A Guide to Pelvic Pain and Menopause

Menopause is a natural phase in a woman’s life that typically occurs between the ages of 45 and 55. This transition marks the end of the reproductive years and is accompanied by a range of physical and hormonal changes. One of the common and often underestimated issues faced by women during menopause is pelvic pain. The discomfort caused by menopause-related pelvic floor problems can significantly impact a woman’s quality of life, and understanding the causes and treatment options – and finding the right pelvic floor specialist or prolapse specialist – will help get you effective solutions.

Menopause-specific pelvic floor problem

The pelvic floor is a complex network of muscles, ligaments, and connective tissues that provide essential support to the pelvic organs, including the bladder, uterus, and rectum. During menopause, hormonal shifts, primarily the decrease in estrogen levels, can lead to various pelvic floor problems that contribute to pelvic pain.

• Vaginal atrophy: Estrogen plays a crucial role in maintaining the health and elasticity of vaginal tissues. With lower estrogen levels, these tissues can become thinner, drier, and more susceptible to irritation and pain during intercourse.
• Pelvic organ prolapse: The loss of estrogen can weaken the pelvic floor muscles, causing the pelvic organs to shift from their normal positions. This can result in discomfort and pain in the pelvic region, along with potential urinary and bowel issues.
• Urinary incontinence: Hormonal changes during menopause can impact the strength of the muscles that control urination. This can lead to stress incontinence – one of the most common pelvic floor problems women experience – where leakage occurs during activities like laughing, sneezing, or lifting, causing pelvic discomfort.
• Muscle spasms: Hormonal fluctuations can also contribute to muscle spasms in the pelvic floor, leading to chronic pain and discomfort.

Causes of pelvic pain during menopause

Several factors can contribute to pelvic pain and pelvic floor problems during menopause:

• Hormonal changes: Estrogen has a significant impact on the health and function of pelvic tissues. Its decline during menopause can lead to the thinning of vaginal walls, dryness, and reduced elasticity, causing discomfort.
• Muscle weakness: Lower estrogen levels can result in weakened pelvic floor muscles, leading to issues such as organ prolapse and incontinence, both of which can cause pain.
• Nerve sensitivity: Hormonal changes and tissue thinning can increase nerve sensitivity in the pelvic region, making women more prone to experiencing pain.
• Pre-existing conditions: Women who had pelvic pain or pelvic floor problems before menopause may find that these problems intensify during this phase.

Treatment options

The good news is that pelvic pain during menopause is manageable, and there are several treatment options available from your pelvic floor specialist or prolapse specialist:

• Hormone therapy: Hormone replacement therapy (HRT) can help alleviate menopausal symptoms by supplementing the body with estrogen. This can help improve vaginal health, reduce dryness, and alleviate pelvic pain.
• Pelvic floor exercises: Kegel exercises and other pelvic floor strengthening routines can help improve muscle tone and support in the pelvic area, reducing pain and the risk of organ prolapse and incontinence.
• Vaginal moisturisers and lubricants: Over-the-counter vaginal moisturisers and lubricants can provide relief from vaginal dryness, making intercourse more comfortable and reducing pain.
• Medications: Certain medications, such as pain relievers, muscle relaxants, or low-dose antidepressants, can manage pelvic pain.
• Lifestyle changes: Maintaining a healthy weight, staying hydrated, and avoiding irritants can contribute to pelvic health.
• Physical therapy: Your pelvic floor specialist or prolapse specialist can work with you to develop a personalised physiotherapy plan to target muscle weakness and pain.

When to speak to a pelvic floor specialist or prolapse specialist

While some degree of discomfort may be expected during menopause, it’s essential to consult the right healthcare practitioner when pelvic pain becomes persistent or severely affects your daily life. Here are some signs that indicate you should seek professional help for your pelvic floor problems:

• Chronic pain: If you experience ongoing pelvic pain that doesn’t improve with at-home remedies.
• Painful intercourse: If intercourse becomes consistently painful or uncomfortable due to dryness, irritation, or muscle tension.
• Bowel or bladder issues: Difficulty controlling urination or bowel movements, sudden urges, or pain while using the restroom can indicate pelvic floor problems.
• Organ prolapse symptoms: A sensation of pressure or bulging in the pelvic region may suggest pelvic organ prolapse.
• Impact on daily life: If pelvic pain starts to affect your ability to perform daily activities or enjoy a good quality of life, it’s time to seek help.

Pelvic pain during menopause is a real concern that should not be ignored. The changes in hormones and the resulting impact on pelvic floor muscles and tissues can lead to discomfort and decreased quality of life. However, with a combination of medical interventions, lifestyle changes, and pelvic floor exercises, women can effectively manage and alleviate pelvic pain during this transitional phase. If you’re experiencing persistent pelvic pain, consulting a pelvic floor specialist or prolapse specialist can provide personalised guidance and solutions to help you navigate this challenging period and any pelvic floor problems that come with it with greater comfort and confidence.