Menopause and Your Pelvic Floor: What Every Woman Should Know by Dr Charlotte Keigwin
Menopause marks a significant transition in a woman’s life. While much of the public conversation centres around symptoms like hot flushes, mood changes or sleep disruption, there is far less discussion about one of the most functionally important yet overlooked aspects of this life stage: the pelvic floor.
If you are perimenopausal or postmenopausal and have started to notice symptoms such as leaking urine when you cough or sneeze, a sudden urgency to find a toilet, or discomfort during intimacy, these changes may be related to a weakening of your pelvic floor. This group of muscles plays a foundational role in supporting the bladder, uterus and bowel, and is closely linked to continence, sexual function, and core stability.
Throughout the reproductive years, oestrogen helps maintain strength, elasticity and hydration in pelvic tissues. As oestrogen levels decline in perimenopause and menopause, these tissues begin to lose tone. The vaginal walls may become thinner and drier, and the supportive structures around the bladder and uterus less resilient. As a result, the muscles responsible for keeping the bladder closed during moments of increased pressure, such as laughing, exercising or lifting, may not contract as effectively as they once did.
Women often experience a gradual progression of symptoms. At first, it may simply be a sense of urgency or increased frequency when needing to pass urine. Over time, this may develop into episodes of leakage, whether triggered by effort or urgency. For others, the first signs may come as discomfort or a sense of pressure in the vaginal or pelvic area, particularly after prolonged standing or exertion. These symptoms may be further compounded by changes in nerve sensitivity, which can make bladder signals feel stronger, weaker or less predictable.
In some cases, particularly when compounded by childbirth history or chronic straining, menopause may contribute to pelvic organ prolapse. This occurs when the bladder, uterus or rectum begin to descend into the vaginal canal due to weakening of their support structures. Women may describe this as a feeling of heaviness, dragging, or the sensation that something is ‘falling’ internally. Although prolapse requires individual assessment and in some cases referral to a gynaecologist, earlier symptoms can often be managed effectively with conservative treatment.
The first line of support for pelvic floor weakness typically involves regular, targeted muscle exercises, commonly known as Kegels. When performed correctly, these can significantly improve strength, coordination and endurance of the pelvic floor. However, it is important to note that many women are unsure whether they are engaging the correct muscles. Working with a specialist pelvic health physiotherapist is often helpful in ensuring the exercises are being performed properly and consistently.
Local vaginal oestrogen therapy can also play an important role. Applied in cream, pessary or ring form, this low-dose treatment helps improve tissue quality and restore moisture and elasticity in the vaginal and vulval region. Unlike systemic hormone replacement, local oestrogen carries minimal risk and is well tolerated by the majority of women.
Behavioural strategies such as bladder training may also be recommended, particularly where urgency or frequency is a concern. This involves gradually increasing the intervals between urination in order to retrain the bladder’s signalling pathways and improve voluntary control.
At Self London, we also offer non-invasive technology-based treatment to support pelvic tissue health and restore function during and after menopause. EmFemme 360 is one such option. This treatment uses radiofrequency (RF) energy to deliver controlled heat to the vaginal and vulval tissues. The device works by gently warming the deeper layers of tissue, which stimulates new collagen formation, improves circulation, and enhances hydration. Over time, this process contributes to increased tissue elasticity, improved strength and greater structural support.
The EmFemme 360 handpiece is designed to deliver uniform energy through a rotating 360-degree probe. Treatments are carried out in-clinic, require no anaesthetic, and typically last less than fifteen minutes. Most patients describe the sensation as a gentle internal warmth, with no discomfort and no downtime. You can return to work or daily activities immediately after your session, although we usually advise avoiding intercourse or the use of tampons for forty-eight hours afterwards to allow tissues to settle.
A typical course involves three to four sessions spaced one to two weeks apart, with maintenance treatments recommended every twelve to eighteen months depending on individual response. Some women notice an improvement in symptoms, such as bladder control or vaginal dryness, within a few weeks, while others observe more gradual results over the course of treatment. EmFemme is not intended as a replacement for pelvic floor exercises or vaginal oestrogen therapy, but rather as an adjunct to support tissue remodelling and enhance outcomes.
This treatment is particularly suitable for women who are noticing early signs of pelvic floor decline but wish to avoid more invasive or hormone-based interventions. It may also be helpful for those who have completed their family, experienced changes following childbirth, or wish to maintain pelvic strength as part of a broader longevity strategy. At Self London, all EmFemme patients undergo a consultation with our women’s health specialist prior to treatment, to ensure that the therapy is appropriate and that any other contributing factors are properly assessed.
One of the strengths of EmFemme is that it supports the foundational integrity of the pelvic floor by improving tissue tone from within. By stimulating collagen production and improving blood flow to the area, it contributes to stronger, more resilient tissue over time. While not a solution for advanced prolapse or significant incontinence, it can offer meaningful support for those in the early stages of pelvic floor weakening, or who simply wish to be proactive in managing the effects of hormonal change on their body.
Alongside targeted treatment, there are lifestyle strategies that can help preserve and protect pelvic health during menopause. Maintaining a healthy weight is important, as excess abdominal pressure can increase the strain on pelvic structures. Staying well hydrated is essential, although it is often helpful to reduce bladder irritants such as caffeine, alcohol and acidic drinks if frequency or urgency is an issue. Avoiding straining during bowel movements or heavy lifting can also help prevent further stress on the pelvic floor.
It is important to remember that pelvic changes in menopause are not just physical. They can affect self-confidence, relationships and overall quality of life. Many women feel reluctant to talk about these symptoms, or fear that they are simply part of getting older. At Self London, we take a compassionate, medical approach to these issues, recognising that pelvic health is a core part of whole-person wellbeing. Whether you are dealing with bladder symptoms, sexual discomfort or simply a sense that something is not as it used to be, there are options, and you do not need to navigate this alone.
If you are experiencing symptoms that affect your quality of life, a consultation is the best place to begin. With over twenty years of experience in women’s health and pelvic medicine, Dr Charlotte Keigwin, offers an individualised, thorough approach to diagnosis and treatment. EmFemme 360 is one of the many tools available at Self London to support tissue health and restore function, but it is always offered as part of a wider plan that prioritises safety, personalisation and long-term results.
Menopause does not mean giving up on strength, comfort or confidence. With the right support, it is possible to manage these changes and feel at ease in your body again. If you are ready to take the next step, we invite you to book a consultation and explore whether EmFemme 360 could be part of your personalised plan.
