Hormonal Changes in Perimenopause: How They Affect Your Pelvic Floor (and What You Can Do About It)

Perimenopause is a major hormonal shift in a woman’s life—and while most people expect hot flashes and mood swings, fewer talk about the effects these changes can have down there.

Let’s change that.

If you’re between your late 30s and early 50s and noticing pelvic heaviness, dryness, leaking, or pain with sex, your pelvic floor may be feeling the impact of changing estrogen levels. As a pelvic floor physical therapist, I see this all the time—and the good news is, there’s help.

What Is Perimenopause, Exactly?

Perimenopause is the transitional phase before menopause when your body begins producing less estrogen and progesterone. It can last several years and usually starts in your 40s (but sometimes earlier). Hormone levels fluctuate—sometimes wildly—which means you may notice:

• Irregular periods

• Vaginal dryness

• Decreased libido

• Mood changes

• Night sweats

• Pelvic floor symptoms

How Hormones Impact the Pelvic Floor

Estrogen plays a major role in maintaining the health of vaginal and urethral tissues, as well as the muscles and ligaments that support your pelvic organs. When estrogen declines, you may experience:

• Thinning of vaginal tissue, leading to pain with sex or during pelvic exams

• Dryness or burning sensations, even without sexual activity

• Weakened pelvic muscles, which can lead to urinary leakage or a feeling of heaviness

• Increased urinary urgency or frequency

• Constipation or pelvic tension due to muscle imbalances

Why Caring for the Pelvic Floor Matters More Than Ever

The pelvic floor is central to so many essential functions—bladder and bowel control, sexual health, organ support, and core stability. During perimenopause, these muscles and tissues may become more vulnerable due to hormonal changes, but the good news is: they can be supported and strengthened.

When we improve:

• Tissue quality through gentle manual therapy, blood flow stimulation, and the use of vaginal estrogen

• Muscular strength and endurance with targeted exercises

• Neuromuscular coordination so the pelvic floor and core work together more effectively

…we often see a significant reduction in discomfort, improvement in bladder and bowel function, enhanced intimacy, and a stronger sense of body confidence.

Caring for your pelvic floor is not just about addressing problems—it’s about enhancing your whole-body wellness, particularly during a time of hormonal transition.

3 Key Tools to Support Your Pelvic Health During Perimenopause

1. Pelvic Floor Physical Therapy

Pelvic PT can make a huge difference. We assess the strength, coordination, and flexibility of your pelvic floor and surrounding muscles. Whether your pelvic floor is holding too much tension (often from years of compensating) or lacks the support it used to have, we create a personalized program to restore function.

What we might work on:

• Manual therapy to reduce fascial restrictions and improve blood flow

• Breathing and coordination exercises

• Neuromuscular re-education

• Core and hip strengthening

• Education around bladder habits, posture, and intimacy

2. High-Quality Lubricants

Vaginal dryness is one of the most common (and frustrating) symptoms of perimenopause. A high-quality, pH-balanced, glycerin- and paraben-free lubricant can significantly improve comfort—especially during sex, exercise, or pelvic exams.

Lubricants can reduce friction, soothe irritation, and improve your relationship with your body. They’re not a luxury—they’re a tool for comfort and function.

3. Vaginal Estrogen

Unlike systemic hormone therapy, low-dose vaginal estrogen works locally to restore moisture and elasticity to vaginal tissues. It can help reduce pain with sex, improve urinary function, and promote pelvic floor health. Many patients are surprised by how much relief this simple, targeted therapy can provide.

If this is something you’re curious about, talk to your healthcare provider. When paired with pelvic floor therapy, vaginal estrogen can be a powerful part of your care plan.

You Deserve to Feel Good in Your Body

Perimenopause doesn’t mean the end of strength, intimacy, or pelvic comfort. In fact, it can be a new beginning—if you have the right support.

You’re not alone. You’re not broken. And with a holistic, compassionate approach to pelvic health, you can feel aligned, confident, and pain-free again.