Why does prolapse at menopause occur? You had your babies years ago. You got through it, recovered, got on with life. And now, in your 40s or 50s, you’ve started noticing something new – a heaviness in your pelvis, a dragging sensation, maybe even a feeling that something is bulging or “coming down.”
If this sounds familiar, you may be experiencing pelvic organ prolapse. And while this might feel alarming, there’s something important to know: prolapse showing up at menopause is incredibly common, it doesn’t mean something has suddenly gone terribly wrong, and it is very treatable.
Here’s why it happens – and what we can do about it.
What is pelvic organ prolapse?
What does prolapse feel like?
Your pelvic organs – bladder, uterus, and bowel – are held in place by a combination of muscles, ligaments, and connective tissue. Together these form your pelvic floor support system. Prolapse occurs when one or more of these organs descends from its normal position because that support system has been weakened or damaged.
Common symptoms include:
- A feeling of heaviness, fullness, or pressure in the pelvis
- A dragging sensation, particularly at the end of the day or after exercise
- A bulge or lump at the vaginal opening
- Difficulty emptying your bladder or bowel fully
- A feeling that something is “coming down” or “falling out”
- Low back ache that worsens with prolonged standing
What types of prolapse are there?
Depending on which organ is involved, you might have a bladder prolapse (cystocele), uterine prolapse, or bowel prolapse (rectocele). Some women have more than one type. A pelvic floor physiotherapist can identify what’s happening through a thorough assessment and explain clearly what’s going on in your body.
Why is prolapse at menopause so common?
The role of childbirth
When you give birth, your pelvic floor endures significant strain. Even without an obvious tear or injury, the muscles and connective tissue that support your pelvic organs are stretched considerably. Most women recover well – but the support structures may never be quite as strong as they were before. The impacts of age and hormone changes as we age can make a prolapse at menopause show up.
How oestrogen has been compensating for years
For years after childbirth, oestrogen plays a vital role in keeping your pelvic floor resilient. It supports collagen production in the connective tissues, helps maintain muscle tone, and assists in keeping everything well-supported. While your oestrogen levels are adequate, your body can compensate for any underlying weakness.
“Prolapse appearing at menopause doesn’t mean you’ve done something wrong or that you’ve suddenly developed a new problem. It often means a pre-existing vulnerability is now showing up. That’s a very different thing.”
Why menopause tips the balance
When oestrogen drops at menopause, connective tissue loses some of its strength and elasticity. Muscles are weakening with the effects of ageing. And the cumulative effect of gravity, time, and daily physical activity – things like lifting, coughing, and exercise – starts to show. What was a hidden vulnerability becomes a real, felt symptom.
What makes some people more at risk of pelvic organ prolapse at menopause?
While prolapse can affect anyone, some factors increase the likelihood:
- Vaginal births, particularly long labours, large babies, instrumental deliveries (forceps or ventouse), or significant birth tears
- Having multiple vaginal births
- Chronic constipation or straining on the toilet over many years
- A history of heavy lifting
- Family history of prolapse
- Having had a hysterectomy
It’s also worth knowing that many women with prolapse had no idea their births had left them vulnerable. It’s not until later in life when a combination of factors start to cause symptoms.
What can physiotherapy do for prolapse?
A lot. Physiotherapy is a first-line treatment for prolapse – meaning it’s recommended before considering surgery in most cases. The evidence shows that targeted pelvic floor rehabilitation can significantly reduce prolapse symptoms and improve the degree of prolapse itself.
What does a pelvic floor assessment involve?
Your first appointment is about understanding your full history – your births, your symptoms, when things changed, and what’s affecting your daily life. If you’re comfortable, we’ll do an internal assessment to see exactly how your pelvic floor muscles are functioning and how significant the prolapse is. From there we build a treatment plan that’s specific to you.
Treatment typically includes a personalised pelvic floor muscle training programme, and education on managing prolapse in daily life. This includes how to lift safely, and advice on physical exercise that is helpful for the individual. We discuss healthy bowel habits and give guidance on maintaining long-term pelvic floor health.
What about pessaries?
A pessary is a small silicone device worn internally that supports the pelvic organs and reduces prolapse symptoms. It’s a very effective, non-surgical option that suits many women – particularly those who want relief while going through physiotherapy, or those who prefer to avoid surgery. We are trained in pessary assessment and fitting and can help you work out whether it might be right for you.
Do I need a GP referral first for help with prolapse?
No – you can book directly with us. If we feel a GP opinion or gynaecology input would be helpful, we’ll let you know and can work alongside your other health providers. Many women come to us first and find they don’t need further help.
What if I’ve been told I need surgery?
Physiotherapy is still very much worth doing, both before and after prolapse surgery. Before surgery, it can reduce symptoms and help you go in with the strongest possible pelvic floor. After surgery, it supports your recovery and helps protect against recurrence.
Many women who come to us expecting they’ll need surgery find that their symptoms improve significantly with physiotherapy alone. It’s always worth giving conservative treatment a proper attempt first.
Don’t wait until it gets worse
Prolapse doesn’t always stay the same – but with the right support, it also doesn’t have to progress. Addressing it early with good pelvic floor rehabilitation gives you the best chance of managing your symptoms effectively and protecting your pelvic floor for the long term.
If you’ve noticed symptoms, please don’t put off getting help. You don’t have to live with that heaviness or dragging sensation as a permanent part of your day.
Think you might have a prolapse? Book a pelvic floor assessment in Wellington – we’ll give you a clear picture of what’s happening and a practical plan to help.
Frequently asked questions
What does pelvic organ prolapse feel like?
The most common symptoms are a feeling of heaviness or dragging in the pelvis, a sensation that something is bulging or coming down, and pressure in the vaginal area that tends to worsen by the end of the day or after exercise. Some women also notice difficulty fully emptying their bladder or bowel. If any of these sound familiar, it’s worth getting assessed by a pelvic floor physiotherapist.
Can a physiotherapist treat prolapse without surgery?
Yes – physiotherapy is the recommended first-line treatment for prolapse before surgery is considered. A targeted pelvic floor rehabilitation programme can significantly reduce prolapse symptoms and in many cases improve the degree of prolapse itself. At our Wellington clinic, many women who come to us expecting surgery find their symptoms improve substantially with physiotherapy alone.
Why has my prolapse appeared now, years after having my babies?
This is very common and has a clear explanation. Childbirth can leave the pelvic floor with underlying vulnerabilities that oestrogen helps compensate for over the years. When oestrogen drops at menopause, that support is withdrawn and what was a hidden weakness can become a real, felt symptom. It doesn’t mean you’ve done something wrong – it means your body needs a different kind of support now.
Is prolapse permanent – will it get worse over time?
Prolapse doesn’t always progress, and with the right support it often doesn’t need to. Physiotherapy can help stabilise symptoms and protect your pelvic floor from further strain. Many women manage their prolapse very well long-term with physiotherapy and lifestyle changes. Surgery is an option if conservative treatment isn’t sufficient, but it’s rarely the only option.
What is a pessary and could it help my prolapse?
A pessary is a small silicone device worn internally that supports the pelvic organs and reduces pro lapse symptoms. It’s a very effective non-surgical option that suits many women — particularly those who want relief while going through physiotherapy or who prefer to avoid surgery. Our Wellington pelvic floor physios are trained in pessary assessment and fitting and can help you work out whether it’s right for you.
Also in this series:
- Blog 1: Why Sex Becomes Painful at Menopause – And What You Can Do
- Blog 3: Why Leaking Gets Worse at Menopause – Even If It Was Never a Problem Before