How hormonal shifts in perimenopause impact your pelvic floor—and what you can do about it
Are you noticing more bladder leaks when you laugh? Feeling a little less “you” in your core? Experiencing pelvic pressure or dryness that wasn’t there before?
You’re not alone. And it’s not just in your head. Hormonal shifts during midlife—especially estrogen loss in perimenopause—can trigger real changes in your pelvic health. But no one tells you that until you’re Googling “pee when I sneeze perimenopause.”
At Peli Health, we’re here to break it down. Because understanding the connection between your hormones and your pelvic floor is the first step toward feeling better, stronger, and more in control.
What Is Pelvic Floor Dysfunction?
Your pelvic floor is a powerful group of muscles that sling like a hammock across the base of your pelvis. They support your bladder, uterus, and bowels, and play a key role in urination, bowel movements, and sexual function.
When those muscles aren’t working properly—either too weak, too tight, or lacking coordination—it’s called pelvic floor dysfunction. That can lead to:
- Bladder leaks (incontinence)
- Constipation
- Pelvic pain or heaviness
- Painful sex
- Reduced sensation or orgasm difficulty
These symptoms are common but not normal. And hormonal changes in perimenopause can make them worse.
The Hormone Connection: Why It’s Not Just About Muscles
As estrogen levels dip in perimenopause (typically in your late 30s to early 50s), the tissues of the pelvic floor start to change. Collagen production declines, circulation slows, and muscle mass drops—yep, even in your vagina.
These changes can lead to:
- Weaker pelvic floor muscles
- Thinner, drier vaginal tissue
- Increased risk of prolapse
- Frequent UTIs or vaginal infections
- Decreased sexual arousal and painful sex
Source: Nuffield Health – Menopause and Pelvic Health
Hormonal changes also reduce blood flow and nerve sensitivity, which can mean:
- Less sensation during sex
- Difficulty orgasming
- Increased urgency or frequency of urination
Basically, estrogen is your pelvic floor’s bestie. And when it starts ghosting, things get weird fast.
It’s Not Just You—And It’s Not Hopeless
Most women don’t get real support for these symptoms. In fact, only 25% receive pelvic floor care postpartum, and even fewer during perimenopause.
So what can you do?
1. Find a Provider Who Gets It
Many women are told their symptoms are just “normal.” Don’t settle. Look for a pelvic health PT or a provider trained in women’s midlife care.
Source: The Origin Way – Perimenopause and Your Pelvic Floor
2. Strengthen (or Relax!) Your Pelvic Floor
Pelvic floor therapy is not just Kegels. Sometimes muscles are too tight. A PT can guide you through exercises, breathwork, and movement to restore function.
3. Explore Hormone Therapy Options
Topical estrogen or full HRT may help rebuild tissue integrity and reduce leaks or pain.
4. Take a Whole-Body Approach
Your pelvic floor is connected to your core, nervous system, and even how you breathe. Programs like Peli Health combine:
- Movement & mobility work
- Core & breath strategies
- Stress and hormone support
What You Can Do Today
- Track your symptoms. Note changes in bladder control, intimacy, strength, or sensation.
- Listen to our Pelvic Power Hour Podcast and take control of your health! It’s a free monthly session packed with real talk, expert advice, and tools you can use immediately. Check out our latest with Cat Reisen, Certified Master Trainer and Menopause Coach where she dives into performance, hormonal shifts and perimenopause.
