Menopause & Prolapse
Menopause & pelvic organ prolapse at a glance
- Changes in a woman’s pelvic floor function often accompany menopause. Weakening of the pelvic support structures can lead to pelvic organ prolapse, in which one or more organs (bladder, uterus, urethra, vagina, small bowel or rectum) of the pelvic area drops out of place.
- While there are many causes of pelvic organ prolapse (heavy lifting, vaginal birth, hysterectomy), the lack of estrogen during menopause thins the support structures and tissue that hold pelvic organs in place, causing them to fall.
Causes of menopausal pelvic organ prolapse
In numerous studies, menopause has been associated with the development of prolapse. The lack of estrogen causes thinning of the vagina and is thought to reduce the strength of the connective tissue supporting it.
Prolapse occurs when the tissues that support the pelvic organs (such as the bladder, uterus or vagina) are stretched and damaged. When this occurs, the organ that they support may drop down and press against the wall of the vagina. This causes a bulge in the vagina that will sometimes protrude through the vagina opening.
Initial prolapse can be due to stress from vaginal childbirth that later becomes evident after menopause with further atrophy of the tissue.
Additionally, the thinning and the lack of vaginal moisture associated with menopause can also cause problems with sexual function. The vaginal tissue becomes frail and less supple, and stretching from intercourse can be very irritating or even painful at times.
Menopausal pelvic organ prolapse symptoms
Symptoms associated with pelvic organ prolapse can range from minor pain and difficulty urinating to emotional distress. Unlike other symptoms of menopause, such as hot flashes, pelvic organ prolapse symptoms can increase with age.
Symptoms related to varying types of pelvic organ prolapse include:
- Pain or a feeling of pressure in the pelvis or vagina
- Feeling that something is coming out of your vagina or sight of tissue protruding from the vagina (which may bleed or feel tender)
- Difficulty urinating or a feeling that the bladder will not empty (incomplete voiding); bowel movement difficulty
- Lower back pain
- Urinary incontinence (urine leakage during sneezing, coughing or exertion)
- Frequent bladder infections
- Painful sexual intercourse (dyspareunia)
Treatments for menopausal pelvic organ prolapse
Since lack of estrogen is the primary cause of menopausal pelvic organ prolapse, treatment in postmenopausal women involves hormone therapy (HT). These can help restore the vagina to premenopausal condition and may help to strengthen the vaginal structures supporting the pelvic floor. The most common HT is low-dose vaginal estrogen replacement, utilizing creams, tablets or vaginal rings.
For advanced conditions of pelvic floor prolapse, your doctor may prescribe a pessary. A pessary is a device that, when placed into the vagina, holds varying organs in place. Normally, the patient is the one to clean the pessary to avoid infection; however some pessaries must be taken out by medical professionals for cleaning.
In severe cases, surgical techniques to restructure support for the prolapsed organ are necessary. Usually performed transvaginally, the surgeon will secure the falling vaginal walls, bladder, urethra or other organ in its proper position.
While the use of mesh for pelvic organ prolapse (known as transvaginal mesh) has come under sharp scrutiny in recent years by both the medical community and consumers experiencing long-term side effects, the use of mesh for urinary incontinence is safe and commonly practiced.