Quick Answer
Yes, it’s genuinely common for prolapse symptoms to feel worse in the days before and during your period. Hormonal shifts across the cycle, particularly falling oestrogen, are understood to temporarily loosen the ligaments and tissue supporting your pelvic floor, which is why heaviness or bulging can feel more noticeable at this time. This isn’t a sign you’re going backwards in your recovery. If the change feels much more severe than usual, or doesn’t ease once your period passes, it’s worth checking in with a pelvic health physiotherapist or GP.
Many women who have prolapse symptoms, as well as practitioners who work with them, will tell you that symptoms often seem to get worse leading up to and during their monthly period. Here’s what’s actually going on, and what you can do about it.
The Role of Hormonal Fluctuations
While more research is needed, we can be relatively confident that the change in symptoms has at least something to do with the hormonal fluctuations that happen in women’s bodies throughout the monthly cycle. In addition to worsening symptoms in the few days before and during early menstruation, some women also report changes in the few days around ovulation. This fits with NHS guidance on pelvic organ prolapse, which notes that day-to-day symptom changes don’t necessarily mean the prolapse itself has changed.
For various reasons and at various times during the cycle, fluctuations in hormones such as oestrogen, progesterone, relaxin, and others can cause ligament laxity, which is a relaxation or weakening of the body’s ligaments and muscles. This is troublesome for women suffering with POP, because weaker ligaments around the pelvis mean the already-fatigued muscles in the pelvic floor have to work harder than they already are to support the pelvis.
Oestrogen increases the integrity of soft tissues like muscles and fascia, so when oestrogen levels are high — in the first phase of your cycle, known as the “follicular phase” — your pelvic floor may feel stronger. During menstruation, when oestrogen is lowest, you may notice your pelvic floor muscles (and all muscles in general) are more fatigued or weaker – this is normal!
So, if you are suffering from pelvic organ prolapse and are already doing pelvic floor exercises for prolapse to strengthen the muscles around the pelvic region, you may notice loosening during menstruation, and it may feel like it’s causing a backslide in symptoms.
How Stress can Influence Symptoms
Like most things in life, the addition of stress can make this feedback loop even worse. Chronic stress can cause the adrenals to work overtime, which causes not only more ligament laxity, but dehydration as well. Dehydration can cause the muscles in the pelvis to be drier and tighter, which can also worsen symptoms of POP.
Tracking your Cycle can Help
So what can women do about all this? Charting your cycle — which simply means keeping track of when you menstruate and how you’re feeling throughout the month — has several benefits, including tracking your mood, energy levels, and overall well being. From the perspective of POP management, the knowledge of when you’re likely to experience an increase in symptoms can calm some of the anxiety often associated with this time.
When you feel that discomfort, you’ll know it’s not because you’re sliding backwards in your rehabilitation efforts, but rather, it’s simply because of your hormones. As an added benefit, it can also provide insight that can help you organise your month, such as what plans to say yes to and which ones to decline, and when to schedule in rest.
Hypopressives can Support you
When it comes to Hypopressives for prolapse, I have personally found that doing a solid hypopressive practice the day before menstruating makes for a much easier day one and two of my cycle. Some people avoid practice on their first couple bleed days depending on how heavy their cramping is, however if you feel up to it, you could try a short practice and see how your symptoms feel. It is something to play around with and see what works for you.
If what you’re noticing feels much more severe than your usual pattern, doesn’t settle once your period passes, or comes with new bleeding, pain, or difficulty emptying your bladder or bowel, that’s worth getting checked by a GP or pelvic health physiotherapist rather than assuming it’s just your cycle.
The main thing is to pay attention to your body, don’t punish yourself or assume it’s your fault, and know that with dedication and patience, it is entirely possible to improve symptoms of POP over time.
