Down-There Discomforts at Menopause: Uterine Prolapse

By: Red Hot Mamas

Published: August 18, 2010

Mama never told me I need to worry about any trouble down under at menopause! Libido issues, sexual discomforts and other gynecological conditions can truly catch many of us off guard at menopause. As estrogen levels decline, many women experience a weakening in the pelvic muscles and connective tissues that can lead to some uncomfortable conditions. Eventually, pelvic floor disorders can develop when pelvic muscles and connective tissue in the pelvis weaken or are injured.

About one-third of all US women are affected by one type of pelvic floor disorder in her lifetime. A common type of pelvic floor disorder is uterine prolapse where a woman’s uterus drops, sag or slip out of its normal position.

Causes of Uterine Prolapse

Pregnancy and delivery of large babies are the main causes of uterine prolapse. However, congenital damage to the pelvic floor can cause uterine prolapse even in young women who have never given birth. Smoking and respiratory diseases such as chronic bronchitis and asthma also may increase your risk of developing a uterine prolapse. In addition, heavy lifting or straining may promote the condition. Aging and a loss of muscle tone associated with reduced amounts of circulating estrogen during menopause may also contribute to the condition. If you experience uterine prolapse, chances are you might have prolapse of other pelvic organs, including your bladder and rectum which may lead to difficulty having bowel movements and/or urinary incontinence.

Symptoms of Uterine Prolapse

Many times, women don’t have any symptoms and the prolapse is considered mild. Moderate to severe cases can cause pressure and discomfort. When symptoms occur, they are often less bothersome in the morning but as the day progresses, they worsen. Often women with uterine prolapse experience a sensation of heaviness or pulling in the pelvis. Painful sex can also be a symptom. Lower back and abdominal pain is common. Bowel movements can become difficult and urinary incontinence may become problematic. If you frequently experience any of these symptoms, keep track of them. Write down the details including how long you’ve had the symptoms, so you can bring them to your next clinican’s visit.

Diagnosing Uterine Prolapse

Uterine prolapse is diagnosed during a pelvic exam. Generally, uterine prolapse is more of an annoyance than a life threatening problem. Only 10%-20% of women with pelvic floor prolapse seek medical evaluation for symptoms. If you’re experiencing symptoms, it’s a good idea to call your clinician. Only a clinician can diagnose uterine prolapse. Expect your clinician to ask about your medical history, including how many pregnancies and vaginal deliveries you’ve had. It’s a good idea to go to your visit prepared. If possible, write down some of your key medical information such as any other conditions you’re being treated for, names of medications, vitamins and supplements you are taking. At the office, they will perform a complete pelvic exam and check the strength of your pelvic muscles. If additional examination is required, your clinician might suggest imaging techniques (an Ultrasound, X-Ray or MRI) to confirm the condition.

Treating Uterine Prolapse

Depending on the severity of your symptoms and the extent of your prolapse, your clinician will compile a treatment plan for you to follow. For mild cases, exercises to strengthen the pelvic floor will greatly improve symptoms. Kegels, pilates and other exercises to help strengthen your core muscles will help. Sometimes you can even reverse a mild case of prolapse with certain exercises. Simple steps like avoiding heavy lifting, achieving and maintaining a healthy weight can ease symptoms.

If your case is more severe, your clinician may recommend a vaginal pessary to hold the uterus in place. The pessary is a rubbery, ring-shaped device that fits inside the vagina. It can be inserted temporarily or permanently. It is custom fit by your clinician, specifically for your body and is designed to support areas of the prolapse.

For even more severe cases, surgery may be required to relieve symptoms. Surgical repair for a uterine prolapse usually requires a vaginal hysterectomy to remove your uterus and excess vaginal tissue. If you plan on having more children, you might not be a good candidate for a vaginal hysterectomy. Another surgical treatment is uterine suspension, which involves putting the uterus back into its normal position by reattaching the pelvic ligaments to the lower part of the uterus.

Avoiding Uterine Prolapse

Sometimes you just can’t prevent a uterine prolapse. However, a few simple steps can help you decrease your risk. Limit heavy lifting and avoid unnecessary straining to have bowel movements. Don’t smoke. Smoking can increase your risk of developing a chronic cough, which can put extra strain on the pelvic muscles. Maintain a normal body weight through careful diet and exercise. Hormone therapy has helped some women maintain strong pelvic muscles and ligaments, but it is not recommended you take it specifically for preventing or treating uterine prolapse.


American College of Obstetricians and Gynecologists. ACOG practice bulletin: Pelvic organ prolapse. Obstetrics & Gynecology. 2007;110:717.

“Uterine prolapse.” Mayo Clinic, n.d. Web. 17 Aug 2010.

“Uterine Prolapse.” Cleveland Clinic, n.d. Web. 17 Aug 2010.