For women wanting to thrive through this transformative time with vitality and confidence.
The transition through perimenopause and menopause brings significant changes to pelvic health that many women aren’t prepared for—and rarely warned about. This life stage deserves attention, support, and specialist care, not dismissal as simply “part of aging.”
Declining estrogen profoundly affects your pelvic floor, bladder, bowel, and sexual health. Estrogen receptors are abundant throughout the pelvis, and when levels drop, these tissues become thinner, less elastic, and more fragile. This affects up to 50-70% of post-menopausal women.
Many women experience these changes in silence, believing nothing can be done. The reality is that there are many evidence-based strategies—from pelvic floor rehabilitation to topical estrogen therapy and lifestyle modifications—that can restore comfort, function, and confidence.
Menopause-Related Concerns I Treat:
Bladder & Urinary Changes
- Stress or urge urinary incontinence (new or worsening)
- Urinary frequency, urgency & nocturia
- Recurrent UTIs
- Burning with urination or incomplete emptying
Pelvic Floor Changes:
- Pelvic organ prolapse (new or progressing)
- Pelvic floor weakness or reduced sensation
- Pelvic heaviness or dragging sensation
Vulval & Vaginal Changes:
- Vulval or vaginal burning, itching, or irritation
- Genitourinary syndrome of menopause (GSM)
- Reduced lubrication
Sexual Health Concerns:
- Vaginal dryness & atrophy
- Painful intercourse (dyspareunia)
- Loss of vaginal elasticity
- Reduced sensation, arousal, or libido
- Difficulty with penetration
Bowel Changes:
- Constipation or changes in bowel habits
- Faecal urgency or incontinence
Frequently Asked Questions
When should I seek pelvic health support during menopause?
Don’t wait until symptoms are severe. If you’re in perimenopause and noticing changes, early intervention can prevent further decline. Even years past menopause, it’s never too late to improve your quality of life.
Will pelvic physiotherapy be enough, or do I need hormone therapy?
This depends on your symptoms, their causes and of course, your preferences. For some, pelvic floor rehabilitation and non-hormonal treatments are sufficient. For others, topical vaginal estrogen is transformative. I’ll work alongside your GP or gynaecologist for comprehensive care.
Can you help with painful sex even years after menopause?
Absolutely. With pelvic floor work, desensitization techniques, education about vaginal health, and appropriate use of lubricants or topical hormones, most women can restore comfortable and pleasurable intimacy.
I have prolapse that seems worse since menopause. What can be done?
Pelvic floor physiotherapy can help manage symptoms and improve muscle support. We often look at all the factors that could also be influencing your prolapse. We can also discuss pessary fitting—a non-surgical device that can be life-changing. Conservative management is often very effective.