Pelvic pain can occur after menopause when your ovaries stop producing estrogen. The vagina and urethra can become dry and irritated, or may have an overgrowth of bacteria in the pelvis region called bacterial vaginosis. Yeast infections can also occur as a result of menopause.

If pelvic pain is persistent after menopause, it can be difficult to treat with medical management alone. It is a common problem for women and can be an outcome of pelvic floor dysfunctions. It is the most common reason that women over the age of 45 go to see their doctor.

This article will discuss the clinical evaluation and treatment for pelvic pain after menopause and how physical therapy can help manage pelvic pain after menopause.

How Can Menopause Cause Pelvic Pain?

The cessation of estrogen production by the ovaries is what triggers menopause. Estrogen affects many systems in the body, including the vagina and pelvic floor muscles.  When estrogen production ends, the vaginal tissues can become dry and irritated. Additionally, estrogen keeps bacteria in check by maintaining the proper balance of good and bad bacteria.

After menopause, reduced estrogen levels cause the vaginal tissues to become more fragile and dry. This can lead to intercourse being painful or difficult, which may cause women to avoid intercourse. Without estrogen, the tissues in the urethra and bladder can thin out and become irritated.

The pelvic floor muscles may also be affected by menopause because they are reliant on estrogen for optimal function. Once they lose their ferocity to hold up the pelvic muscles, they can stretch out and become loose, causing urinary leakage during activities like coughing, laughing, or jogging.

Signs and Symptoms of Pelvic Pain

It is helpful to collect a history of symptoms to understand the mechanisms involved and develop a treatment plan. It is important to note whether there are any triggers or irritants that worsen symptoms, such as caffeine or alcohol. It can be helpful to include a sexual history in the evaluation of pelvic pain.

Some pain may be due to dyspareunia or vulvodynia if there is penetration or generalized itching and burning of the genital region. It is important to assess the location, quality, and radiation patterns of pelvic pain. To accurately diagnose pelvic pain, we need to know its radiation patterns.

Ranging from mild to severe, here are some common signs and symptoms associated with pelvic pain after menopause:

• Irritation or itching of the vulva or vaginal canal
• Vaginal dryness or atrophy
• Pain during intercourse
• Urgency, pressure, or pain with urination
• Increased urinary tract infections
• Diminished vaginal lubrication

When to See a Doctor

It is important to have pelvic pain evaluated by your health care provider, especially if the pain is persistent after menopause. If you have a pelvic floor disorder or a history of recurrent urinary tract infections, it is important to follow up with your health care provider for further evaluation and treatment options.

It is important to note that pelvic pain does not always indicate a serious or dangerous disorder. Sometimes there is no underlying diagnosis and the pain will resolve on its own with time. However, if pelvic pain is persistent and is not responsive to standard medical care, you can be referred for physical therapy.

The Best Treatment

Pelvic pain after menopause can be treated by managing the underlying pelvic floor disorder. If it is related to sexual dysfunction, counseling and behavioral therapies along with medical management can help. Also, physicians may prescribe medications that increase vaginal lubrication or estrogen replacement therapy to minimize vaginal tissue atrophy. These include local estrogen creams, vaginal tablets, or oral medications.

Managing urinary incontinence can help reduce the pain associated with pelvic floor disorders and manage pelvic pain after menopause.  Pelvic floor therapy may be effective in treating pelvic pain associated with urinary incontinence. Modifying or reducing activities that increase pressure on the pelvic floor muscles can be helpful. Other medications include topical anesthetics, antihistamines, and prescription pain relievers. In some cases, medications can worsen the condition, so it is important to consult with your doctor before starting any new medications.

What Does Physical Therapy Treatment Entail?

Physical therapy is the most effective non-surgical treatment for pelvic pain after menopause. It can help reduce the frequency and severity of the pain and discomfort that you experience. Patients often describe a resolution of their symptoms after physical therapy treatment.

Many women who have menopause-related pain are hesitant to go to physical therapy because they think it will entail being touched by a stranger. It is important to know that women are an integral part of the physical therapy treatment process at our clinic, not just patients under observation.

To achieve the best results in treating pelvic pain after menopause, therapists individualize your treatment by incorporating specific exercises for your needs. A typical per-session treatment plan includes:

• Education about the pelvic floor muscle system
• Exercises to strengthen the muscles of your pelvic floor
• Stretches for tight or weakened muscles around the pelvis
• Coordination exercises that improve function and control of surrounding muscles
• A home exercise program tailored to your needs
• Relaxation and breathing techniques
• Hydrotherapy recommendations, such as warm Epsom salt baths
• Education about lifestyle modifications, such as dietary changes and stress management
• Information about medications and their side effects

Maintaining a regular schedule of physical therapy visits can help reduce the frequency and severity of pelvic pain.

Conclusion

Pelvic pain after menopause is a common, but often unrecognized or underdiagnosed, symptom of pelvic floor dysfunction. Treatments are available to manage the uncomfortable symptoms associated with pelvic floor disorders.  Physical therapy is the most effective non-surgical treatment for pelvic pain and can help address many of the root causes of pelvic floor dysfunction.

Patients often describe a resolution of their symptoms after physical therapy treatment. If you would like to find out more about pelvic pain and how we can help, feel free to contact our clinic for a free consultation. We will be able to see if we can help with your specific needs.