Pelvic pain after menopause can have several potential causes. The most common reasons include:
- Atrophic vaginitis - Thinning of the vaginal walls due to lower estrogen levels leads to inflammation and irritation. This can cause burning, itching, and pain, especially during sex. Keeping the vagina lubricated with moisturizers can help.
- Urinary tract infections (UTIs) - The urethra shortens and thins after menopause, making it easier for bacteria to reach the bladder and cause an infection. UTIs often cause pain when urinating along with an urge to urinate frequently. Seeking prompt medical treatment is important.
- Endometriosis - This condition with tissue similar to the uterus lining growing outside the uterus can persist after menopause. It can cause chronic pelvic pain that may worsen close to when a menstrual period would have occurred before menopause.
- Adenomyosis - This condition of the uterine lining growing into the muscle wall of the uterus also may continue after menopause. It can lead to pelvic pain, painful sex, and heavy menstrual bleeding before menopause.
- Ovarian remnant syndrome - After surgical removal of the ovaries, small pieces of ovarian tissue may remain and become active after menopause when hormone production decreases. This can cause periodic pelvic pain.
- Pelvic floor dysfunction - The pelvic floor muscles and connective tissue can become painful from conditions like vulvodynia. Physical therapy helps address muscle spasms, inflammation, and nerve pain contributing to discomfort.
Other less common causes include:
- Fibroids or benign tumors in the uterus
- Scar tissue binding organs together
- Bowel conditions like irritable bowel syndrome
- Pelvic adhesions
- Pelvic organ prolapse
Managing pelvic pain typically involves:
- Keeping the vagina lubricated with moisturizers to prevent irritation
- Treating any infections promptly with antibiotics or antivirals
- Considering hormonal therapies like low-dose vaginal estrogen products to reduce atrophy
- Trying over-the-counter pain medications
- Exploring physical therapy to relax pelvic floor muscles
- Using vaginal dilators progressively to gently stretch tightened pelvic floor tissues
If pain persists or limits your activities, see your healthcare provider for an evaluation. Tests like pelvic exams, ultrasounds, laparoscopy, or MRI help identify contributing conditions. Based on the cause, treatment options range from lifestyle measures and topical therapies to medications, injections, nerve blocks, hormone therapy, or surgery.