You might think of physical therapy (PT) as something you need after an injury. But can it help with menopause symptoms? In many cases, yes. PT may help with joint pain, urinary incontinence (loss of bladder control), pain during sex, and more.

Still, physical therapy doesn’t always come up during conversations with a menopause specialist. To help you feel informed and supported, ThisIsMenopause spoke with Dr. Cindi Rauert Lanners, a board-certified clinical specialist in women’s health and pelvic health in Colorado who has a doctorate in physical therapy.

What Is Physical Therapy?

Physical therapy, also called physiotherapy, is a type of medical care that helps you move your body more easily and safely. You work with a licensed physical therapist who creates a plan based on your needs.

Your physical therapist may guide you through exercises and use manual therapy (hands-on techniques), such as joint or soft tissue mobilization, to improve movement. They may also use other approaches — like dry needling or biofeedback — depending on your symptoms and goals.

Physical therapy may have a wide range of benefits, including:

• Improving your range of motion
• Helping you move and function more easily
• Supporting recovery from injuries
• Helping prevent injuries from occurring
• Reducing pain
• Boosting quality of life

How Can PT Help With Perimenopause Symptoms?

During perimenopause, your body produces less estrogen. With hormonal changes, you may notice new symptoms. Some research suggests that physical therapy may help improve certain menopause-related symptoms.

Genitourinary Syndrome of Menopause

Physical therapy can play an important role in treating genitourinary syndrome of menopause (GSM) — a cluster of symptoms that involve the vaginal and urinary tissues. GSM affects 27 percent to 84 percent of postmenopausal women.

GSM develops as estrogen levels decline, Lanners said: “In the vaginal tissues, it can make the muscles atrophy, meaning they get smaller. That estrogen really plumps up the pelvic floor muscles and all of the tissue. When we start to lose it, we see some changes in that external vulvar tissue. It can become more sensitive and more painful. The internal mucosal lining of the vaginal tissue can also become dry and irritated.”

GSM can affect daily comfort and overall well-being. Symptoms may include:

• Frequent urination or a sudden urge to urinate
• Bladder leaks, such as when sneezing
• Urinary tract infections
• Vaginal dryness
• Pain during sex

How PT Helps With Genitourinary Syndrome of Menopause

Pelvic floor physical therapy can address GSM-related concerns such as bladder leakage and sexual function. Your therapist will ask about your symptoms and goals so they can tailor a treatment plan to your needs.

“In physical therapy, we can teach people how to contract but also to lengthen the muscles in the pelvic floor,” Lanners said. “As pelvic floor physical therapists, we can palpate those muscles internally. This means we’re able to put pressure on those muscles and see: Are they doing the job in the best way that they can? Are they wimpy? Are they strong but not coordinated?”

A physical therapist can also teach you breathing exercises to help relax and lengthen the pelvic floor. “A Kegel exercise involves contracting those muscles,” Lanners said. “Some people call it a reverse Kegel when they’re lengthening the pelvic floor, and that’s done with breathing.”

If you have tight or tender pelvic floor muscles, this strategy may help improve comfort during sexual activity.

Your physical therapist may help you build up the muscles that support the pelvic floor, including the abdomen and hips. In some cases, these muscles may be weak. In others, they may be strong but not moving through a full range of motion or working in a coordinated way.

Musculoskeletal Syndrome of Menopause

Muscle and joint pain are common during perimenopause and menopause. One study indicated that over 70 percent of women in menopause report these types of symptoms. In another study, 21 percent of women described joint pain as their most bothersome menopause symptom.

The term “musculoskeletal syndrome of menopause” describes a group of symptoms that affect the muscles, joints, and bones. These changes are linked to shifting hormone levels, including a drop in estrogen during the menopause transition.

Estrogen helps support joint and tissue health. As levels decline, pain or stiffness in the hands, shoulders, knees, and other joints can increase.

How PT Helps With Joint Pain

“We often use a combination of manual therapy techniques where we’re hands-on treating the joint or the affected body part. Then we do some movement, and as you feel more confident, you’ll exercise at home,” Lanners said. “It’s really that combination of the two things that can be super helpful.”

If you have a specific goal, it’s important to let your physical therapist know. For instance, if you have a condition like frozen shoulder and want to return to activities such as golfing, your therapist can help you work toward that goal. They can also teach strategies to help maintain joint mobility over time so you can keep doing the activities that matter to you.

Other Menopause-Related Symptoms

During the menopause transition, some symptoms — such as joint pain or discomfort during sex — may be more noticeable. Others, such as insomnia, anxiety, or depression, may be less visible but can still affect your daily life.

How PT Helps With Sleep and Mental Health

A physical therapist can offer strategies to improve sleep quality. They can provide tips for better sleep habits, gentle exercises (including breathing techniques), ways to reduce pain that may be interfering with sleep, and guidance on comfortable sleep positions.

Physical therapy may also support mental health. Movement, exercise, and relaxation techniques help calm the nervous system and reduce stress. A physical therapist can suggest ways to build an exercise routine or introduce new lifestyle habits that may help improve mood.

Physical therapists tailor treatment plans to each person’s goals and preferences. “Whatever form you can be most consistent with over your lifetime is going to be extremely beneficial,” Lanners said.

How Can You Find a Physical Therapist for Menopause Symptoms?

If you’re interested in trying physical therapy, you may be able to start without a referral. All states support direct access to physical therapy, meaning you can see a physical therapist without first seeing another healthcare provider. However, some insurance plans, including Medicare, may still require a referral.

If needed, you can ask your primary care provider, gynecologist, or other healthcare professional for a referral. If you’re not sure where to start, the American Physical Therapy Association (APTA) offers a physical therapist locator tool, Lanners said. You can also search specifically for an APTA pelvic health physical therapist.

Get the Help You Need

Lanners encourages everyone with symptoms to consider seeing a physical therapist, especially for pelvic floor dysfunction. “These symptoms can be common, but they’re not normal, and they do impact your quality of life over the long term,” she said.

“You deserve to be more comfortable — to not have to put up with an overactive bladder, urinary leakage, painful sexual activity, or any other challenge that’s going on,” Lanners said. “It’s better to treat it when your symptoms are more mild to moderate than when they’re more severe.”