How Estrogen Affects Your Pelvic Floor

For most people, hormones are confusing and a little scary — in part because they play an unseen (and sometimes traumatizing) role in milestones like puberty and perimenopause. As both a pelvic health PT and puberty survivor, I know that understanding exactly what your hormones are doing during these new phases can be a gamechanger.

All three of your sex hormones — estrogen, progesterone, and testosterone — are basically like physiological parents telling the organs in the body what to do and when. It’s a pretty big job, so whenever fluctuations happen (i.e. during menopause and other life stages) they can cause seemingly overwhelming symptoms like bladder leaks. The more you understand the role of estrogen in particular, the better you can navigate any unexpected changes that come up.

Why estrogen matters

Estrogen is produced by the ovaries and, in smaller amounts, by the adrenal glands, and its responsibilities include everything from helping protect your bones, to contributing to heart and blood health, to giving the uterus a heads up when your period is going to start. It’s only one hormone, but many structures in the pelvis are impacted by estrogen, including the vulva, vaginal canal, bladder and urethra — which is why it’s so important to consider your hormones if you’re experiencing pelvic floor dysfunction, such as bladder leaks.

As a vagina owner ages, estrogen levels naturally decrease, which leads to many bodily changes  including, but not limited to, the end of menstruation. While no longer having a period may be cause for celebration, this lack of estrogen is not unlike when Michael Scott left The Office: things just aren’t quite the same. 

That said, aging and life events like menopause aren’t the only factors in declining estrogen levels. All kinds of things can contribute to hormonal imbalances and a lack of estrogen, including: 

• Types or cancer and cancer treatments 

• Surgeries, such as total hysterectomies

• Certain medications. 

How hormonal changes cause leaks

No matter the cause, a lack of estrogen means the tissue of the bladder and urethra isn’t as happy or healthy as it once was. These tissue changes and their symptoms are often referred to as genitourinary syndrome of menopause (GSM), and some tell-tale signs include pain with sex, vaginal dryness, and urinary incontinence! (Side-note: some providers may use the term vaginal atrophy instead of GSM).

When your body’s tissue is less robust, it means it’s unable to work efficiently — the bladder is weaker and the urethra is less rigid, and your pelvic floor muscles (which are tasked with supporting the vaginal canal and the bladder) aren’t able to provide as much support. All of this can mean leaking. 

But there are things you can do about this! First, don’t be embarrassed— urinary incontinence is a common symptom, but it does not need to be your new normal. If you experience leaks, you should talk to a trusted healthcare provider, who might recommend any of the following:

• Additional tests, if they suspect an underlying hormonal imbalance might be the cause (which might also require a physical examination). 

• Medications, including a topical hormone cream or patch to help replenish hormone levels 

• Seeing a pelvic floor PT (like yours truly) to treat the pelvic floor muscles that support the bladder and urethra 

If hormones are to blame for your bladder woes, you have many options for treating and improving your symptoms. The first step is just reaching out for help!

Have you gone through perimenopause or other hormone fluctuations? How did you navigate your symptoms? Share your story in the comments.

Dr. Rachel Gelman is a pelvic floor physical therapist in San Francisco. She specializes in the physical therapy management of numerous pelvic pain disorders, including bowel, bladder, and sexual dysfunction. Rachel is passionate about healthcare and strives to promote quality education regarding pelvic and sexual health. She is an adjunct instructor in the Doctor of Physical Therapy Program at Samuel Merritt University where she teaches the pelvic health curriculum.