She's Got Issues "Your Pelvic Floor in Perimenopause"
- Jennifer Kinder PT, DSc.
- Oct 7, 2023
- 4 min read
Your Pelvic Floor In Perimenopause
“Something just isn’t right down there….” As a pelvic health physical therapist I am often the first provider a woman shares this vulnerable statement to. The rollercoaster of hormones we
experience during peri/menopause can pull a number on our emotions, pelvic and overall
health. Vaginal dryness? Painful sex? Incontinence? Prolapse? Constipation? The good news is there are lifestyle habits we can implement to improve the experience. Often women are already doing some of these and simply need to modify how they are doing them to actualize the reward!
#1: The Kegel
It is known that about half of women do Kegels incorrectly. When contracting your pelvic floor you want to make sure that on exhale you are engaging the muscle together and UP. How do you know if you are doing this? A hand mirror is an excellent biofeedback tool to see if your perineum (that region between your vagina and anus) is lifting and supporting your intraabdominal pressure (and your organs) the correct way. More on this in number 2.
#2: Are you a chest breather?
How we breath affects our pelvic floor. Fascinating right?! Place one hand on your chest and
another on your belly. Inhale, which hand rose? Did one rise at all? What happened when you exhaled? It is amazing to see the different breathing styles we have adopted throughout our life. The best-balanced breathing pattern is on inhale: ⅓ chest, ⅓ lateral rib cage, and ⅓ belly filling up. When you inhale, if your chest rises first vs your belly, I encourage you to practice some belly breathing: inhale into your belly and on exhale just let the belly fall. When we hold our breath or “suck in” air into our chest, this can affect the pressure we are putting on our pelvic floor contributing to incontinence (leaking of urine with cough, sneeze, laugh, or exercise), painful sex, constipation, and prolapse. Another benefit of practicing belly breathing? It can often decrease anxiety. A win-win!
#3: The Regel (yes, I made this up- I hope you never forget it!)
I would say about 75% of the patients that walk through my door have too tight of a pelvic floor. This is a problem; think about this… if you were to clench your fist as tight as you can and hold it in that position repeatedly throughout your day (and life) how strong do you think it would be once you tried to open it? Upon opening your hand it would be weak, tingly, and painful! When muscles are held in a tightened position over time, they can become shortened and weakened; unable to go through their normal range of motion, decreasing their strength. Short and weak pelvic floor muscles are unable to hold back urine/feces/gas/organs and contribute to incontinence, prolapse, constipation, and painful sex. Knowing how to RELAX your pelvic floor is just as important as knowing how to contract your pelvic floor. Let’s do it!
-Inhale into your belly and think of that perineum region between your sits bones.
-On exhale, think of your pelvic floor muscles and perineum relaxing and gently lengthening. A helpful cue is thinking of “warm melted cheese” between your sits bones while allowing the muscles to relax. Note you are not bearing down or pushing! This is a mere relaxation, like stretching your hamstring muscle, only it's your pelvic floor. Happy baby and child’s poses are great stretches for your pelvic floor. I often get emails from my patients who experience pain with sex “we had sex and it wasn’t painful! All I kept thinking was ‘warm melted cheese’!”
#4 Physical activity
Remember when you used to go to the gym for 2 hrs.? Or a daily yoga
class? Insert career, kids, life- where did the time go? For women going through
peri/menopause this awakening can remind them of the physical activity that perhaps they
unintentionally let slide away. Implementing resistance training and moderate-high level cardio is optimal for muscle mass, heart, bone, brain, and mental health. For cardio: walking is a great start! For strength training: picking 5 large muscle groups for strength training (starting with 2 sets of 10 reps for each exercise is a great place to start too). Are you getting the weekly 150 minutes of moderate exercise OR 75 min of vigorous recommended? Track it and see!
#5 “Lip balm”
The variation in faces matches the variations in vulvas we see :) Decreasing estrogen affects
the fat deposits within the labia, contributing to the atrophy we see in the vulva. Blood flow
decreases to the area which is why exercise, Kegels, and Regels are important- to increase the oxygen these tissues receive. If someone is experiencing vaginal dryness using a vaginal
moisturizer, like V-Magic, can help. For intercourse using a water-based lubricant, like Slippery Stuff, is best.
This information is educational in nature and not meant to diagnose or treat.
Always check with your MD before starting a fitness routine.
Dr. Jennifer Kinder PT, DPTSc is a Board Certified Women’s Health Clinical Specialist and
Associate Professor in the Departments of Physical Therapy & Rehabilitation Science & Anatomy at UCSF.
Email: Jennifer.Kinder2@ucsf.edu
IG: @jen_kinder_pt
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This post is so incredibly informative! Dealing with the changes that come with perimenopause can be such a mental and physical drain. I remember last year when I was dealing with some of these health shifts, the brain fog was so bad that I could barely focus on my coursework. It got to the point where I was so overwhelmed that I actually searched for someone to take my online exam just so I wouldn't fail while I was trying to get my health back on track. It’s so important to talk about these issues because they really do affect every part of our lives, including our productivity and education. Thank you for shedding light on this!
Reading She’s Got Issues “Your Pelvic Floor in Perimenopause” really struck a chord with me because I’ve seen so many brilliant women struggle through similar challenges without proper guidance; as a current PhD student juggling research with a part‑time role at Academic Editors where I assist other students in their academic work and offer support in Copyediting for Books, I’m deeply passionate about helping others navigate difficult moments like these, especially since in my own college days I suffered a lot from health‑related hustles that made balancing studies and wellbeing incredibly hard, so hearing honest, evidence‑grounded discussions about pelvic floor health in perimenopause feels both validating and empowering for anyone walking a similar path.
I really appreciated your clear explanation about pelvic floor concerns during perimenopause because it’s a topic many of us quietly struggle with and your tips feel practical and empowering. Last year I was juggling workouts with a tough semester and even looked for take my online Statistics class help so I could make time for pelvic floor exercises without falling behind. Your post reminds me how important it is to take care of our bodies and minds together.
I really appreciated your post about pelvic floor issues in perimenopause and how common it is to feel like your body is suddenly changing in ways you did not expect. Reading your honest take reminded me of a time when I was juggling deadlines and health even i had service to do my assignment while I focused on self‑care, because balancing everything can feel overwhelming. Your insights make those challenges feel more normal and easier to talk about.
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