Postmenopausal Pelvic Pain and Pressure
After menopause, pelvic floor symptoms don’t necessarily go away. In fact, hormonal changes during perimenopause and postmenopause can contribute to a variety of pelvic, bladder, bowel, and sexual health symptoms.
You may already be familiar with some of the more common symptoms of menopause, such as hot flashes, brain fog, and difficulty sleeping. But the genitourinary symptoms of menopause (GSM) are also incredibly common and can have a significant impact on your quality of life. [Insert link to GSM blog]
There are also other causes of pelvic pain and pressure that become more common or more noticeable during the menopausal transition. Many of these conditions are treatable and benign, but pelvic pain should never automatically be attributed to "just menopause."
Let's take a look at some of the most common causes of pelvic pain and pressure after menopause, what they may feel like, and when it's important to see your doctor.
What Is "Postmenopause"?
To understand postmenopause, it helps to define the three stages of the menopausal transition.
Perimenopause: The menopausal transition. This is the period when hormone levels fluctuate, menstrual cycles may become irregular, and symptoms such as hot flashes, sleep changes, mood changes, and changes in vaginal and urinary function can begin.
Menopause: The point in time when you have gone 12 consecutive months without a menstrual period, assuming there is no other medical explanation for the absence of your period.
Postmenopause: The period of life after menopause.
Hormonal changes don't stop at menopause. Estrogen levels remain lower after menopause, and these changes can continue to affect the tissues and systems of the pelvis.
What Causes Pelvic Pressure After Menopause?
There isn't one single cause of pelvic pressure after menopause.
Lower estrogen levels can affect the vaginal and vulvar tissues, bladder and urethra, bowel function, and the muscles and connective tissues of the pelvic floor. These changes can contribute to symptoms such as:
Vaginal dryness or irritation
Pain with penetration
Urinary urgency or frequency
Changes in bladder control
Constipation or difficulty emptying the bowels
Pelvic floor muscle tension
A feeling of heaviness or pressure in the pelvis
Pelvic pressure can also be caused by conditions that are not directly related to menopause, including pelvic organ prolapse, constipation, bladder conditions, gastrointestinal issues, or an ovarian or other pelvic mass.
This is why persistent or new pelvic pain or pressure deserves an evaluation rather than automatically being attributed to hormonal changes.
How Hormonal Changes Affect Pelvic Tissue
Estrogen plays an important role in maintaining the health and function of the vulvar and vaginal tissues. As estrogen levels decrease during and after menopause, these tissues can become thinner, drier, and less elastic.
These changes are part of genitourinary syndrome of menopause (GSM) and can contribute to burning, irritation, vaginal dryness, pain with penetration, and urinary symptoms.
Hormonal changes can also occur alongside changes in muscle strength, coordination, and connective tissue support. These factors may contribute to pelvic floor dysfunction and can make symptoms such as pelvic pressure, urinary urgency, constipation, or pain more noticeable.
It's important to remember that pelvic pressure is not always caused by low estrogen alone. If you're experiencing a new or persistent sensation of pressure, your healthcare provider can help determine what's actually causing it.
Pelvic Organ Prolapse and What It Feels Like
Pelvic organ prolapse occurs when one or more of the pelvic organs — including the bladder, uterus, or rectum — bulges downward into the vaginal canal because the muscles and connective tissues supporting those organs are no longer providing the same level of support.
Age, pregnancy and childbirth, chronic constipation or straining, genetics, changes in connective tissue, and hormonal changes can all play a role.
Prolapse can feel different from person to person. Common symptoms include:
A feeling of heaviness or pressure in the pelvis
A sensation that something is "falling out"
A feeling similar to a tampon slipping or falling out
A vaginal bulge that you can see or feel
Increased urinary frequency or urgency
Difficulty emptying the bladder
Constipation or difficulty completely emptying the bowels
Discomfort with prolonged standing, walking, lifting, or exercise
Prolapse is classified into different stages based on how far the affected tissue descends. Some people have significant prolapse with very few symptoms, while others experience substantial discomfort from a relatively mild prolapse.
Can Pelvic Floor PT Help Prolapse?
Absolutely.
Pelvic floor physical therapy is an important conservative treatment option for pelvic organ prolapse. Your therapist can evaluate the strength, endurance, coordination, and resting tone of your pelvic floor muscles and determine how they are working with the rest of your body.
Treatment may include strengthening the pelvic floor and surrounding muscles, improving pressure management, addressing constipation and bowel mechanics, modifying movements that aggravate symptoms, and teaching you how to coordinate your pelvic floor during activities such as lifting, coughing, exercising, and getting up from a chair.
The goal isn't simply to "do more Kegels." Your pelvic floor needs to be able to contract, relax, and coordinate appropriately with the rest of your body.
Ovarian Cysts After Menopause
Ovarian cysts can occur at any age, although the types of cysts commonly seen before menopause are less common after menopause because ovulation has stopped.
A cyst or other ovarian/adnexal mass after menopause may be found incidentally during imaging, or it may cause symptoms such as:
Pelvic or abdominal pressure
Dull or aching pelvic pain
Sudden or sharp pelvic pain
Bloating
Feeling full quickly
Changes in bowel or bladder function
Pain with penetration
Importantly, new pelvic symptoms after menopause should not automatically be assumed to be an ovarian cyst. If your doctor suspects an ovarian or pelvic mass, they may recommend an ultrasound and, depending on the findings and your individual risk factors, additional testing or follow-up.
Most ovarian cysts are not cancerous, but ovarian masses after menopause deserve appropriate medical evaluation.
Can Pelvic Floor PT Help With Pain From an Ovarian Cyst?
Pelvic floor physical therapy does not treat or remove an ovarian cyst itself. However, if a cyst or other pelvic condition has contributed to ongoing pelvic pain, the muscles of the pelvic floor can become protective, tense, and painful.
A pelvic floor physical therapist can help address this secondary muscle tension and improve movement, breathing, pressure management, and pain sensitivity.
If you have an unexplained new pelvic mass or significant pelvic pain, however, medical evaluation should come first.
Digestive and Bladder Issues That Can Mimic Pelvic Pain
Not every sensation of pelvic pressure actually originates from the pelvic floor.
The bladder, bowel, reproductive organs, and pelvic floor are all located close together, and symptoms from one system can sometimes feel like they're coming from another.
Constipation, trapped gas, urinary tract issues, bladder irritation, and gastrointestinal conditions can all create sensations of pressure or pain in the pelvis.
Constipation is particularly important because repeatedly straining to have a bowel movement can increase pressure through the pelvic floor and may contribute to or worsen prolapse symptoms.
If you are experiencing persistent constipation, significant changes in your bowel habits, blood in your stool, unexplained weight loss, or ongoing abdominal or pelvic pain, it's important to discuss those symptoms with your physician. Depending on the symptoms, a gastroenterologist may also be appropriate.
When Should You See a Doctor?
While occasional bloating or mild discomfort can happen at any age, new, persistent, or unexplained pelvic pain after menopause should be evaluated.
Contact your healthcare provider if you experience:
New or persistent pelvic or abdominal pain
Sudden or severe pelvic or abdominal pain
A new feeling of pelvic pressure or heaviness
A vaginal bulge or tissue protruding from the vagina
Pain with penetration that is new or worsening
Persistent bloating or abdominal swelling
A significant or persistent change in bowel habits
Chronic constipation or difficulty emptying your bowels
New urinary symptoms
Unexplained weight loss or loss of appetite
Any vaginal bleeding after menopause
Vaginal bleeding after menopause should always be evaluated by your healthcare provider.
Where to Find Pelvic Floor Therapy for Menopause Symptoms
Pelvic pain and pressure after menopause can have many different causes. Sometimes the symptoms are related to hormonal changes. Other times, they may be related to pelvic organ prolapse, pelvic floor muscle dysfunction, bowel or bladder issues, or another medical condition.
A pelvic floor physical therapist can perform a comprehensive evaluation of your pelvic floor, hips, abdomen, breathing mechanics, strength, and movement patterns to help identify factors contributing to your symptoms.
And if your symptoms are outside the scope of physical therapy, your therapist can help you determine when it's appropriate to see your gynecologist, primary care provider, gastroenterologist, or another specialist.
You don't have to accept pelvic pain or pressure as "just part of getting older."
If you're experiencing postmenopausal pelvic pain or pressure, reach out to our team at Cappuccino Physical Therapy. Our pelvic floor physical therapists specialize in helping women understand what's happening in their bodies, reduce pain, improve pelvic function, and get back to the activities they love.
You deserve care that takes your symptoms seriously. And relief is more possible than you might think. At Cappuccino Physical Therapy, we work with women in perimenopause/menopause all the time and can help you get rid of your pain and back to your daily life.
Give us a call today.
