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Pelvic floor exercises during menopause
Leaks when you cough, laugh or lift are common after menopause and often improve with training. Here is what the evidence supports and how to practise correctly.
In this guide6
This is common, and it is treatable
Urinary leaking with coughing, laughing, sneezing or lifting affects a large share of women after menopause, and most never mention it. A Cochrane review of pelvic floor muscle training against no treatment found that women doing the training were more likely to report cure or improvement of incontinence, with better quality of life scores. The evidence is stronger for this than for most things sold to women of this age.
Finding the right muscles
The contraction is a lift and squeeze around the openings, as if stopping wind and holding urine at once, drawn gently upwards and inwards. Your buttocks, thighs and stomach should stay quiet, and you should keep breathing. Do not practise by stopping your urine mid-flow more than once as a test; done regularly it can interfere with bladder emptying.
The programme that was actually tested
Trials typically use eight to twelve contractions, three times a day, most days, for at least three months, mixing long holds of six to eight seconds with a few quick contractions. That repetition is the part people skip. Attach the sets to things you already do daily, such as the kettle, the news and brushing your teeth, and the habit survives a busy week.
| When | What | How many |
|---|---|---|
| Morning | Long holds, 6-8 seconds | 8-12 |
| Midday | Long holds plus quick contractions | 8-12 plus 10 quick |
| Evening | Long holds | 8-12 |
| Before effort | The knack: contract, then cough or lift | Every time |
Use it before the moment, not after
The most useful skill is the one physiotherapists call the knack: a deliberate contraction just before you cough, sneeze, lift a bag or stand up from a chair. Practising the contraction on its own builds the muscle; timing it against real pressure is what stops the leak. Train both.
What to expect, and when to get help
Improvement usually starts around six to eight weeks and continues for months. If nothing has changed after three months of genuine practice, or if you have pain, a dragging or heavy sensation, leaking of stool, or you are unsure you are contracting correctly, ask for a referral to a pelvic health physiotherapist. Being examined by someone who can confirm the contraction is the single fastest way to fix a programme that is not working.
Training around it
You do not have to stop lifting. Exhale on the effort, avoid holding your breath under a heavy load, and progress weight gradually. If a particular movement provokes leaking, reduce the load rather than abandoning the pattern, and rebuild it as the pelvic floor gets stronger. Vaginal dryness and urinary urgency have separate treatments, including non-hormonal options, and they are worth raising with your clinician rather than tolerating.
Questions
Do pelvic floor exercises really work after menopause?
A Cochrane review found women doing pelvic floor muscle training were more likely to report cure or improvement of urinary incontinence than women receiving no treatment, with better quality of life scores.
How long until leaks improve?
Most trials run for at least three months, and women often notice change around six to eight weeks of consistent daily practice.
Should I stop lifting if I leak?
No. Reduce the load, exhale on the effort, contract before you lift, and rebuild gradually. If it persists, see a pelvic health physiotherapist.
Further reading
- Dumoulin et al. (2018), Pelvic floor muscle training versus no treatment for urinary incontinence in women, Cochrane Database of Systematic Reviews
- The 2023 nonhormone therapy position statement of The North American Menopause Society, Menopause
- World Health Organization 2020 guidelines on physical activity and sedentary behaviour, British Journal of Sports Medicine
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