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Menopause and pelvic floor health

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There are many issues relating to menopause which women are reluctant to talk about; hot flushes, brain fog and mood swings to name but a few. But the development of urogynaecological conditions such as urinary incontinence, recurrent urinary tract infections (UTIs), vaginal dryness and pelvic organ prolapse are often mentioned less frequently.

Our guide below identifies the most common ‘GSM’ or ‘genitourinary syndrome of menopause’ conditions you might experience as you approach and enter this phase of your life. We’ll also outline the treatments that our CQC rated Outstanding private hospital can offer to help you manage your symptoms and get back to your day-to-day activities.

Urinary incontinence

During the menopause, hormone levels – including oestrogen – decrease, which can weaken the muscles that support your bladder (known as your pelvic floor) and cause an involuntary leakage of urine.

According to TENA, up to 50% of post-menopausal women experience urine leakage at some point.

There are two main types of incontinence:

Stress incontinence

Stress incontinence is where a leakage of urine when you put pressure on the bladder, for example when you laugh, cough, sneeze or lift something heavy.

Urge incontinence (also known as an overactive bladder)

Urge incontinence, or an overactive bladder, is a sudden need to urinate or a situation in which you can’t make it to the loo in time. You may also wake up several times in the night with a sudden need to go to the toilet. This is caused when your pelvic floor muscles contract involuntarily.

How to manage urinary incontinence

  • Do regular pelvic floor exercises, also known as Kegel exercises. These are clench-and-release exercises which strengthen the muscles around your bladder and vagina
  • Avoid caffeine, fizzy drinks and alcohol
  • Eat a healthy diet, reducing the amount of spicy food you consume
  • Maintain a healthy weight
  • Stop smoking
  • Limit how much you drink in the evening to reduce the need to go to the toilet in the night

Treatment for urinary incontinence

As well as lifestyle changes, it’s important to speak to your GP or one of our Private GPs who specialise in women’s health to get a diagnosis and treatment plan. This could include Hormone Replacement Therapy (HRT); vaginal oestrogen, which is applied into your vagina; or a referral to our experienced Continence Care team who will offer guidance on anything from pelvic floor exercises to potential surgeries.

Urinary Tract Infections (UTIs)

Urinary tract infections (UTIs) are a common condition, caused when bacteria – usually from the vagina or rectum – enter the urinary tract via the urethra (the tube through which urine exits the body) and reach the bladder.

Women are more likely to get UTIs than men as they have shorter urethras, which means bacteria have a shorter distance to travel to reach the bladder.

In addition, if you’re menopausal, a decrease in the levels of oestrogen can lead to changes in the lining of the bladder and can weaken the muscles of the urethra. This makes it easier for bacteria to enter your urethra and move to your bladder.

What are the most common UTIs in women?


Cystitis is an infection of the bladder and is the UTI which most frequently affects women. It’s most commonly caused by E.Coli bacteria, which are harmless when found in the bowel but can cause infection elsewhere in the body. You can suffer recurrent episodes of cystitis, which can be uncomfortable and upsetting.

Pyelonephritis (kidney infection)

A kidney infection can be a painful condition caused by cystitis which has travelled from the bladder into the kidneys. If a kidney infection is left untreated it could lead to kidney disease.


Vaginitis is a swelling in and around the vagina, which can lead to similar symptoms to cystitis including pain when you pee.

What are the symptoms of UTIs in women?

Women and men often experience very similar symptoms when they have a UTI. These include:

  • Needing to pass urine more often that usual
  • Pain or a burning sensation when passing urine
  • Strong smelling or cloudy urine
  • Stomach ache or lower back ache (especially in kidney infections)
  • An unusually high or low temperature
  • Nausea and vomiting
  • Confusion (this can be mistaken for dementia in older women)

How can I treat a UTI?

  • Stay hydrated, drink plenty of water
  • Place a heated pad to your back or abdomen to relieve pain

According to the NHS website, UTIs are one of the causes of life threatening E.Coli bloodstream infections in England. If left untreated, UTIs can also lead to severe sepsis, so it’s important to speak to your GP or one of our Private GPs who specialise in women’s health to get a diagnosis and treatment plan.

How to prevent UTIs

  • Keep hydrated
  • Urinate before and after sex
  • Wipe front to back when you go to the toilet and keep your genital area clean and dry
  • Have a shower rather than a bath
  • Avoid wearing synthetic underwear
  • Avoid perfumes, strong fragrances and powders around the genitals

Vaginal dryness and irritation

Often, menopausal women – as well as those who have undergone some cancer treatments – can suffer with dryness and thinning of the vaginal tissues as a result of a lack of oestrogen. This is known as vaginal atrophy.

As well as causing itching and soreness around the vagina and making sex feel uncomfortable, vaginal atrophy can lead to urinary incontinence and frequent UTIs as discussed above.

How can I manage vaginal dryness?

There are some things you can try at home, such as:

  • Using unperfumed soaps when washing your genitals
  • Trying water-based lubricants before sex
  • Enjoy more foreplay so you become naturally lubricated before sex

If the dryness continues for more than a couple of weeks, you have unusual bleeding or discharge from your vagina after sex or between your periods – and it’s affecting your day to day life – you should make an appointment to see a GP or one of our expert Consultant Gynaecologists for a diagnosis.

How is vaginal dryness treated?

There are several treatments for vaginal atrophy; your clinician can discuss these with you.

  • Topical treatments such as water-based vaginal lubricants
  • Over-the-counter vaginal moisturiser which you should use every couple of days
  • Hormone Replacement Therapy (HRT)
  • Vaginal creams containing oestrogen
  • Oestrogen tablets of rings, which can be inserted into your vagina
  • MonaLisa Touch® – a gentle, hormone-free laser treatment

Pelvic organ prolapse

A prolapse happens when your pelvic organs push forward, due to the muscles in your pelvic floor becoming weak as a result of low oestrogen levels during menopause.

The most common types of prolapse are:

Prolapsed uterus or womb (also known as vaginal prolapse)

This happens when your pelvic floor muscles are unable to support your womb, and it slips into the vagina.

Bladder prolapse

Your bladder is supported by the front wall of your vagina. If this wall begins to deteriorate as a result of low levels of oestrogen during the menopause, the bladder can slip into the vagina.

Small bowel prolapse (enterocele)

When the small bowel (intestine) slips into the pelvic cavity and pushes on the top of the vagina, a bulge is created. It often has no to mild symptoms and treatment will depend on how much they affect your day-to-day life.

Rectal prolapse

A partial prolapse is when the lining of the bowel slides down until it protrudes outside the anus. A complete rectal prolapse is when the whole rectal wall collapses.

What is the treatment for pelvic organ prolapse?

Pelvic organ prolapse is usually confirmed by a pelvic examination. Treatment can include pelvic floor exercises, pessary rings, hormone creams or surgery such as colporrhaphy for vaginal prolapse or enterocele repair for a small bowel prolapse.

Help and support for urogynaecological conditions at Benenden Hospital

If any of the issues mentioned in this article are affecting your life during the menopause, and it’s becoming difficult for you to undertake long journeys, watch a movie or go on holidays, it's time to ask for help. Our private GPs offer a 25-minute appointment and can provide a diagnosis in some cases or refer you to our Continence Care team or expert Consultant Gynaecologists or Urogynaecologists for treatment.

To book or find out more, contact our Private Patient team via LiveChat, by completing our online enquiry form or by calling us on 01580 363158.

Published on 09 April 2024