When pain starts to feel different through menopause

More is changing than you might realise

Oestrogen plays a part in tissues throughout the body, so falling levels during menopause have a surprisingly wide reach.

Bone density drops fastest around this stage of life, while changes in muscle mass and strength affect how the body feels and responds to everyday movement. Joints and tendons often become part of the picture too, with some women noticing new stiffness, frozen shoulder, or pain around the hip and heel.

In Stephanie’s words, “Much of it is silent, which is why it matters.” Other changes make themselves known when you reach for something on a high shelf, get up after sitting for a while, go for a run, or simply realise that something which used to settle quickly now seems to linger.

Your pelvic floor is part of the picture too

The pelvic floor is a group of muscles that works like a hammock, running from the pubic bone at the front to the tailbone at the back. It supports the bladder, bowel and reproductive organs, and helps with continence, sexual function and managing pressure when we cough, sneeze or lift.

The pelvic floor muscles, vagina and urethra all have oestrogen receptors. As oestrogen levels fall, these tissues may become thinner, drier and less elastic, while changes to the bladder and urethra often bring urgency, needing to go more often or recurrent urinary infections.

You might also notice leaking when you cough, jump or exercise, or a feeling of heaviness or dragging. That heaviness is sometimes linked with prolapse, where one of the pelvic organs sits lower in the vagina. “It’s common, and very treatable,” Stephanie reassures.

Some women also notice a sudden, sharp, zinging pain known as lightning crotch. Research is still limited, though Stephanie explains it’s thought to relate to hormonal effects on nerves and tissue sensitivity, and it’s worth having assessed.

She also has a word of advice for anyone who has started doing pelvic floor exercises on their own. “Not every leak means a weak pelvic floor. Sometimes the muscles are too tight, so it’s worth getting assessed before doing endless squeezes.”

These symptoms deserve attention, especially when they begin to change how you move, exercise, sleep or feel in everyday life. As Stephanie puts it, “Common doesn’t mean normal, and you don’t have to put up with it.”

Building strength through menopause

Changes in muscle through midlife are another reason strength deserves a place in the menopause conversation.

“Research shows people can build strength and muscle at any age,” says Stephanie.

During menopause it may take a little more effort and consistency, while the capacity to become stronger is still very much there. What makes the difference, she explains, is gradually increasing the challenge over time, ideally with two or three strength sessions a week and enough protein to support them.

This matters for more than muscle alone. Bones and tendons respond to load too, so the right strength work supports them while helping you stay comfortable and capable in the movement that belongs to your life. That might mean lifting a suitcase into the overhead locker, carrying the shopping, running, gardening or simply feeling steadier day to day. As Stephanie says, “This is a time to build, not just to manage symptoms.”

The right place to begin looks different for everyone. Your history, current symptoms, previous experience with exercise and what you want to be able to do all belong in the conversation.

Where women’s health physiotherapy can help

A women’s health physiotherapy appointment starts with exactly that kind of conversation.

Your physiotherapist will talk through your symptoms, history and goals before deciding with you what assessment would be most helpful. An internal examination may form part of a pelvic health assessment, only ever with your consent, and it isn’t always needed. The assessment shows whether your pelvic floor is weak, too tight or not coordinating well, because each needs a different approach.

From there, support is shaped around what your body is actually doing. That might involve pelvic floor strengthening or relaxation work, support with bladder and bowel habits, or strength training. Stephanie also works alongside your GP, so if something like vaginal oestrogen is part of your plan, your physiotherapy can be built around how your body responds.

Many women come to see Stephanie once they’ve started leaking, noticed heaviness, or been told they have a prolapse and aren’t sure whether exercise could make things worse. “Physiotherapy can also help before things become a problem, so there’s no need to wait until you’re struggling.” 

Your body continues to change through menopause, just as it has at every other stage of your life. Having someone take the time to understand those changes, alongside your movement, your history and everything else going on, can make the way forward feel clearer, and much more your own.

If changes in pain, movement or pelvic health are starting to get in the way of everyday life, Stephanie and our women’s health team are here to listen and help you understand what’s going on.

Whenever you feel ready, you can book an appointment with us here.