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The LIFTMOR trial studied 101 postmenopausal women with low bone mass. For eight months, one group completed two supervised, 30-minute sessions each week of progressively introduced heavy resistance and impact exercise. The programme included deadlifts, back squats, overhead presses and jumping chin-ups with drop landings. The comparison group followed a low-intensity home exercise programme.

Lumbar spine bone mineral density increased by 2.9% in the supervised group, compared with a 1.2% decrease in the comparison group. Femoral neck bone density was largely maintained in the supervised group while it declined in the comparison group. Leg and back strength, and performance on physical function tests, also improved. These results apply to a carefully screened group training with close supervision; the trial did not establish whether the programme prevents fractures.

At Refresh Physio, Catherine brings expertise in exercise prescription and resistance training to individualised rehabilitation. Assessment is made of each person’s starting point, goals and bone health, then guide the gradual progression of exercises and loading. LIFTMOR supports the value of supervised, well-designed training for women with low bone mass.

If you’ve noticed vaginal dryness, discomfort, pain during sex, bladder irritation, or recurrent urinary symptoms since entering perimenopause or menopause, you’re not alone. These symptoms may be caused by Genitourinary Syndrome of Menopause (GSM)—a common condition affecting around 60–75% of women after menopause.

GSM develops as oestrogen levels decline, causing changes to the tissues of the vulva, vagina, urethra and bladder. Unlike hot flushes, these symptoms usually don’t improve over time without treatment and can gradually worsen if left unaddressed.

Common symptoms include:

• Vaginal dryness or reduced natural lubrication
• Burning, itching or irritation
• Pain during intercourse
• Vaginal tightness or discomfort with penetration
• Urinary urgency or frequency
• Burning when passing urine
• Recurrent urinary tract infections
• Reduced sexual comfort and confidence

How can physiotherapy help?

Pelvic health physiotherapy is an important part of managing GSM, particularly when pain, muscle tension or pelvic floor dysfunction contribute to symptoms.

Your assessment may include:

• Education about GSM and the changes that occur during menopause
• Advice on vaginal moisturisers and lubricants
• Assessment of pelvic floor muscle function
• Treatment of overactive or painful pelvic floor muscles
• Vaginal dilator therapy where appropriate
• Strategies to improve comfort during intimacy
• Bladder and bowel management advice
• Exercise and lifestyle recommendations to support pelvic health

Treatment is always individualised and designed around your goals and comfort.

Other treatment options

Many women benefit from combining physiotherapy with medical treatment.

Depending on your symptoms, your GP or menopause specialist may recommend:

• Non-hormonal vaginal moisturisers and lubricants, which can improve comfort and reduce friction.
• Low-dose vaginal oestrogen, available as creams, pessaries, tablets or rings. These treatments act locally to restore the health, thickness and elasticity of vaginal tissues and are considered safe and highly effective for most women.
• Other prescription options, such as vaginal DHEA (prasterone) or ospemifene, may be suitable for some women depending on their medical history.

If you have a history of breast cancer or other hormone-sensitive conditions, treatment decisions should be made in collaboration with your GP, menopause clinician or oncologist.

What about vaginal laser therapy?

Vaginal laser therapy has been studied as a possible treatment for GSM. While some women report improvement, current evidence is still evolving, and larger, high-quality studies are needed to confirm its long-term safety and effectiveness. At present, professional menopause societies generally recommend established treatments, including vaginal moisturisers, vaginal oestrogen where appropriate, and pelvic health physiotherapy, as first-line management.

You don’t have to put up with these symptoms

Many women assume that vaginal dryness, bladder symptoms or painful sex are an inevitable part of ageing—but effective treatments are available.

If GSM is affecting your comfort, confidence or quality of life, we’d be happy to assess your symptoms and work alongside your GP or menopause specialist to develop a personalised treatment plan.

Understanding Your Pelvic Floor

Your pelvic floor is a group of muscles that form the base of your pelvis. These muscles provide
support for your bladder, bowel and uterus (or prostate in men) and play an important role in
bladder and bowel control, sexual function, pregnancy, childbirth and everyday movement.
Healthy pelvic floor function is about much more than muscle strength. Your pelvic floor needs to
contract when support is required, but it also needs to relax and lengthen at the right time. It should
respond automatically to everyday activities such as coughing, sneezing, lifting, running and jumping,
while also relaxing to allow comfortable bladder and bowel emptying, sexual activity and childbirth.
The pelvic floor also works as part of a wider team of muscles, including your diaphragm, abdominal
muscles, back muscles and hips. Together, these muscles help regulate pressure within your
abdomen, support your spine and pelvis, and contribute to efficient movement during work,
exercise and sport.

When the pelvic floor is not functioning optimally, symptoms can occur. These may include bladder
leakage, urinary urgency or frequency, constipation or difficulty emptying the bowel, pelvic organ
prolapse, pelvic pain, pain during intercourse, or difficulty returning to exercise after pregnancy.
Importantly, these symptoms are not always caused by weakness. Sometimes the pelvic floor is
overactive, unable to relax effectively, or not coordinating appropriately with the rest of the body.
At Refresh Physio, assessment goes beyond measuring muscle strength. We assess how your pelvic
floor contracts, relaxes, coordinates, responds to movement and functions as part of your whole
body. Treatment is individualised and may include education, pelvic floor muscle retraining,
breathing and pressure management, strength and exercise prescription, movement retraining,
bowel and bladder strategies, and guidance to help you confidently return to the activities that
matter most to you.

Whether your goal is to stop leaking, reduce pelvic pain, improve prolapse symptoms, return to
running after having a baby, or simply feel stronger and more confident in your body, pelvic health
physiotherapy aims to restore optimal function—not just stronger muscles.

Iron Deficiency in Active Women & Female Athletes

Iron deficiency is one of the most common—and often overlooked—factors limiting health, recovery, and performance in active women.

From supporting oxygen transport and energy production to playing a key role in muscle function and recovery, adequate iron levels are essential for optimal training and everyday wellbeing. Yet many women are at increased risk due to a combination of factors, including menstrual blood loss, high training loads, and low energy availability (RED-S).

Even in the absence of anaemia, low iron levels can impact:

• Endurance and aerobic capacity
• Strength and training adaptations
• Recovery and fatigue levels
• Cognitive function and concentration

Female athletes—particularly those in endurance sports—are especially vulnerable. Repeated training stress, inadequate dietary intake, and physiological demands can create a mismatch between iron intake and losses.

At Refresh Physio, assessment goes beyond symptoms alone. We consider the full picture:

• Training load and recovery
• Menstrual health
• Nutrition and energy availability
• Injury history and performance goals

Where appropriate, we can guide evidence-informed strategies including nutrition, supplementation, and training modifications to restore iron levels and support long-term health and performance.

Early identification and targeted management of iron deficiency can make a meaningful difference—not just to performance, but to how you feel day to day.

Reference

Pengally et al., 2024

Obstetric anal sphincter injuries (OASI) are severe perineal tears that can occur during vaginal birth and involve damage to the anal sphincter muscles. These injuries are estimated to affect around 1–5% of women following childbirth and may have important implications for pelvic floor function and overall wellbeing.

Women who sustain an OASI may experience symptoms such as difficulty controlling gas or bowel motions, faecal urgency, pelvic or perineal pain, urinary symptoms, or discomfort with sexual activity. While prompt recognition and immediate surgical repair after birth are essential components of care, recovery can take time and some women may continue to notice ongoing symptoms in the months or years following delivery.

Research shows that persistent bowel or pelvic floor symptoms can impact confidence with exercise, social participation and intimacy, highlighting the importance of comprehensive follow-up and rehabilitation. Contemporary clinical guidelines recommend pelvic health physiotherapy as part of multidisciplinary recovery, supporting women to optimise pelvic floor function, improve symptom control and safely return to valued daily activities.

Future birth planning is also an important part of recovery after OASI. Women are often supported to make informed decisions about the mode of delivery in subsequent pregnancies, taking into account their current symptoms, pelvic floor function and individual preferences. Collaborative care involving obstetric providers and pelvic health physiotherapy can help guide this process, with the aim of reducing the risk of further injury while supporting confidence and wellbeing in future pregnancies.

Early assessment and individualised rehabilitation can make a meaningful difference to long-term outcomes. If you have experienced a severe tear during childbirth and are noticing ongoing pelvic floor symptoms, seeking specialised pelvic health support may help you regain comfort, confidence and function.

New research published in Medicine & Science in Sports & Exercise (the flagship journal of the American College of Sports Medicine) is challenging long-held assumptions about high-intensity and high-load resistance training in early pregnancy.

This study examined women in their first trimester who were already engaged in high-load resistance training prior to pregnancy. Importantly, it explored an area often missing from pregnancy exercise research: pelvic floor health.

Key findings included:

• Pelvic floor symptoms (including stress urinary incontinence) did not worsen in the first trimester and, in many cases, improved
• Many women safely maintained high training loads (>80% of pre-pregnancy 1RM)
• Miscarriage rates were consistent with population norms, with no increased risk associated with high-load training
• Pre-conception pelvic floor symptoms were common — highlighting the importance of pelvic health assessment before and during pregnancy
• Fatigue and nausea, rather than safety concerns, were the main barriers to exercise in early pregnancy

This research reinforces the importance of individualised, evidence-informed guidance rather than blanket restrictions — particularly for active and athletic women. It also highlights a critical gap in care following miscarriage, where many women receive little or no guidance on returning to exercise.

(Prevett & Davenport, 2026)

The Knack: Timing Matters for Bladder Control

Did you know that timing your pelvic floor contraction can significantly reduce urinary leakage?

The Knack is a pelvic floor strategy that involves a gentle lift of the pelvic floor muscles just before activities that increase abdominal pressure — such as coughing, sneezing, lifting, or jumping.

Research shows that performing a well-timed pelvic floor contraction before these moments can dramatically reduce urine leakage, particularly for women with stress urinary incontinence. In some studies, leakage during coughing was reduced by up to 98% when the Knack was used correctly (Miller et al., 2008).

The Knack works by helping the pelvic floor brace and support the bladder neck and urethra before pressure hits. While strength is important, evidence shows that timing and coordination are just as critical.

He mea nui te wā tika — timing matters.

It’s important to know that the Knack is not just a simple squeeze. Correct activation, timing, and integration with breathing and movement are key for it to be effective. Research shows that women who receive guidance and practice with a physiotherapist report significant improvements in bladder control compared with general advice alone (Miller et al., 2020).

Ū tonu ki te wā tika.
Consistency and correct technique are essential.

A pelvic health physiotherapist can:

• Check that you’re activating the correct muscles
• Tailor the technique to your body, symptoms, and activities
• Integrate it safely into daily tasks, exercise, and sport

Learning and practising the Knack under professional guidance ensures maximum benefit and safety

 

• MHT is the most effective treatment for hot flushes & quality-of-life symptoms in menopause. Confusion following the early 2000s Women’s Health Initiative (WHI) led to fear & misinformation… Evidence has been updated… He maramatanga hou, he oranga hou – new knowledge supports better wellbeing. 

 

Myth 1: MHT will make you gain weight – He whakaaro hē tēnei – this is incorrect. 

• Women using MHT do not gain more weight than women who don’t. Midlife weight changes are mainly due to ageing, lifestyle & social factors. Menopause can shift fat distribution toward the abdomen – not caused by MHT. Ko te pakeketanga te take matua – ageing is the main driver. 

 

Myth 2: Breast cancer is the most common cause of death after menopause. 

• Fear of breast cancer is a major reason women avoid MHT. Heart disease & stroke are far more common causes of death. Breast cancer deaths are lower than cardiovascular causes. Me matua titiro ki te katoa o te hauora – we must look at the whole picture of health. 

 

Myth 3: 1 in 4 women on MHT get breast cancer – He iti noa te tūraru – the risk is small & time dependent. 

• This is misreported MHI data. Updates evidence shows: 

Combined MHT (oestrogen + progestogen) 

No increase in breast cancer risk in women  aged 50 – 49 or within 10 years of menopause.

After 13 years: Small increase (9 extra cases per 10,000)

Oestrogen-only MHT – no breast cancer risk even after long term follow-up. 

 

Myth 4: MHT increases heart disease risk. 

• Analysis of 40,000+ women shows:

No increase in deaths from heart or blood vessel disease. 

No increase in heart atacks or angina. 

This applies to healthy women & those with existing cardiovascular disease. 

Mā te mohio tika ka heke te mataku – knowledge reduces fear. 

 

Myth 5: You need a blood test to diagnose menopause – Ehara i te mea me whakamātou toto – it is not necessary to have a blood test. 

• Menopause is a clinical diagnosis + 12 monthjs after your last period – blood tests may help only: 

Women under 40.

Women with a hysterectomy & symptoms. 

Ka rangona te tinana – the body tells the story 

 

Myth 6: Natural therapies are safer & just as effective – He iti noa te tainakitanga mō ēnei rongoā – there is limited evidence for these treatments. 

• MHT remains the most effective treatment for menopause symptoms. Many “natural” products lack evidence, regulation or safety testing. Some (e.g soy) may be insafe for women who can’t take MHT. online products may be contaminated or unreliable. Kōreri ki tō rata – always discuss options with your doctor.

 

Myth 7 & 8: Bioidenticals & progestogens – Ngā tangirua e rua – 2 areas of confusion. 

• Compounded bioidentical hormones:

Are not safer or better than prescribes MHT. they are not regulated, quality & safety are not checked. Associated with serious risks (e.g endometrial cancer). 

• Progestogens:

Not all progestogens carry the same risks 

Progesterone is different from synthetic progestins

He rongoā mō te tangata, ehara i te rongoā kotahi mō te katoa – Treatment should be individualised, there is no one size fits all. 

 

Myth 9: Non-hormonal options work just as well – He iti ake te whai hua i te MHT.

• Non-hormonal medications are less effective for hot flushes.
• Useful when MHT isn’t appropriate or desired. 
• Decision making should be shared and informed. 

 

KEY MESSAGES: 

Many myths stem from early MHI reporting. 

Modern evidence shows that MHT is effective & safe for many women. 

Best outcomes occur when MHT is started within 10 years of menopause. 

He mana tō te wahine ki te kōwhiri – women deserve informed choice. 

 

 

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