Midlife Leaks Are Common, Not Inevitable: Teaching PfilAtes™ to Clients in Menopause

PfilAtes™ Instructor Notes · Week 5

Many midlife clients run, lift, and hike, and some quietly leak during jumping jacks, assuming it’s just part of getting older. Your job isn’t to treat it or to talk hormones. It’s to give her a pelvic floor routine she can feel, and to know when her questions belong with her clinician.

What the research says (and doesn’t)

• Timing matters. In the SWAN study of midlife women, starting to leak (at least monthly) was more likely during the perimenopause years than before them (Waetjen et al., Obstetrics & Gynecology, 2009). That’s an association, not proof that hormones cause leaks.
• Muscle matters. Across 7 observational studies of more than 45,000 adults, people with age-related muscle loss had higher odds of urinary leakage (Guo et al., BMC Geriatrics, 2026). It doesn’t show that exercise reverses it, but it’s a fair reason to keep her strong.
• The pelvic floor is measurably different. Postmenopausal women with stress leakage had weaker pelvic floor muscles on manual testing and surface EMG than women without leakage (Zhang et al., Experimental and Therapeutic Medicine, 2025). EMG here is a way to assess, not a therapy.

Scope: what to say about hormones

Clients will ask whether they need estrogen or HRT. That’s a medical question. Try: “That’s a great question for your doctor. What I can do is help you train the muscles that support your bladder.”

The movement: Side-Lying Bent Knee Lift

It’s low-impact and easy to feel. Lie on one side, head on the extended arm, top hand on the mat in front. Keeping the knee bent, lift the top leg. Peak engagement comes about halfway to vertical, at roughly 45 degrees.

Add the pulse at that 45-degree point:

1. Stay small. Lift and lower the knee in a tiny range around the hold point. Don’t drop all the way down.
2. Breathe it out. Each lift gets a quick, forceful, open-mouthed exhale that snaps the deep abdominals in.
3. Lift from inside. On that same exhale, squeeze the glute and draw the pelvic floor up on purpose. On the inhale, let everything soften.

Cue to borrow: “Knee up, ‘ha,’ lift inside. Now let it all go.”

Know when to refer

Send her to her physician or a pelvic health physical therapist if she reports burning or frequent urinary infections, vaginal dryness or pain with intercourse, a heaviness or bulging feeling, blood in the urine, sudden new urgency, or leaking that keeps getting worse.

Your drill this week

Pick one client over 45. Teach the Side-Lying Bent Knee Lift on both sides, have her rate how strongly she feels it on the Movement Selection Worksheet (0 none to 3 strong), and ask her to add it to her routine twice a day for a week. Next session, ask what she noticed during her workouts.

References - Waetjen LE, et al. Association between menopausal transition stages and developing urinary incontinence. Obstet Gynecol 2009;114(5):989–998. doi:10.1097/AOG.0b013e3181bb531a. PMID 20168098. - Guo Z, et al. Sarcopenia as an independent associated factor for urinary incontinence in adults: a systematic review and meta-analysis of observational studies. BMC Geriatr 2026;26(1):1338. doi:10.1186/s12877-026-08035-z. PMID 42919125. - Zhang Z, et al. Pelvic floor muscle function differs between postmenopausal women with and without stress urinary incontinence: an experimental parallel-controlled study. Exp Ther Med 2025;30(2):160. doi:10.3892/etm.2025.12910. PMID 40599420.