Exploring the connection between menopause and pelvic floor disorders
Learn from an expert who has been there and done that.
Briana Walton, MD | Urogynecologist
Each October, Menopause Awareness Month shines a spotlight on an often-overlooked chapter in women’s health. Menopause symptoms aren’t just about hot flashes or saying goodbye to periods — it’s a life stage that touches nearly every system in the body, including one area women rarely talk about out loud: the pelvic floor.
Dr. Briana Walton, a urogynecologist in Maryland who specializes in Female Pelvic Health, wants to change that silence.
| “Menopause can have a significant impact on the pelvic floor,” she explains. “It’s not just hormone changes — it’s muscle strength, tissue health, even sexual function and confidence. And women deserve to know what’s happening to their bodies and what options are available.” |
Menopause 101: The Basics
Did you know that the average menopause age in the U.S. is 51? But perimenopause symptoms can begin years earlier during perimenopause, when estrogen levels start to fluctuate.
“Menopause is less like a light switch turning off, and more like a dimmer switch, with a short, flickering on and off,” says Dr. Walton. “Hormones like estrogen and testosterone decline gradually and erratically, and that transition can affect everything from mood to sleep to pelvic health.”
If you’ve ever wondered when does menopause start, or when does perimenopause start, the answer varies — but both stages can influence hormone imbalances that affect your overall wellbeing.
The scale of this transition is huge: around 1.3 million women in the U.S. reach menopause every year (North American Menopause Society, 2023). And because life expectancy is rising, women now spend up to one-third of their lives in menopause.
The Pelvic Floor: An Unsung Hero
When people think about menopause, they rarely think about the pelvic floor. But they should.
The pelvic floor is a group of muscles, ligaments, and tissues that act like a hammock to support the bladder, uterus, and rectum. When estrogen levels drop, the pelvic tissues lose structural support and the blood flow around the urethra decreases, which could contribute to urinary incontinence.
“All of this can increase the chance or severity of urinary incontinence and pelvic organ prolapse,” Dr. Walton explains. “Women may also notice changes in sexual function, more frequent bathroom trips, or disrupted sleep from nighttime urination.”
These are common signs of menopause in women and can be linked to symptoms of hormonal imbalance in a woman.
It’s not just physical. The emotional toll is real. Research shows that over 25–50% of women with stress urinary incontinence experience symptoms of anxiety or depression symptoms. “Women change their routines, mapping out bathrooms, avoiding activities they love; all because they’re afraid of leakage or embarrassment,” says Dr. Walton.
Stress Urinary Incontinence: More Common Than You Think
Stress urinary incontinence (SUI) happens when physical pressure — coughing, laughing, sneezing, exercise — causes urine leakage. SUI is a major problem affecting 20 – 40% of all women.
“Many women think a little leak is just a ‘gift’ of having babies and aging, but that’s a gift I would not accept,” says Dr. Walton. “There are effective treatments — and not all of them involve surgery.”
Non-surgical options include:
- Lifestyle changes: reducing caffeine and alcohol, quitting smoking, maintaining a healthy weight.
- Pelvic floor therapy: targeted exercises for incontinence (Kegels) often guided by a physical therapist using biofeedback.
- Absorbent products: pads and liners for daily management.
- Pessaries: small vaginal devices that provide extra support.
When conservative options aren’t enough, surgical treatments may be recommended. Bulking is a permanent substance injected around the urethra to stop leakage. Nevertheless, it is not considered a long-term treatment as most patients experience a recurrence of their SUI. Another recommended option with proven effectiveness and higher satisfaction rates is a sling for leakage.
| “Slings are minimally invasive procedures where a small piece of mesh supports the urethra, much like a hammock,” Dr. Walton explains. “Patient satisfaction is high — up to 90% at 24 months for the Altis® Single Incision Sling System — and many women say their only regret is not doing it sooner.” |
Pelvic Organ Prolapse: When Organs Shift
Another condition tied closely to menopause is pelvic organ prolapse (POP), which occurs when pelvic organs like the bladder, uterus, or rectum slip into the vaginal canal.
“Up to 50% of women with prolapse also have urinary incontinence,” says Dr. Walton. “The two often occur together, which can make symptoms even more challenging.”
Early prolapse can often be managed with the same conservative approaches as incontinence — lifestyle changes, pelvic floor therapy, or pessaries. But in more advanced cases, surgery may be necessary.
“The key is tailoring treatment to each woman,” Dr. Walton emphasizes. “Every woman’s body, goals, and comfort level with procedures are different.”
The Mental Health Connection
Menopause is not just about physical changes. Anxiety and depression symptoms and the sense of loss are common — and often compounded by pelvic floor issues.
“When women lose confidence in their bodies — when they feel embarrassed or can’t be intimate the way they want — it deeply affects their sense of self,” Dr. Walton says.
The good news? Solutions exist.
| “You don’t have to accept leakage, prolapse, or pain as your new normal. Treatment can restore not just function, but confidence and quality of life.” |
Why Awareness Matters
Menopause is universal, but awareness and support are not. A 2022 survey by The Menopause Society found that nearly half of women felt unprepared for menopause, and many did not know about treatment options for conditions like incontinence or prolapse.
That’s why Menopause Awareness Month is critical. It’s about breaking silence, sharing knowledge, and encouraging women to seek help.
| “Women spend a third of their lives in menopause,” says Dr. Walton. “It shouldn’t be a period of suffering. With the right care for women, it can be a time of strength, resilience, and even empowerment.” |
Taking Action: What Women Can Do
If you’re approaching menopause — or already navigating it — here are some steps to protect your pelvic health:
- Talk openly: Bring up incontinence, prolapse, or sexual changes with your doctor. These aren’t “embarrassing” topics — they’re medical conditions.
- Stay proactive: Practice pelvic floor exercises, maintain a healthy lifestyle, and avoid habits that strain your pelvic muscles.
- Explore your options: From therapy to devices to surgery, there are solutions for every stage and symptom.
- Find a specialist: Urogynecologists like Dr. Walton focus specifically on female pelvic health. (If you’re searching online, you can look for a urogynecologist near me to find local support.)
- Support awareness: Share stories, attend events, and help normalize the conversation around menopause.
A Final Word
Menopause isn’t an ending. It’s a transition — one that millions of women walk through every year. With awareness, open conversations, and expert care, the challenges of menopause — including pelvic floor issues — can be met head-on.
| As Dr. Walton puts it: “Getting older doesn’t mean giving up on living fully. The more we talk about menopause and pelvic health, the more women will realize they are not alone — and that there are real solutions.” |
Find a female pelvic health specialist near you
Locating a doctor with the expertise and empathy to treat your condition is key. You’re probably wondering, “Is there a pelvic surgical specialist near me?” We’ve got that covered.
Think you may be experiencing symptoms of stress urinary incontinence or pelvic organ prolapse?
To help you better understand your symptoms and take the first step toward relief, we invite you to fill out this quick, free, and confidential self-assessment. Help is on the way.
