Menopause & Pelvic Organ Prolapse

By Kim Vopni, The Vagina Coach — Certified Pelvic Floor Fitness Specialist · Published March 21, 2022

Direct Answer

Menopause can contribute to pelvic organ prolapse because declining estrogen thins and weakens the tissues that support the bladder, uterus, and rectum. This can cause a bulge or heaviness in the vagina, along with urinary or bowel symptoms. Treatment options range from hormone therapy and pelvic floor exercises to a pessary or surgery, depending on severity.

Key Takeaways

• Declining estrogen during menopause thins and weakens the connective tissue and muscles that support the pelvic organs, increasing prolapse risk.
• Common symptoms include pelvic pressure, a bulging sensation in the vagina, urinary leakage, frequent bladder infections, and bowel movement difficulty.
• Hormone therapy (HT) may help restore some strength to vaginal tissues, but it is not a stand-alone fix for prolapse.
• Targeted pelvic floor exercises can strengthen supporting muscles and ease mild to moderate prolapse symptoms.
• When conservative options are not enough, surgery may be recommended, and the Pelvic Surgery Success Program can help you prepare and recover.

Menopause often brings changes in a woman’s pelvic floor function.

The pelvic floor muscles can be weak, overstretched, slow to work, too tight or torn just like the other muscles of your body.

When the pelvic floor weakens it can lead to pelvic organ prolapse, where one or more organs of the pelvic area drop out of place. (bladder, uterus, urethra, vagina, small bowel, or rectum)

Causes of menopausal pelvic organ prolapse 

While there are many causes of pelvic organ prolapse (heavy lifting, vaginal birth, hysterectomy), the lack of estrogen during menopause thins the supporting structures holding pelvic organs in place, causing them to fall.

Initially, prolapse can happen with stress from vaginal childbirth and later in life with menopause there can be further thinning of the tissues. When the tissues supporting the pelvic organs are thin or damaged, the organs they support may drop down and press against the wall of the vagina. This causes a bulge in the vagina that will sometimes protrude through the vagina opening.

The lack of vaginal moisture associated with menopause can also cause problems with sexual function. The vaginal tissue becomes frail and less supple and stretching from intercourse can be very irritating or even painful at times.

Symptoms of menopausal pelvic organ prolapse

Symptoms can range from minor pain and difficulty urinating to emotional distress. Unlike other symptoms of menopause, such as hot flashes, pelvic organ prolapse symptoms can increase with age. Other Symptoms 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
• Tissue protruding from the vagina (bleeding or tenderness)
• 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 (dyspareunia)

Treatments for menopausal pelvic organ prolapse

Since the reduction in estrogen is the main cause of menopausal pelvic organ prolapse, hormone therapy (HT) can help restore the vagina to premenopausal condition and may help to strengthen the vaginal structures supporting the pelvic floor. If your prolapse conditions are advanced, your doctor may prescribe a pessary. A pessary is a device that, when placed into the vagina, holds varying organs in place.

In severe cases, surgery may be necessary. If you are considering surgery as an option, you may find my Pelvic Surgery Success Program beneficial. You will learn from me as well as Doctors, Pelvic Health Physical Therapists and Nurse Continence Advisors. You will also learn from others who have had surgery and what they wish they had known, done differently and what advice they want to share.

Frequently Asked Questions

Can menopause cause pelvic organ prolapse? Yes. The drop in estrogen during menopause thins the tissues that support the bladder, uterus, and rectum, which can make existing prolapse worse or contribute to new prolapse symptoms.

What are the symptoms of prolapse during menopause? Common symptoms include a feeling of pressure or bulging in the vagina, urinary leakage or frequent infections, difficulty with bowel movements, and lower back pain.

Does hormone therapy help with pelvic organ prolapse? Hormone therapy can help restore some strength to vaginal tissues, but it works best alongside other treatments like pelvic floor exercises rather than as a stand-alone cure.

Can pelvic floor exercises improve prolapse symptoms? Yes, targeted pelvic floor exercises can strengthen the muscles supporting your pelvic organs and reduce mild to moderate prolapse symptoms, though severe prolapse may need additional treatment.

When is surgery necessary for pelvic organ prolapse? Surgery may be recommended when prolapse is severe or conservative treatments have not relieved your symptoms; your doctor can help you weigh the risks and benefits of each option.

Is pelvic organ prolapse after menopause permanent? Not necessarily. Many women see improvement with pelvic floor exercises, a pessary, or hormone therapy, though some cases of advanced prolapse may require surgical repair.

Recommended Exercise Programs:

The 28-Day Challenge and Buff Muff Membership

I recommend checking out my comprehensive pelvic health education and fitness programs on my Buff Muff App. The most complete Pelvic Floor & Kegel exercise App to strengthen the pelvic floor.

The Buff Muff 28-Day Challenge (housed in the App) gets you started, and the Annual membership keeps you progressing so you can laugh, run, jump, and lift without the pesky leaks and annoying discomfort of prolapse symptoms.

Other Resources:

• Follow My Personal Journey with Prolapse
• Pelvic Floor Dysfunction Exercises & Treatments
• Menopause Belly Happens – But it is NOT Mandatory
• Why women have Painful Sex (Dyspareunia)

If you enjoyed this article, you might also like our episode:
Pelvic Organ Prolapse With Sherrie Palm of APOPS

Listen to the episode