Midlife, Hormones and Structural Health: Why Pelvic Floor Care Matters More Than Ever by Dr Charlotte Keigwin
Women in their forties and fifties are often proactive about their health. Many engage in weight training, manage nutrition carefully, optimise sleep, and consider bioidentical hormones or HRT. Yet despite this diligence, one key area is frequently overlooked: pelvic floor support.
The pelvic floor is not just a set of muscles involved in continence. It is a structural system that contributes to core stability, sexual function, bladder and bowel control, posture, and mobility. As oestrogen levels decline during perimenopause and menopause, both the tissues and musculature of the pelvic floor begin to change. These changes are biological, measurable, and can have widespread implications for long-term health.
Collagen loss, vascular reduction, and thinning of the urogenital mucosa all begin in midlife. Even in women without prior childbirth trauma, the pelvic floor becomes more vulnerable to weakness and dysfunction. Symptoms such as urgency, frequency, vaginal dryness, reduced sexual sensation, and stress incontinence may appear subtly at first, but often progress over time if not addressed.
Historically, these changes were ignored or dismissed. Until the 1990s, exclusion of females in medical research and clinical trials was not unusual. As a result, conditions disproportionately affecting women, including pelvic floor disorders, genitourinary syndrome of menopause, and urogenital atrophy, were understudied and poorly managed. The current generation of midlife women is among the first to seek proactive, preventative care in these domains, and clinical practice is beginning to reflect this shift.
At Self London, pelvic health is approached as a critical part of intelligent ageing. Consultations for patients experiencing changes to pelvic function are led by a women’s health expert with over twenty years of medical experience. Her approach combines clinical assessment with advanced, non-surgical interventions, including radiofrequency-based vaginal rejuvenation.
One of the most effective treatments offered in this context is EmFemme 360, a radiofrequency therapy designed to support vaginal and vulvar tissue quality. By gently heating the tissues to therapeutic temperatures, EmFemme stimulates fibroblast activity, leading to increased collagen and elastin production. This results in improved hydration, greater elasticity, and enhanced structural resilience of the vaginal lining. It also improves local blood flow, which supports tissue oxygenation and cellular turnover.
Treatment is suitable for women noticing early signs of change, such as dryness, discomfort during intimacy, or subtle bladder symptoms, as well as for those who wish to invest in prevention. The typical protocol involves three short sessions, spaced one to two weeks apart, with no downtime. Maintenance may be recommended annually, depending on tissue condition and symptom profile. Consistent care can prolong the benefits, especially when paired with other forms of intervention such as vaginal oestrogen or physiotherapy.
What distinguishes EmFemme from other treatments is its ability to restore tissue function without hormones or invasive procedures. It is not a cosmetic procedure or a substitute for medical therapy where indicated. Rather, it is a valuable tool in the arsenal of midlife structural support, particularly for women unable or unwilling to use oestrogen, or for whom physiotherapy alone has been insufficient.
The effects of pelvic tissue decline are not limited to the pelvic region. A weakened pelvic floor compromises core strength, reduces balance, and impacts confidence in physical movement. In women who lift weights or engage in athletic training, even subtle pelvic dysfunction can disrupt progress. For this reason, EmFemme is often combined with Pure Impact, a doctor-led protocol designed to activate deep pelvic, gluteal and abdominal musculature using supramaximal electromagnetic stimulation. Together, the treatments support both tissue integrity and muscular control, addressing pelvic health from multiple levels.
While no single intervention can halt the ageing process, targeted treatments such as EmFemme offer a meaningful way to mitigate its effects. They also provide an important psychological benefit. Women who feel supported in their bodies tend to move more, train more confidently, and experience better quality of life. In this sense, pelvic health is not only medical but foundational to overall wellbeing.
Patients considering EmFemme will first undergo a comprehensive consultation to screen for suitability and ensure the treatment is aligned with each woman’s broader health plan. In cases where EmFemme is not appropriate, alternative treatments, such as topical oestrogen, lubricants, or referral to a specialist pelvic floor physiotherapist, are discussed. The goal is to provide accurate information, clear guidance, and a thoughtful roadmap for women who want to preserve their autonomy and comfort into later life.
Crucially, EmFemme should not be seen as a response to crisis, but as part of a shift towards proactive female healthcare. Just as resistance training preserves muscle mass and bone density, radiofrequency-based interventions help preserve tissue tone and function. Neither should be left until symptoms become severe.
The conversation around pelvic health is changing. For too long, women have been expected to accept discomfort, inconvenience or embarrassment as a normal part of ageing. That narrative is no longer acceptable. Evidence-based treatments now exist, and they can be delivered in ways that are discreet, safe, and grounded in medical oversight.
There is no need for gimmicks, dramatic claims, or vague promises. Pelvic health is not a luxury. It is a critical part of female wellbeing, longevity, and physical independence. For the midlife woman who is lifting, training, and investing in her future, support must extend beyond the visible muscles and into the core of structural health.
If you would like to explore EmFemme 360, Pure Impact, or other pelvic health options a consultation provides the best place to begin. Self London leads with medicine, not marketing.
