What changes in the body at this stage
The menopause is not a single day; it is a passage. It begins with the perimenopause, often in the early to mid-forties, with irregular cycles, lighter sleep, mood changes and hot flushes. It is confirmed after 12 months without a period.
Falling oestrogen does far more than cause hot flushes. The tissues of the vulva, vagina, urethra and bladder become thinner, less elastic and less lubricated. The pelvic floor muscles lose mass, like the other muscles in the body. The bladder can become more sensitive.
Dryness, burning, recurrent urinary infections, pain during sex and bladder leaks are common, but not normal. They are not “just your age”, and you do not have to accept them in silence.
What may lie at the root
Behind a symptom such as leaking there may be a weak pelvic floor, but also one that is too tense, habits that have crept in (going to the loo “just in case”), long-standing constipation, a persistent cough, or births from many years ago that are only now making themselves felt.
Pain during sex often starts with dryness and gets worse because the body learns to protect itself: the muscles tighten in anticipation of pain. That cycle can be broken.
A heavy feeling in the vagina may point to a prolapse, meaning the bladder, uterus or rectum has descended. Symptoms often improve with the right training and changes to everyday habits.
How we can support you
- Pelvic physiotherapy: we start with a conversation about bladder, bowel, sexuality and your history of births and surgery. Then we assess posture, breathing and, with your consent, an external and internal assessment of the pelvic floor. Treatment may include muscle training with biofeedback, manual therapy, bladder retraining (a bladder diary and urge-control techniques), dilators and guidance on choosing lubricants and vaginal moisturisers. If your doctor has prescribed a pessary, we can help you get used to it.
- Acupuncture: may help ease hot flushes, sleep disturbance and tension. It is a complementary support, with mixed research results.
- Visceral osteopathy: may improve abdominal and pelvic mobility and help with constipation.
Many women also benefit from local or systemic hormone treatment, which is decided by your gynaecologist or GP. Physiotherapy and hormone therapy are not either-or: they often work best together.
When to see a doctor
Book an appointment with your doctor promptly if you have:
- any vaginal bleeding after the menopause, even if it is light or happens only once;
- blood in your urine or stools;
- unexplained weight loss, persistent bloating or feeling full quickly;
- a visible bulge outside the vagina that does not go back in, or difficulty emptying your bladder;
- fever with pain passing urine or back pain;
- new, persistent pelvic pain.