your body, especially:

• your breathing diaphragm

• your deep tummy muscles

• your hips and glutes

• your feet and posture

• even your jaw and nervous system (yes, really)

So when we talk about pelvic health, we’re really talking about how your whole body is working together, not just one set of muscles. Even tightness in the shoulder can tighten your fascia, and therefore affect your pelvic floor.

So Why Do Problems Happen?

Usually, it’s not one big dramatic cause. It’s more like a slow build-up of little things over time, such as:

• childbirth, tears or surgery

• hormonal changes

• poor breathing habits

• chronic tension or stress

• sitting a lot

• lifting without support

• connective tissue traits like hypermobility

• chronic constipation or irritable bowel syndrome

Then menopause comes along and slightly reduces the strength and elasticity of tissues… and suddenly symptoms appear.

It can feel like it’s come out of nowhere, but your body has probably been coping quietly for years.

Let’s Clear Up Something About Prolapse

Prolapse does not mean your organs are about to fall out of your body. That old description has terrified generations of women for no good reason.

These days, prolapse is described as excessive movement of pelvic tissues. It can involve the bladder, bowel, uterus, or a combination, and it’s graded from mild to more advanced.

Many women live full, active lives with prolapse — hiking, dancing, lifting weights — once they learn how to support their bodies properly.

Symptoms That Are Common — But Not “Normal”

You might recognise some of these:

• heaviness or dragging

• pressure or bulging

• lower back or pelvic pain

• needing to wee all the time (or not being able to fully empty)

• constipation

• pain during sex

• leaking when you cough, sneeze, or exercise

• feeling tight, tense, or disconnected in your pelvis

These symptoms are common in midlife, but they are not something you just have to accept. Help exists, and improvement is very possible.

A Quick Word About Vaginal Atrophy and GSM

Low oestrogen can also cause what’s now called Genitourinary Syndrome of Menopause (GSM), which includes:

• vaginal dryness

• irritation

• painful sex

• frequent UTIs

• fragile tissue

This often goes co-exists with prolapse and bladder symptoms. The good news? Local vaginal oestrogen is very safe and very effective for many women and can make a huge difference to comfort and tissue health.

If no one has mentioned this to you, please know you’re not alone — it’s still wildly under-treated.

What Actually Helps (And It’s Not Just Doing Kegels)

Pelvic health in midlife is about supporting your whole system, not hammering one muscle group. We want to relax and release the pelvic floor muscles before we start to stabilise and strengthen them.

Here’s what really makes a difference:

🌬️ Breathing (yes, really)

Your pelvic floor moves with your breath. If your breathing is shallow or held, your pelvic floor can’t work properly either.

🧠 Awareness Before Strength

A lot of women have pelvic floors that are already too tense. Learning to relax and feel the area often comes before strengthening. Look at yourself in the mirror and touch the area of your pelvis, vagina etc - learn what is your normal.

⚖️ Learning How to Handle Pressure

We can’t avoid pressure — we need it to move and live. The trick is learning how to breathe and move so pressure doesn’t overload the pelvic floor.

🌀 Restore Tissue Bounce

Hydration, gentle movement, and fascia work all help tissues stay resilient.

🚫 Stop “Just in Case” Wees

Frequent preventive trips to the toilet actually reduce bladder capacity over time.

👣 Posture and Feet Matter

Tight footwear and stiff feet can affect pelvic tension through the fascia network.

🚶‍♀️ Regular, Gentle Movement

Walking, hip circles, dancing in the kitchen — it all helps circulation and tissue health. 

🏋️‍♀️ Load Gradually

Strength training is brilliant for bones and confidence — it just needs correct breathing and progression.

🚽 Better Bathroom Habits

Leaning forward, lifting the feet (use a stool or a bin!), no endless sitting on the loo and not straining protects both your pelvic floor and your bowels.

🧘 Calming the Nervous System

Stress tightens the pelvic floor just like it tightens your shoulders. Relaxation is part of pelvic health.

🍓Better Eating Habits

Reduce bladder irritants such as sugar and alcohol. Improve gut health - look into prebiotics and probiotics. Drink enough water (counterintuitive but vital).

🤲 Getting the Right Support

Women’s health physios and pelvic-aware movement teachers can be absolute game-changers.

So… Should You Be Doing Kegels?

Maybe. Maybe not.

For some women, Kegels help. For many others — especially those with prolapse or pelvic pain — they can actually make things worse.

About half of women with prolapse have pelvic floors that are too tight rather than too weak. Which means relaxation, coordination, and whole-body release and movement are far more helpful than endless squeezing.

This is why there’s no one-size-fits-all solution.

Why Pilates Can Be So Helpful in Menopause

Pilates works beautifully for women in midlife because it focuses on:

• breath and movement together

• posture and alignment

• hip and glute strength

• gentle core support

• nervous system regulation

Instead of isolating the pelvic floor, Pilates helps it do its job naturally as part of the whole body — which is exactly what we want.

A Little Hope From Personal Experience

There was a time when I struggled to walk on gentle hills because of pelvic pain and pressure. Last summer, I climbed Scafell Pike ^💪.

Bodies change, yes — but they can also adapt, strengthen, and heal in ways that might surprise you.

It is not too late. And you are not broken.

How I Can Support You

If you’re navigating perimenopause, menopause, or post-menopause and want kind, informed support, I offer:

• Pilates classes for all levels

• Private 1:1 sessions

• Reiki to support stress and nervous system health

• Pelvic floor workshops coming soon

You can also follow me on Facebook and Instagram for updates, tips, and upcoming events.

You deserve to understand your body, feel confident moving again, and know that you’re not facing this stage of life on your own.