Menopause and Pelvic Floor Dysfunction

Menopause is one of the biggest shifts in a woman’s body, and it often comes with a variety of unexpected symptoms. Both short-term and long-term effects of menopause can have an impact on your comfort and health.

Pelvic pain after menopause can be linked to a number of factors, but most women do not fully understand them. A study of 165 postmenopausal women revealed that 68% felt they were uninformed and wanted to know more about pelvic floor dysfunction.
Causes of Pelvic Pain in Menopause
Before actual menopause, women can remain in a perimenopausal for as long as four years. During this time, in addition to when your menopausal, it’s not uncommon to experience pelvic pain.

Below are some of the most common causes of pelvic pain in menopause.

Menstrual Cycles

During the perimenopause period, you may still have regular menstrual cycles. You may find your cramping is more intense than it used to be, and your premenstrual symptoms, like mood swings, acne flares and breast tenderness, may also be more severe.

Menstrual cramping is directly related to your hormone levels, specifically progesterone and estrogen. As these levels fluctuate, it’s not uncommon to have increased pelvic discomfort.

It’s important to note that during this time that as estrogen levels drop, progesterone levels increase. Progesterone is the hormone, which makes your uterus contract when menstruating. The higher your progesterone levels, the more severe the cramping can be.

Vaginal Atrophy

Lower levels of estrogen can also cause thinning of the vaginal walls. This can lead to vaginal dryness with itching. It’s also not uncommon to experience lower abdominal pressure or a feeling of fullness in conjunction with vaginal atrophy, particularly when having intercourse. Since your vagina is less pliable, it doesn’t expand as easily as it did prior to menopause.


In some cases, women can develop endometriosis during and after menopause. Research published in March 2020 found that out of 42,079 women who underwent surgery for endometriosis, 17.9% were perimenopausal (ages 45-55) and 2.55% were postmenopausal.

As estrogen levels decrease, women may develop this inflammatory disease and experience pelvic pain. Additional symptoms include pain when urinating, pain while passing a bowel movement and general constipation.

If you have a history of endometriosis, symptoms may not resolve once you go through menopause. Even if you never had the condition, if you experience any of the signs, it is best to reach out to your doctor.

Diagnosis through ultrasounds, MRIs and laparoscopic procedures can reveal the health of your organs and detect endometrial tissue.

Pelvic Floor Dysfunction

Your pelvic floor consists of a group of muscles and ligaments in the pelvic region. It functions as a sling, which supports all the organs within your pelvic region. Contraction and release of the pelvic musculature is what controls bowel and bladder function.

In women, the pelvic wall is closely linked to comfort and pleasure during sexual intercourse. If you insert anything into the vagina, or engage in penetrative intercourse, then you may experience pain if you are suffering from pelvic floor dysfunction.

As you enter perimenopause and then eventually menopause, the pelvic floor may weaken. It can lead to lower abdominal and pelvic pain, a feeling of heaviness and incomplete emptying of the bowel and bladder.

At the onset of menopause, and until you’re considered post-menopausal, your pelvic floor muscles may weaken. If this happens, it can result in other types of pelvic floor issues.

One of the most common concerns among menopausal women is in reseed urgency and frequency. Most notably, an increased need to use the toilet more frequently and urgently.

A feeling of incomplete emptying is another common complaint.

Pelvic floor dysfunction during menopause can occur due to weight gain. Similar to pregnancy weight gain, weight gain in menopause can put undue stress on the pelvic girdle and musculature, both leading to symptoms of dysfunction.

Symptoms of Pelvic Floor Dysfunction

There are a variety of symptoms that overlap between menopause and pelvic floor dysfunction. And while they might be hard to distinguish, here are some of the most common ones:

  • Lower abdominal pain
  • Low back pain
  • Urinary frequency and urgency
  • Pressure in the rectum and pelvic area
  • Constipation
  • Pain during sexual intercourse

If you experience any of these alongside typical menopausal symptoms, it’s important to reach out to your primary care physician or gynecologist. They can help you ensure there are no underlying conditions and prescribe treatment options to improve your comfort.

Diagnosing Pelvic Floor Dysfunction

As with any medical concern, it’s never a good idea to try and self-diagnose. Because menopause and PFD can have overlapping symptomology, careful medical assessment is important.

If you’re not sure whether you’re in menopause, the first step is seeing your gynecologist. They will perform a hormone panel to determine your levels. They may also perform a pelvic exam to look for obvious menopausal changes.

If you think you’re suffering from pelvic floor dysfunction, your doctor will also perform testing to diagnose muscle weakness. They may also use a perineometer to measure pelvic muscle contractions.

Treatment Options for Menopausal Pelvic Floor Dysfunction

If you’re diagnosed with PFD, there are things you can do to improve your symptoms. Kegel exercises, which requires you to contract and release pelvic and vaginal muscles, can improve urinary symptoms.

Alternatively, you can also look into physical therapy options as well. Pelvic floor physical therapy involves specialized exercises that can improve the symptoms of PFD.

Before initiating therapy, your therapist will inquire about your symptoms. They will then perform a variety of tests to gauge your core strength and stability of your pelvic floor muscles.

Your therapist will also examine your lumbar spine and sacroiliac joints for pain or tenderness.

If you feel comfortable with the internal exam, your therapist will also assess your pelvic tone. Using a gloved hand, they will insert their fingers into your vaginal canal to palpate (examine) the pelvic floor. They can then assess your ability to perform contraction and release exercises.

Afterwards, they will create a customized treatment plan to help strengthen your core, reduce pain and improve stability of your pelvic floor.

While every patient is different, some of the most types of PFD therapy include stabilization exercises, biofeedback, electrical stimulation, vaginal dilators and trigger point therapy.

Final Thoughts

If you’re diagnosed with pelvic floor dysfunction, you don’t need to be embarrassed. Speak with your physicians about treatment options, like physical therapy as well as exercises you can perform at home.

If you would like to work with a pelvic floor therapist, please contact Lake City PT to schedule an appointment to discuss your treatment options.