How Hormones can Impact the Pelvic Floor

by Courtney Giroux, LMT

What is the Pelvic Floor? If we break it down; the pelvic floor is made up of muscles and ligaments that support and cradle the bladder, uterus or prostate, and the bowels. Many of you come to our office because we help with the many symptoms that Pelvic Floor Dysfunction causes, which can include; pelvic pain, incontinence/leaking of urine or bowels, urge to urinate, trouble fully emptying the bladder/bowels, constipation, painful intercourse, painful menstruation or ovulation, and more. Most often we see them being caused/brought on by pregnancy, labor/delivery, injury, etc. Did you also know that how your hormones are functioning, actually can contribute to how your pelvic floor may be functioning, too?

We want to touch on a few specific hormones that affect the pelvic floor. I’ll explain how each one works in the body and also what effect it can have, specifically to the pelvic floor.


Estrogen is a hormone that is released mostly by the ovaries, and it can be released by the adrenal glands as well. It is involved in the development of breasts, pubic hair, armpit hair, and regulates menstrual cycle by increasing at ovulation to help release the egg.

Estrogen is produced with varying levels within your system depending on time of ovulation. Estrogen is at its highest during ovulation. These higher levels of estrogen cause something called ligament laxity.  This is exactly how it sounds our ligaments can become more relaxed and loose during this period. When this happens, the muscles in the pelvic floor and those surrounding the pelvic may need to compensate, working harder in supporting the contents of the pelvic. You may begin to notice the feeling of being ‘off’ or ‘out’ at this time. Maybe thinking to yourself, ‘I could use an adjustment, I should get in for a massage, or back to physical therapy’.

As individuals, women produce a varied amount of estrogen. If one is producing less then normal amounts of estrogen, decreased ligament laxity is most likely not an issue. Breastfeeding or menopausal mamas are two examples of who might notice decreased estrogen levels within their systems. Decreased estrogen levels can cause a decrease in vaginal lubrication, as estrogen helps with the production of lubrication. One may notice dry tissue. This can be cause for concern if pain or tearing with intimacy is noticed. Lubrication would be recommended to decrease vaginal wall muscle tightness in response to added dryness.


Relaxin is produced by the ovaries during the menstrual cycle and placenta during pregnancy. It’s main purpose is to prepare the body for birth by relaxing ligaments, joints, and even muscles during labor and delivery of your baby. That’s right, this hormone causes ligament laxity as well.

I honestly was surprised to find that Relaxin is produced in our body even when we aren’t pregnant – how crazy is that?? It is released after the peak of estrogen, after ovulation, to help get the body prepared for possible pregnancy. Relaxin peaks around the time of menstruation. Even though this is a normal part of our monthly cycle, this means that there can be ligament laxity in the pelvis as well, and you may notice some of your symptoms around this time as well. For example, I notice that during this time my neck always goes out of alignment and triggers a migraine and my S.I. Joints tend to come out of alignment, which can lead to some pain in my pelvic floor during my period.

During pregnancy, there may be different times in your pregnancy where you notice shifts and pulls on your body and its alignment.  This is due to baby growing and changing. For some pregnant mamas this is when their symptoms begin, during pregnancy, when many may assume that it only starts after the mom delivers the baby.


All of these are produced by the adrenal glands, which sits on top of the kidneys. Aldosterone helps regulate electrolytes and blood pressure levels. Cortisol regulates blood sugar and affects the immune system. Adrenaline is the hormone directly involved with the sympathetic nervous system or what is known as “Fight or Flight”, which we talk about so much here at Moment of Truth!

We all know that stress is not good for our body, when we are stressed (ex: anxious, scared, angry, overworked, not enough sleep, trauma) these hormones are released. When these hormones are over produced, we enter Flight or Flight mode. We feel like we are running on overdrive, and over time this can result in, you guessed it – ligament laxity.  Hormones produced by the adrenal glands also add in regulation of electrolyte balance, blood sugars and one’s immune system. So if someone’s adrenals are really struggling, it not only can cause the ligament laxity, it can also mean someone may be chronically dehydrated, and what happens with muscles that are dehydrated? They will be dry and tight, plus loose ligaments, you can see how this could definitely cause an impact to the pelvic floor.

Sigh. Know anyone who works their body too much, doesn’t get to sleep much – for years, and is stressed a lot? Hmmmm, nope, can’t think of anyone!


So obviously I didn’t write this to be a Debbie Downer and give us one more reason to think we’re “doomed” as women because of our periods, because for one thing, not everyone will be affected by these symptoms. Information is power! Use this to bring more awareness to what is going on in your body at this time. I think it is good for everyone to try to get a sense of when their cycle is, when their ovulation is, this isn’t always possible depending on many things, but if you just aren’t sure – there are plenty of apps out there to help with tracking your cycle, and even ovulation test to get an idea of when you ovulate, even what your cervical mucus should look like at what stage of the cycle. Most of the apps have places where you can make notes of how your body is feeling at those times. Make note of how your whole body feels, but also specifically to the pelvic floor.

If you are having any pelvic floor symptoms that are bothering you, know that you don’t have to live with them. It may be that these need to be addressed/evaluated by Amy or Melissa first to determine the best plan of treatment. But they can help with examining where the imbalances are at the time, and work manually on the muscles and fascia in the pelvic floor and in the body that are pulling on those areas, to bring fresh blood flow and water to the tissue, calm the muscles which will result in better alignment and more mobility. We know Amy has mentioned many times that Kegals are not always the answer, so if you aren’t sure, get in with Amy or Melissa to get some pointers on what you should be doing as far as exercises, vaginally but also strengthening exercises for the body and since we have many ligaments that affect the pelvis, Amy and Melissa can guide you on which exercises may be necessary to strengthen muscles around the pelvis as well. I have some training in Pelvic Floor Dysfunction as well, so in conjunction with treatment for pelvic PT, during our massage sessions I can also work muscle groups that directly impact the pelvic floor,
without internal work, to optimize your healing.

Bodywork has been shown to directly impact the hormones our adrenals release and can help trigger the Parasympathetic Nervous System, which helps calm down our nervous system and get it out of Fight or Flight, and release hormones for better sleep! So when you see me, Amy or Melissa, this helps! Now more than ever we are seeing how stress affects our body, regular bodywork not only feels good, but science shows the amazing things it does for you. Amy, Melissa and I all have training in Abdominal Visceral work, this means we can work on the organs and even help them function more optimally! Visceral work can even be done over the uterus and ovaries to help clear away scar tissue or tight areas around them which can actually impact how they are working, and we have had clients talk about their symptoms during their cycle improve!

Here are some natural options I have found on this journey that you are welcome to research and discuss with your doctor:

  • Staying hydrated – It’s easy to forget! Especially when we are being pulled in all directions.
  • Mindful of movement/bending – Work on squatting when bending, hold baby/toddler centered in the body, rather than on hip. 
  • Listen to your body during these shifts – Breathe into stretches rather than forcing to avoid over-stretching.
  • Use your ball – The one that Amy or Melissa gave you that the kids find and it ends up somewhere in the toy room. (So does mine.) Once you find it, just again, use your breath to work on softening. This will help with relaxing the muscles, but also help maintain alignment. 
  • Breath work – Any slow, focused breathing, but we love to show our clients Hum and Swallow to calm the nervous system. https://www.youtube.com/watch?v=EZ_ABShVVV4
  • Yoga – For overall strengthening, some poses are great for the pelvic floor, and yoga also includes breath work, we are so excited to offer this in the new space. Until then, Heather, who will eventually be in the new space with us, has great videos right here: https://www.youtube.com/channel/UC0fnWRd_rUkOmKX-eKmYohg
  • Vitamin C – For collagen to support ligaments. 
  • Magnesium – Easily depleted during pregnancy and sometimes hard to get levels back up in Postpartum and this is so important for our muscles, sleep, but mental health as well because this is an essential mineral. Epsom salt and magnesium oil are great topical ways to get your magnesium in, we also carry Natural Calm in the office, which is a magnesium drink. 
  • Adaptogens – Herbs/plants that are helpful with hormonal and stress support. 
    Examples: Red Raspberry Leaf, Maca, Ashwagandha, Holy Basil, Reishi, and Ginseng.

I hope it was helpful to learn a little more about your body, and of course, if you have any concerns about your hormones, don’t be afraid to reach out to your doctor. Remember, information is power! The more you know about what is going on in your body, the more you can learn how to nourish it.

This information meant to be educational and instructional. It is not able to diagnose or treat a specific issue and it is definitely not a substitute for a professional evaluation.

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  1. This is great information to have. You are the first person I've ever seen talking about this, and I learned something new! I was hoping to see more of a connection to how hormone fluctuations can affect the pelvic floor specifically: pain, hypertonicity, burning sensations, etc. I have hypertonic pelvic floor which showed up a couple of years ago, although I didn't know that's what it was. The symptoms felt like I had some type of raging infection. I then discovered I was suffering from premature ovarian insufficiency and my estrogen levels were very low. With BHRT and high levels of estrogen from pellets my symptoms nearly disappear. However, when I switched from pellets to patches, I can't get those high levels, and now I have vaginal pain every month when ovulation hits, and it usually continues until my period begins. It's difficult to discern which of my symptoms are from insufficient vaginal estrogen and which are from the fluctuations causing my pelvic floor to freak out. I would love to be able to target and reduce this pain by hacking my hormones and that may be achieved through understanding of the entire process. Knowledge is key! 🙂

    1. HI Anna – it sounds like you’ve done a LOT to educate yourself and as you probably know, so tricky to draw direct conclusions about impact of hormones on the pelvic floor. We find the most successful combo with out clients is when we combine the manual therapy we offer with thorough bloodwork and assessment of hormone levels, gut health, immune system function and nutrition so we have relationships with several naturopaths, functional medicine chiros, and the like to support our clients in all these areas. It truly takes a team. I’m curious if you’ve had any pelvic floor therapy?

  2. I’ve noticed I been suffering burning pains, pains around my pelvis, having to go pee, hurts when I sit sometimes feels like I have something going on down there, painful side and clear or wet discharge during or days before ovulation. Is this normal? Is it part of ovulation. Has been happening for a couple years now. I workout and try to do kegels, but sometimes I just can’t or it doesn’t help. Noticed it seems to go away leading to a week before my period as well.

    1. Hi Vanessa – Having some discharge is normal at different times in your cycle. Leaking pee is not normal, although fairly common and very treatable. Burning pain is also not normal. It’s possibly that kegels are making tension worse. You definitely shouldn’t have pelvic pain with sitting or even ovulation. A pelvic physical therapist would likely be the most thorough evaluation of your tissues to help sort out what might be causing this and resolve it. You can also try some of our breathing techniques. CLick HERE for a relaxation video and let us know if you’d like any other resources. Feel free to call 623-226-4002 for more info!

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