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Periods and the Pelvic Floor

Hello friends! Vagina owners can do wonderful things with their bodies (like growing another human being), but along with that comes the monthly visit that no one looks forward to. Each month your body prepares to grow and nurture a baby, but if the egg does not get fertilized, then your body gets rid of it to prepare for the next one. Your body uses different hormones to make this process happen. With these hormone changes, you may feel changes in the way your pelvic floor muscles work.

Estrogen is one of the many hormones that fluctuates in your body during different parts of the menstrual cycle. Estrogen helps to make the menstural cycle function and it is important for the functioning of the pelvic floor muscles. Normal estrogen levels help to keep blood flow to the pelvic floor muscles and keep them plump and lubricated. When estrogen levels are lower (like during your period or during menopause), your pelvic floor muscles may be weaker and less elastic than during other times of your cycle (Miscussi, 2015). During your period, estrogen levels are at their lowest. This can cause symptoms of pelvic floor dysfunction, or make symptoms that you already have worse.

If your pelvic floor muscles are weaker, you may notice more symptoms of pelvic organ prolapse like heaviness, pressure, or vaginal bulging. You may also get symptoms of urinary or fecal incontinence. If you sneeze while you’re on your period, do you pee a little? That’s stress incontinence. But the good news, is that a healthy pelvic floor can still do it’s job even when estrogen levels are low! If you get symptoms of pelvic floor dysfunction during your period, seeing a pelvic floor physical therapist can be a great resource to help with pain, incontinence, and prolapse.

A pelvic floor physical therapist can also be a good resource when you have heavy, painful periods which are often accompanied by tight and oversensitive pelvic floor muscles. A physical therapist can perform a thorough evaluation and help you to address any tightness or weakness in the pelvic floor and the surrounding muscles (like the back, hips, and abdominals).

While periods can often cause some pain, this pain should not interfere with your ability to take care of your daily responsibilities (like work or school) or cause you to curled up in bed. Pain with periods should normally be relieved by over-the-counter medications.

You may have heavy periods if:

  • Your period lasts longer than 7 days

  • You have to get up in the night to avoid bleeding through

  • You have to change your product every hour

  • You have to use more than one product (i.e. tampon and pad, menstrual cup and pad)

  • You have clots larger than the size of a quarter

It is important to see a healthcare provider because heavy, painful periods may be a sign of endometriosis, polycystic ovarian syndrome, fibroids, cancer, and other health problems. A physician can help to diagnose and rule out any medical conditions, and a pelvic floor physical therapist can be a great part of your medical team to help address any pelvic floor symptoms that can come along with these conditions. When talking with your providers be sure to ask them what diagnoses they think may be causing your symptoms. They may prescribe a hormonal birth control which can help with symptoms, but this often only masks whatever condition is causing the heavy, painful periods.

Here are some tips from our friend @bumppelvichealth on managing period symptoms:

Here are some great resources to help you manage pelvic floor symptoms:

For providers, check our online courses to help your athletes with urinary incontinence. Consider joining our Ambassador Program and most of our courses are included with your membership!

What experiences or tips do you have that can help others? We’d love to hear them. Please join the conversation in the comments section below.  

Written by Emily Reul, PT, DPT


1.Micussi MT et al. Is there a difference in the electromyographic activity of the pelvic floor muscles across the phases of the menstrual cycle? J Phys Ther Sci. 2015;27)7:2233-2237.


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