Hormones and the Pelvic Floor

Hormones impact many aspects of our health and biology, including the pelvic floor. Patients of Absolute Health and Wellness experiencing pelvic floor dysfunction are often asked to visit our naturopath (in addition to our pelvic floor physiotherapists) to address some of the other causes of pelvic floor dysfunction, including hormones.

Hormones and Pelvic Floor Dysfunction

There is strong evidence that hormones have some impact on the pelvic floor. There are still a lot of questions as to HOW hormones affect the pelvic floor, but we understand their effect.

There are certain conditions during which hormone balance is lost, and there are some interesting trends in pelvic floor dysfunction.

Overactive Bladder and Estrogen

Over active bladder is a complicated condition in which frequency of urination increases, often at night time (nocturia). This can be with or without a sense of urgency or urinary incontinence [1]. Research has shown overactive bladder is associated with lower estrogen. Topical estrogen therapies were found to be helpful [1].

Urinary Incontinence

Urinary incontinence is a condition in which the control of urine voiding is diminished or lost. There are different types of urinary incontinence. Similarly to overactive bladder, low estrogen is associated with urinary incontinence and topical estrogen administration has been found to be helpful [1]. Learn more about urinary incontinence here.

Menopause

Menopause is defined as the withdrawal of estrogen as women age. Pelvic floor dysfunction is higher among perimenopausal and post-menopausal women aged 60 plus, at a rate of 39-50% [2]. Once again lower estrogen seems to have a relationship with pelvic floor dysfunction.

Estrogen and the Pelvic Floor

The evidence above shows estrogen may have an important role to play in preserving pelvic floor function. It appears certain conditions are associated with lower levels of estrogen.

The link is strong enough that some Danish scientists investigated how estrogen helps the pelvic floor. People used to assume estrogen strengthens the pelvic floor muscles. It turns out, estrogen benefits the pelvic floor but not by affecting the muscles directly [3]. The scientists looked at ultrasound of the muscles before and after estrogen administration and found no changes, although during that same time symptoms improved. The consensus is estrogen helps the pelvic floor by some means other than the muscles themselves. Keep in mind the pelvic floor contains multiple layers and other tissues other than muscle. For a review, read the article The Pelvic Floor Anatomy.

Too Much Estrogen Can be Bad

If estrogen seems to protect the pelvic floor, what about conditions defined as being estrogen dominant, such as PCOS and endometriosis?

PCOS and endometriosis are two distinct conditions, but the underlying issue in both cases is estrogen dominance. Click here to learn more about estrogen dominance. Both of these estrogen dominant conditions are associated with increased pain, inflammation and abnormal periods. Separate articles can be found on PCOS and Endometriosis.

Summary

Pelvic floor dysfunction affects many women and seeing a Pelvic Floor Physiotherapist is important. In additional to structural abnormalities, other controllable factors could be at play, such as hormones. Hormones being too high or too low can affect the pelvic floor. Discuss your pelvic health with our pelvic floor physiotherapists and/or naturopath today!