Exercises for Incontinence and Bone Health

Estrogen is the scaffolding molecule. It maintains bone mineral density. It preserves collagen in connective tissue. It supports the structural integrity of your pelvic ligaments. When it drops, all three systems weaken simultaneously.

The bone loss numbers are stark. Women lose up to 20% of their bone density in the five to seven years following menopause. A meta-analysis of exercise and bone health found that impact and resistance exercises improved lumbar spine and femoral neck BMD in postmenopausal women. The effect was dose-dependent: more intense exercises produced larger improvements.

Pelvic floor research is equally compelling. A systematic review and meta-analysis found pelvic floor muscle training reduced urinary incontinence symptoms in postmenopausal women with moderate to large effect sizes. But the interesting finding was that combined exercise, meaning pelvic floor work plus general fitness, produced better outcomes than pelvic floor training alone.

A randomized controlled trial comparing Pilates to targeted pelvic floor exercises found equivalent incontinence improvements. That matters because many women cannot correctly activate their pelvic floor in isolation. Whole-body exercises that include the pelvic floor as part of the kinetic chain may be more practical for most women.

The exercises for incontinence and bone health on this page are designed to address both issues simultaneously. Because in perimenopause, they are the same problem: estrogen-dependent tissue losing its structural support.