Could hormones be the cause of pain and injury?

Jun 30, 2022

Ah hormones, it’s a love-hate relationship for most women, we can thank them for the raging acne we had during our teenage years, or the emotional roller coaster we go through each month. However, the role they play in our bodies is much greater than this and can even influence pain and injury risk.

Let’s talk about their impact on our pelvic floor. First off, what is our pelvic floor? Our pelvic floor is made up of muscles and ligaments that support the bladder, uterus or prostate and the bowels. Our hormones have a direct impact on how our pelvic floor functions.

I’ll explain the role of the hormones and the body and the effect it plays on the pelvic floor.



Oestrogen is produced at vary levels in your menstrual cycle, with highest levels during ovulation. Higher levels of oestrogen cause ligament laxity, this is when the ligaments become relaxed and loose, to get ready for pregnancy. When this happens, the muscles in the pelvic floor and surrounding areas may need to work harder to compensate. You may notice an increase in incontinence symptoms at this time, such as leakage when you laugh or sneeze too hard.

On the other hand, decreased oestrogen levels can cause a decrease in vaginal lubrication, as oestrogen helps with lubrication production. This is a common compliant by menopausal women. Decreased lubrication can lead to vaginal irritation and pain or tearing with penetration.


Testosterone has many great benefits such as boosting mood and cognitive function and maintaining bone health. Testosterone peaks around ovulation, you may notice during this time you have more energy, you feel stronger and have a higher libido. You can thank testosterone for this!

During ovulation is a great time for women to do more strength training, as testosterone levels reduce before menstruation, you should do more low impact exercise such as walking, yoga or Pilates.

Progesterone and Relaxin:

Both hormones are produced to help prepare the body for birth (even if we are not pregnant!), by relaxing ligaments, joints, and muscles. Levels of progesterone and relaxin peak around the time of menstruation. Symptoms are likely to increase during this time as both your muscles and ligaments are relaxed. Urinary incontinence is the most common symptom associated with excessive levels of these hormones!

Having the knowledge about your cycle is key. There are many apps available to tract your cycle. You may need to alter your exercise or rehabilitation throughout your cycle to account for these hormonal changes. If you do experience any symptoms such as urinary leakage during ovulation or menstruation, you may have an underlying pelvic floor dysfunction.

Pelvic floor dysfunction can lead to several conditions including, but not limited to:

  • Urinary frequency or urgency
  • Urinary stress incontinence (i.e. leakage when coughing, sneezing, exercising, etc)
  • Faecal incontinence
  • Pelvic organs prolapse
  • Pain during penetration

Although these symptoms are common, they are not normal and are not something we should play off as a “normal part of being a woman”. Although, we cannot directly control our hormones, the good news is that we can improve the function of the pelvic floor muscles by addressing strength, endurance, and areas of tightness. If you are experiencing any of these symptoms, please visit a pelvic floor specialist for a full assessment.


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- Made it back onto tennis / squash courts to (tentatively!) celebrate 1 year anniversary of my surgery 
- Ran my fastest 10k at 43.57! 
- Ran 5k in 21:30 (vs pre-surgery PB of 20:18) 
- I increased my single leg calf lift to 59 kg (vs ~18 kg initially a few months ago) 
- I had a final appt with my consultant, who discharged me while congratulating me on a wonderful recovery

All the above is to illustrate that I'm absolutely delighted with the progress I have made since last summer when I couldn't do anything and the outlook seemed bleak. I'll be forever grateful for Louise’s guidance and support as I've navigated the long road back from my injury, and I appreciate the continued advice to help me prepare for more dynamic activity. Louise has been really fantastic and I couldn't have asked for better care.

Recovering from a full Achilles rupture. Started my work with Nina in feb and my progress has only been positive and upwards and I am almost at full speed again. Nina put me back together again almost from scratch. She is the best physio I have ever worked with and will again. Very knowledgable and very hard working. Can’t recommend enough.


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I am 84 years old, and have always been fit and healthy and exercised regularly. 3 years ago I underwent emergency surgery for peritonitis, and had a colonoscopy bag for 6 months and straight after surgery to reversal of the stoma. After this surgery I felt my legs very weak. To complete my drama, during the last summer I developed an abdominal hernia and had surgery for hernia repair. This made me even weaker specially at my legs. I have recovered but felt weak. I started my sessions at ALO Physiotherapy at the beginning of January, with the Vibra Machine combined with specific exercises. I have now recovered my body strength, particularly in the legs. I am now walking normally and without pain. I am delighted!


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Where do I begin? The journey has been too long with Andre Oliveira and ALO Clinic , as he helped me both physically and mentally to overcome an injury I had in both of my knees. A small injury , after following wrong treatment became chronic and I found myself unable to walk/stand/run and do the simplest things- the mental impact was worse. I was introduced to Andre by Eleftherios Pavlidis who runs Laertion in Athens. lefteris with his team were the first to accommodate the problem and told me what I need to do. As a Londoner, I was introduced to Andre and ALO Clinic, and the rest is history. Since February 2017 when I had the first session with Andre and he identified the biomechanic nature of the problem, along with the use of Tecar the results were visible after one month. Since then, along with personal effort and strengthening I did always guided by Andre, I the problem is restored and the pain is gone. I highly recommend ALO Physiotherapy Clinic , and Andre Oliveira for anyone who suffers from sport injuries , amateurs or professional top athletes.


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The care I received from ALO Physiotherapy was outstanding from the first session to the last. Sessions with Louise were informative as well as practical, allowing me to understand the context/logic behind treatment as well as tips to prevent future injuries. Louise was always readily available to answer my questions and the treatment process was collaborative rather than being prescriptive. Beyond the expertise of the team the quality of the equipment and facilities was incredibly high and aided my recovery significantly. I would recommend ALO Physiotherapy to anyone who requires physiotherapy treatment in the Marylebone area.

ALO is an excellent well-run clinic and Louise Hynes who looked after me is a superb physiotherapist. Louise is knowledgeable, skilled and very efficient at her job. My sore shoulder was sorted out in no time thanks to her. Thank you, Louise, and thank you ALO.

Julian Webber, Harley Street Endodontist.

ALO is an excellent well-run clinic and Louise Hynes who looked after me is a superb physiotherapist. Louise is knowledgeable, skilled and very efficient at her job. My sore shoulder was sorted out in no time thanks to her. Thank you, Louise, and thank you ALO.

Julian Webber, Harley Street Endodontist.

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