By the Auckland Physiotherapy Team · 8 min read · Auckland Physiotherapy, Newmarket
Perimenopause and menopause are significant transitions — and for many women in Auckland, they arrive with symptoms that are either dismissed as just part of ageing or simply never connected to the pelvic floor. Leaking when you cough or sneeze, pain or discomfort during sex, a feeling of heaviness in the pelvis, or struggling to keep up with the strength training you know your body needs — these are not things you have to accept. A pelvic health physiotherapist can assess, treat, and in many cases prevent these issues from progressing.
This blog covers three key areas where pelvic health physio makes a meaningful difference during this stage of life: incontinence, sexual pain and discomfort, and strength training for bone density and symptom management.
Experiencing any of these symptoms around perimenopause or menopause?
You’d need a 45-minute session with one of our pelvic health physios in Newmarket to properly assess what’s driving them and build a plan that works for your stage of life.
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Why oestrogen matters for pelvic health
The hormone changes of perimenopause and menopause — primarily the decline in oestrogen — affect pelvic health in several direct and well-established ways. Oestrogen plays a role in maintaining the strength and elasticity of the connective tissue and muscle of the pelvic floor, the thickness and lubrication of the vaginal wall, and the health of the urethral tissue. As oestrogen declines, these tissues become more vulnerable to dysfunction, and symptoms that may have been mild or absent earlier in life can develop or worsen.
This does not mean that problems are inevitable — but it does mean that addressing the pelvic floor proactively during this window matters more than at almost any other time in a woman’s life.
1. Treating and preventing incontinence
Approximately one in three women experience some degree of urinary incontinence, and this number increases significantly around and after menopause. The two most common types are stress urinary incontinence — leaking with coughing, sneezing, laughing, or exercise — and urge urinary incontinence, where there is a sudden strong urge to go and not always enough time to make it to the toilet.
Both types become more common during the menopausal transition, and both are directly influenced by the hormonal and tissue changes described above. Declining oestrogen reduces urethral closure pressure and can affect the sensitivity and function of the bladder. At the same time, pelvic floor muscles that may already be operating below capacity can struggle further without the connective tissue support that oestrogen previously provided.
Importantly, incontinence is not an inevitable part of menopause, and it is not simply a consequence of having had children. It is a treatable condition. Research consistently shows that appropriately prescribed pelvic floor muscle training significantly reduces or eliminates leakage in the majority of women — but the key word is appropriately prescribed. Up to 50% of women perform a pelvic floor contraction incorrectly when given verbal cues alone, which means self-directed kegel exercises without assessment frequently miss the mark entirely.
At Auckland Physiotherapy’s Newmarket clinic, our pelvic health physios perform a thorough assessment to identify the specific type of incontinence you have and the dysfunction driving it — whether that is pelvic floor weakness, poor coordination, urethral closure issues, prolapse, bladder habits, or a combination. Treatment is then matched to what your assessment actually shows, not a generic programme.
Related reading:
Incontinence is treatable, not inevitable. A proper assessment is what makes the difference.
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2. Treating and preventing sexual pain and discomfort
Pain during or after sex — known clinically as dyspareunia — is one of the most common and least talked-about symptoms of menopause. Research suggests that between 17% and 45% of postmenopausal women experience genitourinary symptoms including vaginal dryness, burning, irritation, and pain with intercourse. This is sometimes referred to as the genitourinary syndrome of menopause (GSM).
The mechanism is well understood: declining oestrogen causes the vaginal tissues to become thinner, less elastic, and less well lubricated. This can make intercourse uncomfortable or painful, and can also contribute to pelvic floor muscle guarding — where the muscles contract protectively in response to discomfort, which in turn worsens the pain with subsequent attempts at penetration.
This cycle of pain, guarding, and avoidance is something a pelvic health physiotherapist is specifically trained to assess and treat. At our Newmarket clinic, treatment for sexual pain and discomfort around menopause typically includes:
It is worth being clear: sexual pain during menopause is not something you have to simply endure or accept as permanent. Many women find that a combination of physiotherapy and appropriate medical management — working with both their GP and pelvic health physio — leads to significant improvement.
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3. Strength training for bone density and menopause symptoms
This is the area that surprises many women — but it is one of the most important contributions a physio can make during perimenopause and menopause, and it is closely linked to pelvic health.
Why bone density matters at this stage
Oestrogen plays a critical role in maintaining bone mineral density. The decline in oestrogen during menopause accelerates bone resorption, and women can lose up to 10% of their bone density in the first five years after menopause. This significantly increases the long-term risk of osteoporosis and fracture. The evidence is clear that progressive resistance training — strength training that places load on the skeleton — is one of the most effective strategies for slowing bone density loss and is recommended as a first-line approach alongside nutrition.
However, for many women approaching or going through menopause, beginning or returning to strength training is not straightforward. Pelvic floor symptoms, joint pain, a history of injury, or simply not knowing where to start safely all present real barriers.
Where pelvic health physio fits in
A pelvic health physiotherapist can bridge the gap between what your body needs (adequate loading through the skeleton) and what your body is currently able to tolerate comfortably. This includes:
At Auckland Physiotherapy’s Newmarket clinic, our pelvic health physios and personal trainers work under the same roof, which means your programme can be genuinely coordinated — not just a referral to a gym with no context about your pelvic floor.
Strength training and menopause symptoms more broadly
Beyond bone density, progressive resistance training has good evidence behind it for reducing several common menopausal symptoms. Studies have shown associations between regular strength training and improvements in sleep quality, mood, energy, and body composition during menopause — all of which are commonly affected by the hormonal changes of this transition. It is one of the most powerful lifestyle tools available during this period, and a pelvic health physio can help you access it safely.
Related reading:
When should I see a pelvic health physio?
The short answer is: you do not need to wait until symptoms are severe. Many of the conditions that become more difficult to manage after menopause — incontinence, prolapse, pelvic pain, sexual discomfort — are significantly easier to treat or prevent when addressed during perimenopause, before oestrogen levels have fully declined. An assessment at this stage gives your pelvic health physio the opportunity to identify what is already changing, what is at risk, and what you can do now to protect your function and quality of life going forward.
If you are in Auckland and already experiencing symptoms, treatment is still very effective — it is simply never too late to address these issues, and most women see meaningful improvement with the right approach.
What does a pelvic health assessment involve? Your physio will take a detailed history of your symptoms, bladder and bowel habits, exercise history, and goals. They will assess your movement, posture, and abdominal and pelvic floor function, and with your full consent may offer an internal assessment to get an accurate picture of your pelvic floor strength, coordination, and tension. You will leave the first appointment with a clear explanation of what they found and a plan tailored specifically to you.
You do not have to just manage these symptoms — you can treat them, prevent them from progressing, and build a body that is strong and resilient through this transition.
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How we can help at Auckland Physiotherapy, Newmarket:
Ready to get started?
You’d need a 45-minute session with one of our pelvic health physios in Newmarket to properly assess your symptoms and build a plan that’s right for your stage of life. Not sure where to start? Book a free call first.
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📞 09 366 4480 · 8 George Street, Newmarket, Auckland 1023
This article is for educational purposes only and does not constitute medical advice. Please consult a qualified health practitioner about your individual symptoms and circumstances.
Tags: Pelvic health · Menopause · Perimenopause · Incontinence · Sexual pain · Bone density · Strength training · Women’s health · Newmarket · Auckland
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