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Pelvic Organ Prolapse in Menopause: What It Is and How It Can Be Helped

by Samaira Farid,
Dr Clare Bourne
Medically reviewed by Dr Clare Bourne
Rest, menstruation and woman on couch with ibs, discomfort and stomach ache with symptoms. Health, fatigue and female person in house with cramps, endometriosis and abdominal pain for period.
Bloume content relating to health, wellbeing and nutrition has been reviewed and validated by relevant medical professionals in the UK, based on UK guidelines and practices applicable at the time of publication. Recommendations in other localities may differ from those found on our site and you should always seek the guidance or advice of relevant healthcare professionals in your area.

You may notice a heaviness low down in the pelvis, a dragging feeling inside the vagina, or a vague but persistent sense that something is not quite right. It can show up as pressure around the lower abdomen and genitals, or the feeling of sitting on a small ball. These are common ways pelvic organ prolapse (POP) can feel day to day, and if any of them sound familiar, speaking to your GP is a sensible next step.1

What you feel can shift through the day. It often gets more noticeable after you have been standing for a while or by late afternoon, and it may ease once you lie down. You might also feel or see a bulge or lump in or coming out of the vagina, or some discomfort during sex. In milder cases there may be nothing to notice at all, and prolapse is only noticed during a routine internal examination like a cervical screening test.2

What helps with pelvic organ prolapse?

Pelvic floor exercises are the first line treatment for mild or moderate prolapse, and they can lower the chance of things getting worse. Supervised pelvic floor muscle training for at least four months is the first thing usually offered for prolapse that causes symptoms, with a pelvic health physiotherapist building a plan around your needs.3

Beyond the exercises, a pelvic health physiotherapist can talk you through other lifestyle factors, including your bowel health, lifting and exercise to help improve your symptoms. Your GP can refer you for physiotherapy.4

Lifestyle factors that reduce pressure on the pelvic floor

A few everyday things shape how much pressure lands on your pelvic tissues. Keeping to a healthy weight, eating plenty of fibre so you don't strain on the toilet, and stopping smoking to cut down on a persistent cough can all take some of that pressure off.5

Heavy lifting is something to seek guidance on, including day to day lifting and exercise. There are no blanket rules when it comes to exercise, however low-impact options such as cycling, swimming or pilates can be better suited for some, however higher impact exercise can be something to work up to with the correct support. If you already have a routine you follow, it helps to run any changes past a pelvic health physiotherapist or your GP first.6

Why menopause increases the likelihood of pelvic organ prolapse

Oestrogen helps keep the muscles and connective tissues that hold up your pelvic organs strong, springy. As you move through menopause, oestrogen levels fall, and those supporting tissues can lose some of their strength. That makes prolapse more likely to develop, or more noticeable if it was already there.7

After an assessment, a doctor may suggest topical vaginal oestrogen, which comes as a cream, pessary, or ring, to ease symptoms that often sit alongside prolapse, like vaginal dryness and discomfort. Systemic Hormone Replacement Therapy (HRT), hormone treatment that works across the whole body, does not treat the prolapse itself, and any decision about hormone therapy is one to make with your GP or specialist.8

When to seek assessment for pelvic organ prolapse

If you notice a heaviness, a bulge, a dragging discomfort, or a lump in or coming out of the vagina, it is worth booking in to see your GP. The same goes if you have urinary symptoms like a slow stream, a sense of not fully emptying your bladder, leaks, or discomfort during sex.9

A GP assessment usually means an internal examination, much like a cervical screening test. Prolapse is common, and getting it looked at early means support can start sooner, when a simple approach often works best.10

Frequently Asked Questions

Sources

  • [1] Pelvic organ prolapse - NHS 111 Wales

    Many women with pelvic organ prolapse describe a sensation of something coming down into the vagina, a feeling of heaviness around the lower abdomen and genitals, a dragging discomfort inside the vagina, or feeling as if they are sitting on a small ball.

  • [2] Pelvic organ prolapse - NHS inform (Scotland)

    It is possible to have a mild pelvic organ prolapse with no symptoms, which may only be discovered during an unrelated internal examination such as a cervical screening test.

  • [3] Recommendations | Urinary incontinence and pelvic organ prolapse in women: management | Guidance | NICE

    Supervised pelvic floor muscle training for at least four months is the first-line treatment for women with symptomatic prolapse, with a physiotherapist creating a tailored programme.

  • [4] Physiotherapy - Pelvic Obstetric and Gynaecological

    A specialist pelvic health physiotherapist can assess a prolapse, create a personalised pelvic floor exercise plan, and provide lifestyle advice on posture and breathing techniques to reduce strain.

  • [5] Pelvic organ prolapse - NHS inform (Scotland)

    Key lifestyle changes to reduce pressure on the pelvic floor include maintaining a healthy weight, eating a high-fibre diet to avoid constipation and straining, and stopping smoking to reduce chronic coughing.

  • [6] Pelvic organ prolapse (POP)

    To avoid worsening symptoms, it is important to avoid repetitive heavy lifting. Low-impact exercises like cycling, swimming, and fast walking are recommended over high-impact activities like running and jumping.

  • [7] Pelvic organ prolapse - NHS inform (Scotland)

    Menopause is a risk factor for prolapse because falling oestrogen levels affect the pelvic floor. Oestrogen is crucial for maintaining the strength, elasticity, and thickness of the muscles and connective tissues supporting the pelvic organs.

  • [8] Pelvic organ prolapse - NHS inform (Scotland)

    While systemic Hormone Replacement Therapy (HRT) does not fix a prolapse, topical vaginal oestrogen (in the form of creams, pessaries, or rings) may be recommended by a doctor to ease associated symptoms like vaginal dryness and discomfort.

  • [9] Pelvic organ prolapse - NHS inform (Scotland)

    A visit to the GP is also warranted for associated urinary symptoms (such as a slow stream, a feeling of incomplete bladder emptying, or incontinence) or discomfort during sex.

  • [10] Pelvic organ prolapse - NHS inform (Scotland)

    A GP can assess a prolapse, typically with an internal examination similar to a cervical screening test. Prolapse is a common condition and can be managed more easily with timely intervention.