The Pelvic Floor

Perimenopause: The Chapter Before Menopause Perimenopause is the transition phase before menopause, when the ovaries gradually slow their production of the hormones oestrogen and progesterone. Unlike menopause, which is marked by the end of menstrual cycles, perimenopause is a shifting and fluctuating period of hormonal change. This stage can begin earlier than many women expect. While the average onset is in the mid-40s, some women experience signs in their late 30s. Perimenopause can last a few months, but for some, it stretches over several years — sometimes up to eight or more. Because the changes happen gradually, early signs are often missed or dismissed as “just stress” or “getting older.” Recognising these changes is the first step in managing them effectively. Common Signs and Symptoms Hot flushes and night sweats Sudden waves of heat, flushing of the skin, and sweating can appear during the day or interrupt sleep at night. These can range from mild to intense and may be triggered by factors such as stress, certain foods, or changes in room temperature. Sleep disturbances Falling asleep can become more difficult, and many women wake during the night without a clear reason. This can lead to fatigue and low energy during the day. Mood changes Shifts in mood, including irritability, anxiety, and sudden emotional reactions, can be linked to fluctuating hormones. For some, these changes can feel out of character and disruptive. Irregular periods Cycles may shorten, lengthen, or become heavier or lighter. Periods may also skip entirely before resuming again, adding to the unpredictability. Cognitive changes (brain fog) Some women report difficulty concentrating, forgetfulness, or losing their train of thought mid-sentence. These changes can be frustrating, especially in work or social situations. Changes in libido and vaginal health A decline in sexual desire, vaginal dryness, or discomfort during intimacy may occur due to reduced oestrogen levels. Physical changes Aches, joint stiffness, changes in skin texture, and pelvic floor symptoms such as urinary leaks, urgency, or a sensation of heaviness can develop. Why This Stage Matters Perimenopause is a natural stage of life, but it can have a significant impact on physical, emotional, and social wellbeing. Many women feel they have to “push through” without support, yet there are effective strategies to help. These may include: Adjusting exercise and nutrition to support hormonal health and bone strength. Learning pelvic floor exercises to address or prevent leaks and discomfort. Using medical treatments such as hormone replacement therapy (HRT) or other symptom-management options under guidance from a healthcare professional. Exploring lifestyle changes like stress management, consistent sleep routines, and reducing trigger foods. Tracking and Seeking Support One of the most useful steps you can take is to track your symptoms. Keeping a simple diary for two to three months can help identify patterns and make discussions with your GP or women’s health physiotherapist more productive. If symptoms are disrupting your daily life — whether that means poor sleep, ongoing discomfort, or emotional strain — professional help is available. The sooner support is sought, the smoother this transition can be. Perimenopause may be a natural phase, but with the right knowledge, tools, and care, it doesn’t have to be a time of uncertainty or struggle.

The Role of Pelvic Floor Physiotherapy After a Hysterectomy A hysterectomy is a significant surgical procedure, and while it can be necessary for a range of medical conditions, recovery requires careful consideration. The pelvic floor and core do not automatically restore their previous function following surgery. Regardless of whether the procedure was performed via an abdominal, vaginal, or laparoscopic approach, targeted rehabilitation is often essential. Pelvic floor physiotherapy provides evidence-based strategies to optimise healing, restore function, and support long-term pelvic health. Below is an outline of how a physiotherapist may assist across the different stages of recovery. Early Recovery (0–6 Weeks) Focus: Education, Protection, Gentle Awareness During the initial post-operative phase, the priority is to protect healing tissues and establish safe movement patterns. A physiotherapist may provide: Pelvic floor education — guidance on how surgery has altered pelvic support, biomechanics, and bladder/bowel function. Breathing and core coordination — gentle diaphragmatic breathing techniques to reduce tension, support circulation, and minimise swelling. Safe movement and postural strategies — instruction on bed mobility, transfers, and walking to avoid unnecessary strain. Scar and tissue healing advice — information to optimise scar recovery, reduce the risk of adhesions, and monitor for signs of complications. Mid Recovery (6–12 Weeks) Focus: Activation, Strengthening, Confidence Once surgical healing is established, rehabilitation progresses to restoring muscle activation and movement control. This may include: Pelvic floor muscle retraining — graded internal or external exercises focusing on coordination, endurance, and strength. Core muscle activation — re-education of deep abdominal muscles, particularly the transversus abdominis, in synchrony with the pelvic floor. Postural alignment and movement retraining — addressing compensatory patterns or protective guarding to optimise pelvic loading. Scar mobilisation — manual therapy to improve tissue mobility, circulation, and sensitivity. Later Recovery (3+ Months) Focus: Return to Function, Fitness, and Lifestyle The longer-term phase of rehabilitation supports a safe return to higher levels of activity and addresses ongoing pelvic health needs. This may involve: Exercise progression and return-to-sport planning — individualised advice for safely resuming walking, lifting, gym training, Pilates, or sport while minimising risk of prolapse or core dysfunction. Bladder and bowel retraining — management of urgency, leakage, or constipation, which may present post-surgery. Support for intimacy and pelvic pain — rehabilitation for dyspareunia, vaginal tightness, or scar-related discomfort. Prolapse prevention and long-term pelvic health — strategies to manage intra-abdominal pressure and maintain pelvic organ support. Why Consult a Pelvic Floor Physiotherapist? Pelvic floor physiotherapists are trained to assess not only the muscles, but the integration of breath, core, scars, posture, and daily movement patterns following surgery. This holistic assessment allows for a tailored rehabilitation plan to support both short- and long-term recovery. Importantly, it is never too late to commence pelvic floor physiotherapy. Whether a patient is six weeks or six years post-hysterectomy, physiotherapy can assist in improving function, comfort, and quality of life. 

Understanding the Risk Factors for Pelvic Organ Prolapse (POP) Pelvic organ prolapse (POP) is a condition where one or more of the pelvic organs (such as the bladder, uterus, or rectum) shift downward and push into the vaginal wall due to weakened support from the pelvic floor. It’s more common than many realise, and while it can feel overwhelming, knowing the risk factors can help you take steps to protect your pelvic health. Key Risk Factors 1. Vaginal Birth Childbirth is one of the most significant contributors to POP. Vaginal deliveries, particularly when forceps are used, when the baby is large, or after multiple births, can place considerable strain on the pelvic floor muscles and connective tissues. 2. Age As we age, our muscles and tissues naturally weaken. This includes the pelvic floor, which means the likelihood of prolapse increases over time. 3. Obesity Carrying extra body weight increases pressure on the pelvic floor. Over time, this added strain can contribute to the development of POP. 4. Genetics Sometimes, pelvic health challenges run in families. If you have a close relative with POP or connective tissue disorders, you may be more predisposed to experiencing prolapse yourself. 5. Menopause Hormonal changes associated with menopause—particularly lower oestrogen levels—can lead to thinning and weakening of pelvic tissues, making them less supportive. 6. Prior Pelvic Surgery Procedures like a hysterectomy can affect pelvic support structures and increase the risk of prolapse later on. 7. Chronic Strain Repetitive straining from chronic constipation, persistent coughing (such as from smoking or lung disease), or frequent heavy lifting can all place continuous pressure on the pelvic floor, increasing the risk of POP. 8. Connective Tissue Disorders Some people have naturally weaker connective tissues due to genetic factors. Conditions like hypermobility can make the pelvic floor less resilient and more prone to prolapse. What Can You Do? While not all risk factors can be avoided, there are proactive steps you can take to support your pelvic health: Maintain a healthy weight to reduce pressure on the pelvic floor. Address chronic straining by managing constipation, cough, or lifestyle factors that increase abdominal pressure. Strengthen your pelvic floor muscles through targeted exercises. A pelvic health physiotherapist can guide you in learning the right techniques. Final Thoughts POP is influenced by many factors—some you can’t control, like age and genetics, and others you can actively address. By understanding your risk profile and making supportive lifestyle changes, you can strengthen your pelvic health and reduce the likelihood or severity of prolapse. If you’re concerned about your pelvic floor or would like personalised guidance, our team at Pelvic Health Melbourne is here to help.