The Link Between Hormonal Changes and Pelvic Pain
Pelvic pain is something many women experience at different points in their lives, but often don’t talk about. While pelvic pain can arise from several causes, one key contributor that’s often overlooked is hormonal fluctuation.
Hormones have a profound effect on every part of the body, including the pelvic floor, reproductive organs, connective tissues, and pain perception. From puberty to menopause, hormonal changes can increase vulnerability to discomfort, inflammation, and tension in the pelvic region.
In this article, we’ll explore how hormonal changes affect pelvic health, common conditions linked to hormone-related pelvic pain, and how physiotherapy can help manage symptoms naturally and effectively.
Understanding Hormonal Influence on Pelvic Health
Hormones are chemical messengers that regulate many of the body’s systems. Oestrogen, progesterone, testosterone, and cortisol are just a few of the key hormones involved in the menstrual cycle and overall pelvic wellbeing.
These hormones influence:
Blood flow to the pelvic organs
The elasticity of pelvic tissues
Muscle tone in the pelvic floor
Pain sensitivity and inflammation levels
Nervous system regulation
When hormonal levels shift, during ovulation, menstruation, pregnancy, postpartum, perimenopause, or menopause, many women notice changes in their pelvic comfort and function. These shifts can contribute to new or worsening symptoms such as pelvic cramping, pressure, pain during sex, or bladder and bowel changes.
Hormonal Conditions That Can Cause Pelvic Pain
1. Endometriosis
Endometriosis occurs when tissue similar to the uterine lining (endometrium) grows outside the uterus, often on the ovaries, fallopian tubes, bladder, or bowel. This tissue responds to hormonal changes during the menstrual cycle and can bleed, swell, and cause adhesions.
Symptoms include:
Severe period pain
Pain with intercourse (dyspareunia)
Chronic pelvic pain
Bloating or bowel discomfort
Fatigue
Oestrogen plays a major role in fuelling endometriosis growth, which is why symptoms often flare during menstruation or ovulation.
2. Polycystic Ovary Syndrome (PCOS)
PCOS is a hormonal disorder characterised by high levels of androgens (male-type hormones), irregular periods, and cysts on the ovaries. While not always painful, PCOS can contribute to pelvic discomfort and tension, especially due to bloating or inflammation.
Women with PCOS may also experience:
Pelvic heaviness
Pain during ovulation
Irritable bowel symptoms
Pain related to ovarian cysts
3. Premenstrual Syndrome (PMS) and PMDD
Many women experience mild pelvic discomfort before their period. However, those with more severe premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) may suffer significant pelvic pain, cramping, irritability, and fatigue. Hormonal fluctuations, particularly a drop in progesterone and oestrogen, are thought to play a role.
4. Pregnancy and Postpartum
During pregnancy, the body produces significantly higher amounts of the hormone oestrogen. This hormone, when produced in large quantities, has an effect on collagen fibres (found in connective tissue which can cause ligaments to soften in order to prepare the pelvis for birth. While necessary, this can cause pelvic girdle pain, SIJ instability, and pubic symphysis dysfunction.
After birth, the sudden hormonal shift, plus the physical impact of delivery, can affect pelvic floor tone and function, leading to ongoing pain or pressure if not properly supported.
5. Perimenopause and Menopause
As oestrogen levels decline in the lead-up to menopause, tissues in the pelvic area can become drier, thinner, and less elastic. Women may notice:
Vaginal dryness
Pain with intercourse
Bladder sensitivity
Pelvic heaviness or prolapse symptoms
These symptoms are often underreported but highly treatable.
How Women’s Health Physio Can Help
Many women are told that their pelvic pain is “just hormonal” or “something to live with.” But there are evidence-based treatments that can help, without relying solely on medication or surgery.
A women’s health physiotherapist is trained to assess the musculoskeletal and functional causes of pelvic pain, including those linked to hormonal shifts. Here's how physiotherapy can support you:
1. Pelvic Floor Assessment and Treatment
Pelvic floor muscles may become either tight and overactive (as seen with endometriosis or chronic pelvic pain conditions) or weak and underactive (common after childbirth or menopause). A physio can assess your muscles and guide you through:
Relaxation techniques (for tension-related pain)
Strengthening exercises (for weak or sagging pelvic floor)
Coordination and control training
Biofeedback or real-time ultrasound
2. Pain Education and Management Strategies
Understanding pain is a powerful first step. Your physiotherapist will explain how hormonal changes affect your nervous system, inflammation, and sensitivity. They’ll teach:
Breathwork and down-training for the nervous system
Gentle movement and mobility exercises
Education surrounding the use of heat for pain relief, EMS modalities such as TENS and activity modification
3. Support During Life Transitions
Whether you’re navigating first periods, fertility challenges, pregnancy, or menopause, women’s health physios provide support through every phase. Sessions are tailored, private, and deeply respectful of your individual experience.
4. Liaison with Other Health Providers
Sometimes pelvic pain requires a multidisciplinary approach. Your physiotherapist can work alongside your GP, gynaecologist, or endocrinologist to ensure holistic care.
You Don’t Have to Put Up With Pelvic Pain
While hormonal shifts are a natural part of life, ongoing pain doesn’t have to be. With the right support, education, and treatment plan, you can move more freely, enjoy intimacy again, and feel more in control of your pelvic health.
At Wholesome Physiotherapy, we specialise in women’s health physiotherapy and provide compassionate, individualised care for women across all stages of life. Whether you’re experiencing period pain, perimenopause symptoms, or pregnancy-related discomfort, we’re here to help.
Book a women’s health assessment today via the link below.