The menopause symptoms few women mention, and what eight weeks of pelvic floor work did

Of all the changes menopause brings, the ones lower down get talked about least. Dryness, burning, needing the toilet urgently and often, a little leak when you cough, sex that has started to hurt. On September 29 the journal Menopause published a small trial asking what eight weeks of guided pelvic floor work could change for women living with exactly that.

What the trial did

Researchers at Hacettepe University in Ankara randomly assigned 58 postmenopausal women with genitourinary syndrome of menopause (the umbrella name for this cluster of vaginal and urinary symptoms) to one of two groups (Menopause, 2026). Thirty received structured education about the condition. Twenty eight received the same education plus 8 weeks of pelvic floor muscle training that was supervised and progressive, which means someone was there with them and the work built up gradually.

At the end, the training group reported larger drops in vaginal and urinary symptoms, less disruption from leaking, and better scores on the sexual part of a menopause quality of life questionnaire. Their pelvic floor muscles tested stronger, and more of them could stop the flow of urine when asked to. The differences held whether the researchers counted every woman who started or only those who finished, and they were unlikely to be chance.

What didn't move matters just as much. Hot flushes, mood and general physical wellbeing came out about the same in both groups, so the training acted where the muscles are and nowhere else, which is what you'd hope an honest result looks like. One note on that urine flow measure: it was a test the researchers used, not something anyone was told to practise, and it's worth checking with a pelvic health physiotherapist before turning it into a habit.

The limits are plain. Fifty eight women, one centre, eight weeks, and no long term follow up in this paper; the comparison group got education rather than a placebo, and the authors themselves call for larger and longer studies.

The context makes it worth reading anyway. The 2020 position statement from what is now The Menopause Society puts the share of postmenopausal women affected somewhere between 27% and 84%, and describes the condition as likely underdiagnosed and undertreated (Menopause, 2020). That is a very wide range. It is also a quiet admission that nobody is quite sure, because so many women never say anything.

Three things worth raising

Ask whether what you're noticing has a name. Many women file dryness under getting older and leaking under having had children, and never bring either up. Saying "genitourinary syndrome of menopause" out loud gives the appointment a frame, and the 2020 statement is clear that in most cases the symptoms can be managed.

Ask whether a referral to a pelvic health physiotherapist makes sense for you. The training in this trial was supervised and built week by week. It was not a leaflet, and education on its own helped less. If all you have been offered so far is a printed sheet of squeezes, it is reasonable to ask whether someone can look at what you are actually doing when you try them.

Ask how muscle work fits with whatever else is on the table. Moisturisers, lubricants and local hormone treatment are conversations for you and your clinician, and this trial did not test training against any of them, so it cannot tell you which to choose. What it does suggest is that the muscles deserve a place in that conversation.

From the inside

What I see again and again in my classes is that many women cannot find their pelvic floor at all when asked to, and the ones who can often bring the whole neighbourhood along: buttocks clenched, belly pulled in, breath held. That is a habit, not a fault, and it is where learning starts (more on pelvic floor tension and awareness).

I teach the Feldenkrais Method®, and an Awareness Through Movement® lesson would come at this indirectly. Sitting on a firm chair, you feel the two sitting bones on the seat and let the pelvis roll forward and back so slightly that someone watching would not see it, going only where it feels easy, pleasant, and comfortable. Somewhere in that tiny rolling, the base of the pelvis starts to announce itself. No squeezing required.

None of this replaces pelvic health physiotherapy. Feldenkrais based work sits alongside it, and alongside the wider physical changes of menopause that tend to arrive in the same years.

The thirty women in the education group were told what was happening in their bodies and why. The bigger change came to the women who spent eight weeks with someone helping them feel a group of muscles most of us were never taught to notice, and I keep wondering how many women, right now, are holding the leaflet.