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When Something Goes Wrong "Down There"

When Something Goes Wrong "Down There"

Understanding common pelvic health issues

Your Body

This article has been archived. We will no longer be updating it. For our most up-to-date information, please visit our pelvic health information here.

You probably don't think much about your pelvic health unless you're having your annual gynecologic exam, getting a Pap test, or experiencing a problem. But no matter what your age, the health of your reproductive and urinary organs—your pelvic organs—is important. If something goes wrong "down there," it affects your overall health and quality of life. And we know that you, like most women today, simply don't have time to put their lives on hold because of uncomfortable, painful or embarrassing symptoms.

When we talk about your pelvic region, we're talking about your vagina, uterus, urethra and bladder. And, when we talk about pelvic health problems, we're talking about conditions associated with these structures, like heavy periods, fibroids, pelvic organ prolapse (POP) and stress urinary incontinence (SUI). A report commissioned by the National Women's Health Resource Center found that at least one-third of all women 21 and older will be treated for one or more of these pelvic health problems by the time they turn 60. In addition, the report found that baby boomer women—those between ages 40 and 60—experience pelvic disorders most frequently. These pelvic-health related conditions can significantly affect your quality of life. Yet, all seem to be something women are reluctant to talk about it, either with each other or with their health care professionals.

And that's a shame, because with good medical care, each of these conditions can be improved or even cured. Diagnose and treat the problem and you improve your overall health and quality of life.

Pelvic Health Through the Ages and Stages of Women's Lives


Menorrhagia, or unusually heavy bleeding during your period, can strike any time during a woman's reproductive lifetime. Unusually heavy bleeding involves a soaked pad and/or tampon every hour or less. It is most likely during puberty and perimenopause (the years just before menopause), when reproductive hormones are erratic, and affects an estimated 10 to 20 percent of premenopausal women in the United States.

Most women diagnosed with menorrhagia are over 30, with about 50 percent older than 45. The cause behind most cases of menorrhagia is unknown, but medical conditions such as fibroids and thyroid conditions can contribute. Plus, about 15 percent of menorrhagia diagnoses are related to von Willebrand's disease, a bleeding disorder that occurs when blood doesn't clot properly. Unfortunately, doctors don't always test for this condition before treating menorrhagia.

Note: Any bleeding after menopause should be investigated immediately. It could be a sign of endometrial cancer.

Your pelvic health changes throughout your life. With every pregnancy and delivery and with every decade, organs shift, hormones fluctuate and your risk of pelvic health issues increases. Specifically, here is what four common pelvic health conditions look like over the years.


Fibroids are noncancerous uterine tumors. They are amazingly common in reproductive aged women, particularly toward the end of a woman's reproductive life. By age 35, 60 percent of African-American women and 40 percent of Caucasian women have fibroids; that percentage jumps to more than 80 percent of African-American women and nearly 70 percent of Caucasian women by age 50. By menopause, a woman's risk of fibroids is 20 times higher than her risk at age 25.

Most women, however, don't even know they have fibroids because they have no symptoms. Still, an estimated 20 to 25 percent of all women between the ages of 30 and 60 have symptoms related to their fibroids. Women are most likely to be diagnosed in their 40s. That could be because fibroids tend to get larger with age.

You have a higher risk of developing fibroids if you are obese or if you have high blood pressure. Conversely, the risk decreases every time you give birth.

Once you reach menopause, however, fibroids usually shrink because they rely primarily on estrogen, as well as progesterone, to grow, and at menopause, these hormones decline.

Stress Urinary Incontinence (SUI)

You have stress urinary incontinence (SUI) if a little (or a lot) of urine escapes when you laugh, sneeze, cough or otherwise strain. The condition affects about 13 million people in the United States, most of them women. Overall, one-third of women will develop SUI within five years of a vaginal delivery. While about one in three women experience some form of incontinence, including SUI, less than half tell their health care professionals about it. In fact, about 61 percent of women had a problem with SUI for four years or more before they sought medical help.

The thing is, without medical treatment, SUI won't go away. And, it may get worse with age.

Pelvic Organ Prolapse (POP)

Pelvic organ prolapse (POP) occurs when one or more organ in your pelvis—your uterus, urethra, bladder urethra or bladder—shifts downward and bulges into your vagina. Some studies find the condition affects up to 40 percent of women aged 50 to 70, and one study of 1,000 women seeking routine gynecologic care found 76 percent had some form of POP. Most women, however, don't have any symptoms.

The risk of POP increases with each vaginal birth (up to five), with age and with excessive weight.

Do you have a pelvic health condition?

  • Do you tend to limit your activities when you have your period for fear of having an "accident"?
  • Do you experience severe cramps or heavy bleeding when you menstruate?
  • Do you feel a heaviness in your lower abdomen, almost as if something within you is dropping?
  • Do you have frequent and unexplained pelvic pressure or pain?
  • Does a little urine escape when you laugh, sneeze or cough?

If you answered "yes" to any of these questions, then it's time to figure out what's going on "down there."

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