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.
But why is that? And what evidence is there of a correlation between menstruation and a change in symptoms.
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.
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!
Remember that for women suffering with POP, rehabilitation efforts are generally focused on strengthening the muscles around the pelvic region, which is why this loosening throughout the hormonal cycle may feel like it’s causing a backslide in symptoms. As noted by Erin Lindberg of Integrative Therapies and Wellness, “ligament laxity [may be] a good thing during labor and delivery, but not so good afterward in relation to the pelvic floor.”
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.
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.
When it comes to hypopressives, 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.
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.