Lifting Heavy with Pelvic Floor Issues: A Menopause Guide

Papayya's Team

September 29, 2026

We’re constantly telling you that strength training is one of the best things you can do in midlife. You can see it, it’s all over the blog.

However, we noticed that once that pelvic pain starts to take its toll when doing a squat, for example, or you started to notice a little “leak” and people quietly started to drop lifting altogether.

We understand that, but you don’t have to. You just need a smarter way to lift.

What’s menopause’s deal?

Hormonal changes during menopause can increase the risk of pelvic floor issues such as urinary incontinence or pain during sex and can reduce the muscle volume and strength of the pelvic floor. And studies show that this is a problem that can affect 41 to 50% of women over 40.

We also know that women lose 3 to 5% of muscle mass per decade during this phase and resistance training helps prevent that loss. And why do you need to keep training? Because losing strength is a bigger risk than lifting weights itself.

What does research show?

Well, there’s mixed feelings about this evidence so let’s talk about.

A systematic review found at the International Urogynecology Journal found a clear connection between pelvic floor dysfunction and women’s participation in powerlifting and weightlifting. Reported incontinence rates were about 41-49% in powerlifters, while it rates 37-54% in weightlifters. Although these are figures that come from athletes, they show that leaking under heavy load is common.

In another study made of trained, premenopausal women who’d had vaginal births and had no prolapse symptoms, a single heavy squat session caused small immediate pelvic floor changes with minor impact on organ support.

And what’s the takeaway then? The takeaway is that heavy lifting isn’t proven to be dangerous, but it isn’t proven to be harmless either. Technique, load selection and listening to symptoms matter a lot.

What doctors recommend.

According to the POGP (Pelvic, Obstetric and Gynaecological Physiotherapy), the UK professional network for pelvic health physiotherapists, you should:

Avoid unnecessary strain. Get advice on safe lifting.
Use “The Knack”. Tighten your pelvic floor muscles before any activity that raises abdominal pressure, such as coughing, or lifting.
Relax between contractions. POGP says to let your pelvic floor muscles relax fully after every contraction.
If exercising triggers stress urinary incontinence, try low-impact activity such as pilates, walking or swimming.
If needed, combine training with treatment.

How to brace without bearing down

Bracing is a bit of a trap. Bracing too hard or holding your breath and pushing can be working against you. Mayo Clinic’s physiotherapist warns that heavy lifting can make you strain your pelvic floor instead of activating it.

Set your posture, take a breath and gently lift and tighten your pelvic floor before you start the rep.
Breathe out as you stand up from the squat. Try not to hold your breath and push down.
Aim for a gentle, even tension around the trunk, as if bracing for a light poke.
Let everything soften at the top or bottom and rest between sets.
If you feel heaviness, bulging or leaking, lighten the load or reduce the reps.

What physiotherapists recommend

According to a PROPEL protocol:

Lower the load;
Reduces reps or slow the tempo;
Change the variation;
Reduce impact;
Track your symptoms.

If you have persistent leaking, heaviness, pain or a feeling of bulging, see your doctor.

Where can a personal trainer fit in

A pelvic health physiotherapist assesses and treats the pelvic floor, but it’s the trainer’s job to help you apply that guidance while you train.

At Papayya, sessions are live 1-on-1 video calls with certified personal trainers that guide you through the whole workout in real time. A trainer can watch your breathing, tempo and range of motion and adjust before symptoms show up. Every session is planned around your goals, fitness level and needs, including existing conditions. For someone managing leaks, that means picking and scaling exercises to what your body can handle today. You don’t need any special equipment, just a phone or a laptop. That makes it easier to build back up gradually at home, without having to go to a busy gym floor.

Bottom Line

Pelvic floor symptoms in menopause are common and they’re not a reason to give up on strength training. The evidence suggests that heavy lifting is worth keeping, with attention to breathing, bracing, load and scaling and with professional support if symptoms persist.