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Is Low Estrogen Causing Your Pelvic Floor Symptoms?

Throughout your life, estrogen is responsible for some wild changes to your body. From growth spurts and puberty, to menstruation, ovulation, and pregnancy, this fluctuating hormone can bring on major transformation. And then comes perimenopause and menopause in your 40s or 50s, when waning estrogen levels transform your body all over again.

While you’ve probably heard all about hot flashes, osteoporosis, and brain fog, you may not be aware that low estrogen can also lead to significant changes in your pelvic floor.

Pelvic floor symptoms to watch out for in perimenopause and menopause:

  • Bladder or bowel leaks
  • Urinary urgency or frequency
  • Pain with vaginal penetration or other sexual dysfunction
  • Difficulty starting the flow of urine or having a bowel movement
  • Pelvic heaviness/feeling of your organs falling out
  • Pelvic pain or low back pain

What’s tricky is that while low estrogen can contribute to these symptoms, it’s not always to blame.

Many factors can cause pelvic floor dysfunction, ranging from daily bathroom habits to past injuries or a history of sexual trauma — and getting to the root of symptoms is key to identifying the most effective treatment.

Whether you’re currently experiencing pelvic floor symptoms or want to prevent them before, during, and after menopause, keep reading to learn more.

Estrogen & Your Urgogenital System

Well known for its major role in puberty and reproduction for those assigned female at birth (AFAB), it can be surprising to learn that estrogen does a whole lot more. Estrogen can affect multiple systems, including your musculoskeletal, cardiovascular, and even your brain and nervous system.

Of all the body systems that are affected by changes to estrogen levels, the most sensitive is the urogenital system, aka the reproductive and urinary organs, and the pelvic floor. This is because the bladder, urethral and vaginal tissues, and pelvic floor are home to many estrogen receptors, which are basically little access points that enable estrogens to efficiently do their job in that tissue.

In those AFAB, healthy estrogen levels are responsible for a normal menstrual cycle, pubic hair growth, breast development, and moisturized vaginal tissues. You can even thank estrogen for the health of the collagen in the pelvic floor, for thickness of the tissues in the vagina, for supporting the urethra and bladder muscle function (the detrusor), and for plentiful blood flow to all of the tissues in the urogenital system.

When within a normal range, estrogen helps keep your urogenital system healthy and working like a well-oiled machine. But too much or too little estrogen can create a challenge for your body. In excess, estrogen is associated with constipation, gynecologic cancers and even cardiovascular disease. When estrogen levels dip, you may start noticing some surprising pelvic floor symptoms.

How low estrogen affects your pelvic floor

During perimenopause (the phase before menopause when our ovarian function starts to wind down) and our estrogen levels decline, it is common to start noticing symptoms of pelvic floor dysfunction such as new or worsened bladder leakage, urgency, or frequency, vaginal discomfort, sexual dysfunction, even symptoms of pelvic organ prolapse. The possible cause? Urogenital atrophy.

Urogenital atrophy describes the effective decline in the tissues of the vulva, vagina, and urinary system thanks to low estrogen. In menopause urogenital atrophy is thought to happen to everyone, even though some people won’t experience any symptoms.

So what can you expect when it comes to your pelvic floor and low estrogen? While our understanding of the relationship between the pelvic floor and estrogen continues to evolve, there are many changes that have been found to impact your pelvic health. With decreased estrogen, there is a decrease in blood flow to the tissues of the vulva and clitoris which can even affect the size of the clitoris. The tissue of the vagina can become thinner and less flexible, produce less natural lubrication, and you’ll likely even notice less cervical discharge, making sex potentially painful and contributing to sexual dysfunction.

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Studies also show that in menopause the supportive connective tissues in the pelvic floor are less resilient which may worsen symptoms or increase the risk of developing pelvic organ prolapse. And when estrogen levels are low, there is less support provided to the urethra and detrusor muscle, so urinary leakage, frequency, and urgency can develop or worsen.

But even if you’re not going through menopause, there are instances that should still be considered when low estrogen could impact your pelvic floor, including:

Get Expert Support for Perimenopause & Menopause

The good news is, if low estrogen is contributing to your pelvic floor symptoms, there are plenty of options available to help. Exogenous estrogen therapies have been shown to improve the urinary and vulvovaginal symptoms of menopause, so contact your physician to get a better understanding of what could be causing your symptoms, and see if exploring hormone therapies is right for you.

A pelvic floor physical therapist can also be a critical resource for you. Pelvic physical therapy is a game changer when it comes to optimizing your pelvic floor muscle health including improving strength and flexibility, so you don’t have to “just deal” with uncomfortable symptoms. And pelvic floor physical therapists tend to be even more tuned into the challenges of menopause than most primary care providers, who receive limited training in this kind of care. So don’t hesitate to book a visit and give your changing body the TLC it deserves.

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Dr. Ashley Rawlins, PT, DPT

Dr. Rawlins is a physical therapist at Origin who specializes in the treatment of pelvic floor muscle dysfunctions including pelvic pain, sexual dysfunction, pregnancy related pain, postpartum recovery, and bowel and bladder dysfunction. In addition to being a practicing clinician, she is a passionate educator and author.

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