Pelvic Pain and Menopause
The hormonal changes which come with menopause can affect many different conditions including fibromyalgia, chronic fatigue syndrome, multiple chemical sensitivity, irritable bowel syndrome and lupus. Aside from being responsible for contributing to these conditions, menopause can also bring about chronic pelvic pain. This pain can come from a variety of gynecologic disorders, including benign or malignant tumors, pelvic adhesions or interstitial cystitis. Other non-gynecologic conditions such as colitis, irritable bowel syndrome, diverticular disease or colorectal tumors can also be responsible for pelvic pain. The most common causes of mild to severe pelvic pain among post-menopausal women are fibroids or vulvodynia.
Common, benign pelvic tumors are present in both pre and post-menopausal women and are the most frequent cause of gynecologic surgery in the United States. In fact, these fibroids are responsible for nearly one third of the hysterectomies performed on women in the U.S. each year. Although many fibroids are asymptomatic, causing little or no pain or bleeding, the fibroids which do cause symptoms can bring on abnormal uterine bleeding, pelvic pain or pressure, a decreased capacity of the urinary bladder, constipation, back pain and even reproductive dysfunction. Because fibroids contain both estrogen and progesterone receptors and respond to any type of hormonal stimulation, enlargement may occur when hormones fluctuate, such as during menopause. Most fibroids tend to be rather slow-growing, therefore it can take months, or even years for them to grow to a point where they cause trouble. While menopause can bring about a decrease in the size of fibroids, they can also begin to cause even more pelvic pain, most especially in women who are taking hormone replacements. Hormone therapy can stimulate fibroid growth, causing a substantial increase in pelvic pain that has been manageable to this point.
The Bladder and Peri-menopause
The smooth muscles of the bladder, vagina and urethra will lose tone as estrogen levels decline during peri-menopause and menopause. In fact, the bladder lining, nerves, blood vessels and muscles which control urinary functions are all affected by estrogen levels, and when those levels decline, many women will experience an increase in pelvic pain as well as a higher susceptibility to bladder problems. The decrease in blood flow and lubrication to the bladder and vaginal tissue causes them to become thinner, drier and more susceptible to inflammation, leading the bladder vulnerable to infection, and bringing symptoms such as pelvic pain, urgency, frequency, and burning as well as mild incontinence at times. Women who are in the throes of early menopause may begin to notice cramping in their pelvic floor around ovulation or right before or after their menstrual periods. Women who already have endometriosis or IBS, may experience more pain from inflammation and built-up scar tissue once the hormones begin to decline. This is a good time in your life to make sure you are keeping your back muscles strong, as women with weakened back muscles may experience more pelvic pain.
Pelvic pain can be so severe as to be debilitating for women, causing their day-to-day lives to suffer disruption. Many times a woman's doctor will brush off her claims of pelvic pain if she is of menopausal age, leaving her feeling as though she has no where to turn for relief. If your doctor is not sympathetic to your symptoms, find another doctor who is, and who can offer you some relief and some hope that your pelvic pain will subside.