How the Menstrual Cycle affects Pelvic Health

Beth Safarian PT Msc. PT, BSc.

It is well known that your menstrual cycle affects many aspects of your body, including your mood, energy levels, and even your skin. However, you may not be aware that it also has a significant impact on your pelvic health. In this post, I will discuss 3 changes in your body that occur during your cycle and explain how they can affect your pelvic health.

Before we explore these changes, it is important to understand what is happening hormonally during a typical 28 day menstrual cycle. The menstrual cycle is divided into four phases: follicular, ovulatory, luteal and menstrual phases. To keep things as simple as possible, I will explain these phases based on an average 28 day cycle.

Menstrual Phase - day 1-5; estrogen and progesterone are both at low levels, but estrogen is slowly starting to increase.

Follicular Phase - day 6-12; estrogen continues to increase at a faster rate and is approaching its peak. Progesterone is remains low and stable.

Ovulatory Phase - day 13-15; after estrogen reaches it’s peak, ovulation occurs (meaning that an egg is released). Estrogen then begins to decline and progesterone is now on the rise.

Luteal Phase - day 16-28; progesterone reaches it’s peak then declines and estrogen remains relatively low. When estrogen and progesterone are at their lowest, this is what triggers the start of the next cycle ( AKA. menstruation).

Now that we have a general understanding of what happens hormonally, we will now explore 3 changes that occur in our bodies during these fluctuations.

1. The Cervix

• During menstruation, the cervix is positioned low, is firm and slightly open

• During early follicular, it remains low and hard

• As ovulation approaches, the cervix moves higher in the vagina, becomes softer and more open to allow for sperm to travel through the cervix easier

• After ovulation occurs, the cervix drops lower and becomes more firm again

2. Vaginal Discharge

• After menstruation, vaginal discharge tends to be minimal for most people

• If there is discharge during the early follicular phase, it tends to be more thick and sticky

• As you approach ovulation, discharge will transition to different types of consistency (creamy, then wet, and finally egg white during ovulation)

• The thin, slippery discharge creates a better environment for sperm to travel in

• After ovulation occurs, discharge tends to decrease in volume and become a thicker consistency again

3. Libido

• Some people with menstrual cycles notice a cyclical relationship with their sex drive

• Typically libido will be low during and right after menstruation, then slowly begin to climbduring the follicular phase

• It will usually reach it’s peak right before ovulation and then begin to decline during the luteal phase

So what does all this information mean in terms of pelvic health? It can be helpful to understand what’s happening to your body and why, especially if you deal with pelvic health concerns such as stress incontinence, prolapse, pelvic pain and dyspareunia. For example, if you have dyspareunia, understanding cycle related changes can help you potentially manage your symptoms more effectively. That might mean using more lubricant and incorporating more foreplay when being intimate right before or after your period. It might look like adjusting your positioning because of where your cervix is at that time. In regards to prolapse and stress incontinence, an increase in symptoms are often reported right before/during menstruation. This is because of the effects of low estrogen on the vagina/urethra and the position of the cervix. In addition, people dealing with dysmenorrhea and endometriosis often have increased pain during this phase as well. Some people may benefit from adjusting the type and intensity of exercise they do during this time to help manage their symptoms. For example, it may be helpful to focus on lower intensity and restorative movement like yoga, swimming or cycling during this phase to reduce their symptoms. If you’re curious about your cycle and how it affects your symptoms, a pelvic floor therapist can educate, give exercise recommendations and suggest strategies to help you improve your pelvic health.