What You Need to Know About Pelvic Prolapse in Perimenopause and Menopause

Many of us don’t want to discuss what goes on below the belly button during the menopause transition. After all, who wants to talk about what’s going on in your pants? But the truth is, things start to happen related to hormone levels, and you need to be aware so you won’t feel alone or worry yourself to death! A common problem for women is pelvic prolapse. Let’s dive in!

Menopause and pelvic prolapse

Changes in a woman’s pelvic floor function often accompany menopause. Weakening of the muscle support structures can lead to pelvic organ prolapse. This condition is when one or more organs (bladder, uterus, urethra, vagina, small bowel, or rectum) of the pelvic area drop out of place. It causes a bulge in the vagina that will sometimes protrude through the vaginal opening.

While pelvic organ prolapse has many causes (heavy lifting, vaginal birth, hysterectomy), the lack of estrogen during menopause worsens the situation by thinning the support structures and tissue that hold pelvic organs in place, causing them to fall.

Pelvic organ prolapse symptoms

Symptoms associated with pelvic organ prolapse can range from minor pain and difficulty urinating to emotional distress. Unlike other experiences of menopause, like hot flashes, pelvic organ prolapse symptoms can increase with age.

Symptoms related to varying types of pelvic organ prolapse include:

• Pain or a feeling of pressure in the pelvis or vagina
• Feeling that something is coming out of your vagina or sight of tissue protruding from the vagina (which may bleed or feel tender)
• Difficulty urinating or a feeling that the bladder will not empty; bowel movement difficulty
• Lower back pain
• Urinary incontinence (urine leakage during sneezing, coughing, or exertion)
• Frequent bladder infections
• Painful sexual intercourse

Treatments for menopausal pelvic organ prolapse

Since lack of estrogen is the primary cause of menopausal pelvic organ prolapse, treatment in postmenopausal women may involve hormone therapy. This approach can help restore the vagina to premenopausal condition and may help to strengthen the vaginal structures supporting the pelvic floor. The most common hormone therapy is a low-dose vaginal estrogen replacement, using creams, tablets, or vaginal rings.

Prolapse is a condition where working with a physical therapist trained in pelvic floor therapy can be very beneficial. Physiotherapy aims to reduce the symptoms and improve your pelvic floor support. Treatment often focuses around the pelvic floor muscles, which help to support and control the bladder.

Physiotherapy will not be able to return the prolapsed pelvic organ(s) to their original position. Still, it can help improve the strength of the pelvic floor muscles so that they provide more support to the pelvic organs to prevent further slippage. Physiotherapy can also play an important part in teaching you how to avoid certain activities and helping you make simple lifestyle changes that will prevent you from causing further damage and stretching of your pelvic floor muscles. It can also teach you how to improve your bladder control.

Advanced Pelvic Floor Prolapse

For advanced conditions of pelvic floor prolapse, your doctor may prescribe a pessary. A pessary is a device that, when placed into the vagina, holds the pelvic organs in place. Normally, the patient is the one to clean the pessary to avoid infection; however, medical professionals must take some pessaries out for cleaning.

Severe cases require surgery (“bladder tack”) to restructure support for the prolapsed organs. This procedure is usually performed through the vagina. The surgeon will secure the falling vaginal walls, bladder, urethra, or other organs back to their proper position.

As if the physical problems associated with prolapse aren’t enough, women with pelvic floor disorders may understandably suffer higher clinical depression and anxiety rates. Additionally, many experience shame related to their symptoms. Since pelvic issues are not exactly dinner table conversations, women may feel very isolated. The emotional issues related to pelvic prolapse are often unrecognized and poorly managed. Holistic prolapse management needs to recognize both the physical and emotional aspects of living with a prolapse so that more women can access emotional support and coping strategies to improve their long-term quality of life.

Get Support

Are you struggling with the emotional issues associated with pelvic prolapse or any other changes in midlife? Be a part of my wonderful, new community called Hormone Harmony with Dr. Anna Garrett! I created it so that women didn’t have to feel alone during perimenopause and menopause. Learn more using the button below.