Perimenopause and your pelvic floor: what’s really happening

What is perimenopause, and when does it start?

Perimenopause is the transition period leading up to the menopause – the point at which your periods stop entirely. It can begin anywhere from your late thirties to your early fifties, and it can last for several years. During this time, oestrogen levels fluctuate and gradually decline, and this hormonal shift affects far more than your cycle: it affects the tissues of your pelvic floor.

What oestrogen does for your pelvic floor

Oestrogen plays a crucial role in maintaining the strength, elasticity and thickness of the muscles and connective tissues throughout your body, including those of the pelvic floor. When oestrogen levels begin to fall, these tissues can become thinner, drier and less elastic. The muscles may weaken. The connective tissue that supports the bladder, bowel and uterus loses some of its integrity.

The result is that women who never had pelvic floor problems before may begin to notice new symptoms during perimenopause. And women who had mild symptoms after childbirth, or who managed things reasonably well for years, can find that those symptoms suddenly get worse.

What symptoms should I look out for?

The pelvic floor changes of perimenopause can show up in several ways:

• Leaking when you cough, sneeze, laugh or exercise – stress incontinence.
• A sudden strong urge to urinate that’s difficult to defer – urgency incontinence.
• Needing to go to the toilet more frequently, including at night.
• A feeling of heaviness or pressure in the pelvis.
• Reduced sensation or discomfort during sex.
• Lower back pain or pelvic instability.

Many women assume these symptoms are simply an inevitable part of getting older. Whether they are hormonal changes or wear and tear, these changes are treatable.

Why manual pelvic floor exercises may not be enough

The standard advice for pelvic floor symptoms is to do pelvic floor exercises (Kegels). And for some women, particularly those who catch things early and do them consistently and correctly, Kegels can help.

But the pelvic floor has three layers of muscle, and manual exercises primarily target the outer and middle layers. The deep layer – the one most affected by the connective tissue changes of perimenopause, and the one most responsible for bladder control and organ support – is almost impossible to reach through voluntary exercise alone.

This is why many perimenopausal and menopausal women find that even when they do their exercises faithfully, the results are disappointing. We hear this in the clinic every day.

What BetterPelvi does differently

BetterPelvi uses rPMS technology to generate up to 12,500 targeted pelvic floor contractions in a single 28-minute session – reaching all three layers of muscle simultaneously, including the deep layer that Kegels simply can’t get to.

You sit fully clothed in the BetterPelvi chair. There are no probes, no wires, no discomfort. Most people feel a gentle pulsing sensation for 28 minutes while the technology does the work.

For perimenopausal and menopausal women specifically, BetterPelvi works directly on the muscle tissue, which means it doesn’t rely on hormonal support to be effective. It produces results through mechanical stimulation rather than hormonal pathways, which makes it particularly well suited to this stage of life.

Many of our patients in this group see significant improvement in urgency, frequency and leaks within four to six weeks of regular sessions.

“I can’t believe it! I’m feeling better every week – it’s like going back in time.”
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What about HRT?

Hormone replacement therapy can help with many symptoms of perimenopause, including some pelvic floor changes, particularly vaginal dryness and discomfort. If you’re considering HRT or are already using it, BetterPelvi works well alongside it.

But HRT alone won’t rebuild weakened pelvic floor muscles. The two approaches address different aspects of the problem, and for many women, combining them produces better results than either alone.

You don’t have to manage this on your own

Perimenopause is a significant transition, and its effects on the pelvic floor are real, common and, importantly, treatable. The fact that most women don’t talk about these symptoms doesn’t mean they’re not experiencing them. It just means too many women are quietly managing something they don’t have to manage at all.

A 60-minute consultation at Signature Health, Blakemere Village, is the place to start. We’ll talk through what you’re experiencing and answer your questions honestly, before a non-invasive pelvic floor strength test and the taster session of the BetterPelvi chair so you can see exactly what treatment involves before making any decisions.