Hormones, prolapse and leakage!

Do you ever reach the middle of your cycle and your symptoms suddenly get worse? 

Yup me too. Two days after ovulation and my vagina feels more lax and I feel a vulnerability to leaking! 

This is the feeling I use to feel for the whole of my cycle but thanks to hypopressives this only happens for a couple of days post ovulation and then things feel more held again! 

This isn't my symptoms getting worse for no good reason- its hormones! And it happens to so many women through their cycle or when they hit perimenopause. 

I wanted to explain why this happens and to let you know how common it is. 

After ovulation, oestrogen drops. It had been building throughout the first half of your cycle - supporting tissue quality, maintaining the health of your vaginal walls, keeping your urethral closure pressure where it needs to be, and maintaining the integrity of the connective tissue that holds your pelvic structures in place. 

Then the egg is released, and that oestrogen peak is gone. 

What follows is the luteal phase, and with it comes a sustained decline in oestrogen that lasts until your period arrives.

This matters for the pelvic floor, because oestrogen receptors are distributed throughout the entire urogenital system. 

Research has confirmed their presence in the vaginal walls, the urethra, the bladder trigone, the pubococcygeus, and the surrounding supportive ligaments of the pelvis. 

These structures aren't just passively sitting there they are actively responding to your hormone levels. 

When oestrogen is high, these tissues are well-hydrated, elastic, and well-supported. When oestrogen drops, even temporarily, the quality of that support changes. The vaginal tissue becomes less resilient. The urethra loses some of its closure tone. The connective tissue that anchors your pelvic organs is less robust. For women who already have some degree of pelvic floor vulnerability -whether that's stress incontinence, urgency, or prolapse - this cyclical dip can be enough to tip symptoms over the threshold.

But oestrogen isn't the only player here.  At the same time that oestrogen is declining post-ovulation, your body is also releasing a hormone called relaxin. Relaxin is produced by the corpus luteum - the structure left behind after the egg is released and it peaks around 14 days after ovulation. Its job is to prepare the body for a potential pregnancy by remodelling connective tissue, softening ligaments, and increasing tissue pliability throughout the pelvis. 

Research published in Frontiers in Endocrinology confirms that relaxin acts throughout the female pelvis during the luteal phase, stimulating enzymes that break down and remodel collagen while simultaneously suppressing the laying down of new collagen. 

The uterosacral ligaments -which are key structural supports for the uterus and upper vagina have relaxin receptors on them, meaning they are directly affected by this process.

So what you have in the post-ovulatory window is a double hit: oestrogen falling away and withdrawing its structural support from pelvic tissues, while relaxin is simultaneously softening and loosening the ligamentous framework of the pelvis.

For me, that's exactly when I feel it most - that laxity, that sense of things not quite being held as firmly as they usually are, the potential of leakage when I jump or run, more heaviness and a higher chance of constipation. 

Now lets talk about that constipation- this is because progesterone rises in the luteal phase and it slows gut motility. 

A 2024 paper examining pelvic symptom dynamics across the menstrual cycle noted that individual women experience these shifts very differently, but that the luteal phase consistently emerges as the window where symptoms are most likely to flare. The same research highlights that the oestrogen and progesterone receptors throughout the lower urinary tract mean that hormonal fluctuations have a real, measurable effect on pelvic muscle function - not just on tissue quality.

 The most useful thing this knowledge gave me, and what I want it to give you,  is the ability to stop panicking on bad days that things have got worse and will stay that way, and  to start working with your cycle instead of against it. 

Tracking your symptoms alongside your cycle is one of the most powerful tools available.  It tells you when to back off high-impact training, when to prioritise bowel health, when to be more intentional about load management, and equally, when you have capacity to push.

It also tells you that what you're experiencing is cyclical and hormonally driven - which means it's addressable. The symptoms you notice post-ovulation are not a sign that things are getting permanently worse. They are a predictable, manageable response to a hormonal window that every woman moves through each month.

What my clients and I notice after doing hypopressives is that the days they feel their symptoms most, is no longer the entire cycle but just a few days post ovulation/ pre menstruation. And the symptoms they do feel on those days are no where near as severer as the symptoms they use to feel during this time.  

If you find you're living with noticeable symptoms for your entire cycle then drop me a message and we can discuss how hypopressives can help you.