Reflecting on "How to Menopause" and the Power of Pelvic Floor Physical Therapy

As a 42-year-old mom of three and someone living through perimenopause firsthand, I recently found myself devouring How to Menopause by Tamsen Fadal. Her honest, clear-eyed take on the real experiences of menopause felt like a breath of fresh air. What stood out most to me was her focus on maintaining the foundations of good health, sleep, exercise, and emotional well-being, all things that often feel like they start slipping just as we need them most.

As a pelvic floor physical therapist and someone personally navigating this transition, I see every day how much the pelvic floor impacts all these pillars, even though it’s rarely talked about.

During perimenopause and menopause, dropping estrogen levels can lead to real changes in the pelvic floor muscles. They may become weaker, less coordinated, and less responsive. This can cause symptoms like urinary urgency, waking at night to pee (nocturia), leaking with movement, pelvic pressure, or pelvic pain. These disruptions don’t just affect comfort — they chip away at critical needs like restful sleep. Frequent nighttime bathroom trips fragment deep sleep cycles, leaving you exhausted even after a full night in bed. Poor sleep then worsens hormonal regulation, mental health, and even muscle recovery, creating a vicious cycle.

Exercise becomes trickier, too. Activities you used to love, like running, lifting, or even yoga, may now trigger leaking, pelvic heaviness, or discomfort. And yet, as Fadal rightly emphasizes, regular movement is essential to protect our hearts, bones, brains, and emotional health as we age. Too many women end up avoiding exercise altogether, simply because no one taught them how to adapt to these new changes safely.

But it doesn’t end with sleep and movement.

Hormonal shifts also affect the pelvic tissues that play a role in sexual health and intimacy. Vaginal dryness, pain with intercourse, and a sense of disconnect from one’s body are incredibly common — and yet, still so under-discussed. Pelvic floor therapy can be transformative here too, by improving blood flow, easing muscle tension, enhancing tissue resilience, and empowering women to regain comfort and pleasure in intimacy.

All of these physical changes, including interrupted sleep, difficulty exercising, and uncomfortable intimacy, can quietly take a toll on mental health, confidence, and body image. It’s easy to start feeling betrayed by your own body, frustrated by the losses, and uncertain of how to move forward. And that’s exactly where pelvic floor therapy can offer a powerful path forward — not just by addressing symptoms, but by helping you rebuild trust in your body, strength in your core, and a renewed sense of connection to yourself.

Reading How to Menopause reminded me that perimenopause and menopause are not just about symptoms to survive, they’re opportunities to reclaim ownership of our health in a new and powerful way. Pelvic floor physical therapy can be a crucial part of that reclamation.

If you’re feeling frustrated, overwhelmed, or simply unsure how to support your body through these changes, know this: you are not alone. I’m right here in it with you — living it, learning from it, and ready to help you navigate this chapter with strength, confidence, and compassion at Freya Wellness.

Book a free pelvic health consult today and start reconnecting with your body from the inside out.

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