Pelvic Floor Physical Therapy During Perimenopause: How to Strength Train Without Causing Prolapse or Hip Pain
Perimenopause and menopause.
Y’all… I’ve been saying this for a WHILE now—years even. The revolution is coming.
And guess what? It’s officially here.
If you identify as a woman and haven’t heard the words perimenopause, menopause, or hormone replacement therapy (HRT)… then, in the kindest way possible, you might be living under a rock. And bless your heart, too.
But here’s the thing no one is talking about enough:
How perimenopause impacts your body when you exercise—especially when you start lifting heavier.
Why Exercise Feels Different During Perimenopause
I was recently asked to give a talk on pelvic floor physical therapy and perimenopause, and I was SO excited—because not surprisingly, I have a lot to say.
One of the biggest trends I’m seeing right now?
Women in their 40s and 50s are diving into strength training and heavy lifting (which I LOVE)… but they’re also experiencing a spike in:
Hip pain
Low back pain
Pelvic floor dysfunction
Pelvic organ prolapse symptoms
And it’s not because lifting is bad.
It’s because your body is changing—and your strategy needs to change with it.
Is Strength Training Safe During Perimenopause?
Let me be very clear, per the Menopause society:
Strength training for women over 40 is one of the BEST things you can do.
It supports:
Bone density
Muscle mass
Metabolism
Hormonal health
Longevity
But there’s a right way to do it—especially during perimenopause and menopause.
Without the right foundation, heavy lifting can contribute to:
Increased intra-abdominal pressure
Poor pelvic floor coordination
Worsening prolapse symptoms
Chronic hip and back pain
Real Patient Example: When Heavy Lifting Triggers Pelvic Floor Symptoms
Case in point:
A 47-year-old woman, “Jessica,” came in for pelvic floor physical therapy with:
Pelvic organ prolapse symptoms
Right glute and hip pain
She had been doing barre classes consistently for years and always had some “annoying” hip discomfort—but like many women, she pushed through it.
Then she added heavier strength training with compound movements.
That’s when everything escalated.
Her hip pain worsened significantly. She started experiencing pelvic heaviness (a common sign of pelvic floor dysfunction), and eventually, the pain affected how she walked.
That’s when she knew something wasn’t right.
What We Found: Common Issues in Perimenopausal Athletes
Her evaluation revealed:
Pelvic floor weakness
Tight hip rotators and glute medius
Functional hip strength deficits
Poor breathing and pressure management during squats
And honestly?
This is not uncommon.
The Missing Link: Pelvic Floor + Strength Training
From a pelvic floor physical therapy perspective, her case was straightforward.
Yes—we treated muscle tightness and used manual therapy to relieve pain.
But that’s just the beginning.
The real work is:
Restoring pelvic floor strength and coordination
Improving breathing mechanics (especially during lifts)
Fixing movement patterns
Building strength progressively
Because if you don’t address the root cause, the pain—and symptoms—will come back.
Why Your Squat Technique Matters More Than You Think
One of the biggest changes we made?
Her squat mechanics.
The technique often used in barre (hello, tuck) is very different from what your body needs when performing:
Barbell squats
Deadlifts
Kettlebell movements
If you’re using the wrong strategy under load, you can:
Increase pressure on the pelvic floor
Overload your hips
Reinforce poor movement patterns
How to Safely Return to Strength Training
I told her she wasn’t quite ready to get back “under the bar” yet—and she was completely on board.
Instead, we created a progressive strength training plan that allowed her to:
Rebuild foundational strength
Improve pelvic floor function
Reduce pain
Safely return to lifting
By our third session, she was already feeling a huge difference.
The Big Question: Should You Stop Lifting?
She eventually asked me:
“Is heavy lifting even right for me?”
And my answer?
The best exercise for you is the one you enjoy.
All movement is good—but consistency is everything. And if you enjoy it, you’re far more likely to stick with it long-term.
You don’t need to stop lifting.
You just need to do it in a way that supports your body—not fights against it.
When to See a Pelvic Floor Physical Therapist
If you’re in perimenopause or menopause and experiencing:
Hip pain that won’t go away
Pelvic heaviness or pressure
Urinary leakage during exercise
Low back pain with lifting
Discomfort with core or strength workouts
It’s time to get evaluated.
These are common—but they are NOT something you have to just live with.
Final Thoughts: You Deserve to Feel Strong at Every Stage
At Empower Yourself PT, our goal is simple:
To help women navigate perimenopause and menopause safely, build strength, and continue doing the workouts they love—without pain, leakage, or fear of prolapse.
Because you deserve to feel strong, confident, and capable in your body at every stage of life.
Ready to Get Back to Feeling Like Yourself?
If you have questions about:
Prolapse symptoms
Hip pain
Exercise during perimenopause
Reach out at info@empoweryourselfpt.com, click here, or call/ text at 832-463-1152. We’re here to help!