What changes in the body at this stage
Between the first period and the menopause, a woman’s body lives in cycles. Hormones shift throughout the month and, with them, energy, sleep, digestion, sensitivity to pain and desire. Getting to know your own cycle is one way of listening to your body.
Many women have learnt that strong pain every month, missing school or work, or pain with penetration is “part of being a woman”. It isn’t. These symptoms are common, but not normal, and they deserve to be looked into.
What may lie at the root
Pelvic pain rarely has a single cause. In the consultation we look at several layers:
- The pelvic floor. The muscles that support the bladder, uterus and bowel can stay permanently tense, like a clenched fist. This can cause pain during sex, pain inserting a tampon, burning or a frequent urge to pass urine.
- The organs and their connections. The uterus, ovaries, bladder and bowel are linked by fascia and ligaments. Surgery, infection, endometriosis or long-standing constipation can reduce that mobility and keep pain going.
- The nervous system. When pain lasts for months, the body becomes more sensitive and reacts to things that used to be bearable. The pain is real, even when scans and tests come back normal.
- The rest of the body. Breathing, posture, the lower back, the hips, sleep and stress all influence the pelvis.
When you are trying to conceive, the whole body matters: the cycle, the bowel, pain during sex, and the anxiety of months of waiting.
How we can support you
The first appointment starts with a detailed conversation about your cycle, pain, bladder, bowel, sex life and medical history. We then assess posture, breathing, the abdomen and the pelvis.
- Pelvic physiotherapy: external assessment and, only with your consent and when it is useful, an internal vaginal assessment to understand muscle tone, strength and painful areas. Treatment may include manual therapy, relaxation and coordination exercises, biofeedback, pain education and, if needed, vaginal dilators for use at home.
- Visceral osteopathy: gentle hands-on techniques over the abdomen and pelvis to improve the mobility of the organs and the tissues around them.
- Acupuncture: may help relieve period pain and support wellbeing across the cycle. When you are trying to conceive, including during assisted reproduction, it can be a complementary support; studies on its effect on pregnancy rates are mixed, and we say so clearly.
- Craniosacral approach: light touch that many women find relaxing at times of pain and anxiety.
This care complements your gynaecologist or fertility clinic and never replaces it.
When to see a doctor
Speak to your GP or gynaecologist, or go to A&E, if you have:
- very heavy bleeding (soaking a pad or tampon every hour for several hours) or bleeding between periods or after sex;
- sudden, severe lower abdominal pain, especially with a late period or a positive pregnancy test;
- fever with pelvic pain, or unusual-smelling discharge;
- unexplained weight loss, extreme tiredness or blood in your stools;
- pain that gets worse month after month, even with medication.
If you have been trying to conceive for 12 months without success (or 6 months if you are 35 or over), ask for a fertility assessment.