The Overlooked Muscle Group Every Active Midlife Woman Should Be Training by Dr Charlotte Keigwin
For women in their forties and fifties who prioritise strength, structure and long-term health, few conversations feel more out of sync than the one around pelvic floor care. Despite lifting heavier, eating better, and often taking a more proactive approach to hormone health than their mothers ever could, many still ignore a crucial part of the body that underpins all of it: the pelvic floor.
The pelvic floor is a complex, hammock-like group of muscles that supports the bladder, uterus and rectum. It plays a central role in continence, core stability and even sexual function. Yet despite its structural importance, it is rarely given serious attention until something goes wrong. Women who lift weights may train glutes, lats and core with precision, but overlook the impact of hormonal changes on tissue integrity and muscle responsiveness deep in the pelvis.
This becomes particularly relevant during the perimenopause and menopause transition. As oestrogen levels begin to fall, the tissues of the vaginal wall, urethra and surrounding musculature start to thin. Collagen production declines, blood flow reduces, and the pelvic floor loses some of the elasticity and tone that supported earlier decades of movement and physical resilience.
Oestrogen has a profound trophic effect on the urogenital tract. During reproductive years, it helps maintain the thickness and hydration of vaginal and periurethral tissues. But as hormone levels drop, these tissues become more fragile, less lubricated and more prone to inflammation. Many women begin to notice subtle changes: a feeling of heaviness in the pelvis, a sudden need to find a toilet during a workout, or discomfort with exercises that never used to cause issues.
These symptoms are often early signs of functional decline. Left unaddressed, they can progress into more persistent issues such as bladder leakage, vaginal dryness, or even pelvic organ prolapse. Yet because these changes are rarely visible, they are easily dismissed until they interfere with day-to-day activities or physical performance.
Pelvic floor decline can also influence how effectively women recruit their core. The fascial and muscular networks that anchor the pelvic region are tied to breath, posture and intra-abdominal pressure. When these are compromised, form can suffer. So can confidence. Women may begin to feel more vulnerable during impact activities such as running or jumping. Some avoid high-intensity training altogether. Others push through, unsure whether their symptoms are normal, or a sign of something more.
There is also a psychological cost. Many active, high-functioning women do not expect to face issues typically associated with older age. When symptoms arise, whether it is urgency, reduced sensation, or a loss of support, they often feel reluctant to speak up. This silence is partly cultural, partly systemic. Conversations about longevity and strength rarely include pelvic health. The result is a knowledge gap that leaves many women without a roadmap.
It is a frustrating paradox. The same women who monitor muscle mass, track macros or supplement creatine are left in the dark when it comes to vaginal tissue support. Pelvic floor care is framed as rehabilitation or recovery, not as prevention or performance. And yet, the two are deeply intertwined.
At Self London, we are seeing a shift. Women are asking better questions. They want to understand how their anatomy is changing, what role hormones play, and how to protect their bodies long-term. In this context, devices like EmFemme 360 offer more than just symptom relief; they offer a way to preserve function and improve comfort without relying on invasive procedures or synthetic hormones.
EmFemme is a non-surgical, radiofrequency-based treatment that delivers controlled thermal energy to the vaginal and vulvar tissues. The technology works by gently heating the deeper layers of tissue, stimulating fibroblasts, increasing local circulation and triggering collagen and elastin synthesis. The result is improved tissue hydration, elasticity and tone. In many cases, this leads to greater comfort during intimacy, improved bladder control, and enhanced confidence with physical activity.
One of the reasons EmFemme stands out is its use of uniform volumetric heating. Unlike some lasers or older radiofrequency treatments that deliver energy in pulses or ablate the surface, EmFemme heats the full circumference of tissue evenly and deeply. This allows for collagen remodelling at a depth that genuinely supports structural repair, while still being comfortable and non-invasive. The sensation during treatment is warm but not painful, and no anaesthesia is required.
Sessions typically last between 10 to 30 minutes and can be tailored to suit individual needs. Most women begin with a course of three treatments, spaced one to two weeks apart. Some begin to notice subtle improvements within days: increased moisture, reduced urgency or a greater sense of tone. Full tissue remodelling continues for several weeks, with benefits typically peaking around three months. Results can be maintained with top-up sessions depending on the individual’s hormonal profile, symptoms and goals.
It is important to note that EmFemme is not intended to replace pelvic floor physiotherapy or hormonal support. It sits alongside these interventions as part of a broader toolkit. What makes it valuable is the way it targets tissue quality directly, working below the surface to reverse the microstructural changes that oestrogen loss creates.
There is also a case to be made for combining EmFemme with strength-focused treatments like Pure Impact, which we also offer at Self London. While EmFemme targets soft tissue and mucosal integrity, Pure Impact focuses on muscle mass and strength, particularly the glutes, hamstrings and deep core. Together, these treatments address both layers of pelvic support: the structural and the functional. This is especially relevant for women who strength train but want to maintain pelvic integrity as they age.
We are also beginning to see a new type of patient: women who are not experiencing severe symptoms, but who want to stay ahead of change. They may be entering perimenopause, noticing slight dryness or changes in bladder control, or simply want to optimise tissue health before it becomes a problem. These are not vanity concerns. They are functional concerns, rooted in the desire to keep moving, lifting and living well without interruption.
For this group, early intervention makes a significant difference. Tissues with higher collagen density and better vascularity respond more favourably to other treatments, including physiotherapy or hormone therapy. By intervening before the integrity of the tissue has broken down significantly, it is possible to preserve function and avoid more complex interventions later on.
Of course, not every woman is a candidate for radiofrequency treatment. Those with certain medical conditions, implanted devices or unmanaged gynaecological issues should be evaluated thoroughly. At Self London, all EmFemme patients are seen by our women’s health doctor prior to starting treatment. With over twenty years of clinical experience, she provides a detailed consultation and medical screening to ensure that every treatment is both safe and appropriate.
This clinical lens is essential. Devices like EmFemme have become popular in some aesthetic settings, but results depend heavily on protocol, training and correct patient selection. We do not treat based on trend or superficial marketing. We treat based on physiology, pathology and long-term planning. That means tailoring treatment to each woman’s hormonal stage, tissue health and lifestyle goals, and avoiding over-treatment in those who do not need it.
We also make it clear that EmFemme is not a replacement for pelvic floor exercises. In fact, we encourage all patients to continue physiotherapy where appropriate. What EmFemme does is improve the internal environment in which those muscles operate. Stronger tissue and better vascularity create better responsiveness. And in many cases, women who had been struggling to feel their pelvic floor muscles during Kegels report increased sensation and control after treatment.
There is no single formula for pelvic health. But for women who want to maintain control, protect structure, and continue moving through life with strength, EmFemme offers a smart, evidence-based tool. It is not flashy or faddish. It is medical technology applied with clinical intelligence, and when used as part of a strategic approach, it can be transformative.
If you are noticing early signs of change, or simply want to stay ahead of decline, we invite you to book a consultation with our experienced women’s health specialist at Self London. We offer individualised advice, evidence-led treatment plans, and care that is rooted in medical integrity.
Pelvic floor care is not optional. It is foundational. And it is time we started treating it that way.
