Why Breastfeeding Can Affect Your Bladder, Vagina and Pelvic Floor!
We've previously talked about Genitourinary Syndrome of Menopause (GSM) - but menopause actually isn't the time for hormonal changes to affect the vulva, vagina and bladder! During breastfeeding, many women (around 1 in 3) experience a temporary drop in oestrogen that can lead to very similar symptoms.
What is Genitourinary Syndrome in Lactation?
During lactation, the hormone prolactin helps your body produce breast milk. One of the effects of prolactin is that it suppresses the production of oestrogen and androgens.
This temporary drop in circulating oestrogen can affect the health of the vulval, vaginal and urinary tissues, leading to what is now commonly referred to as Genitourinary Syndrome in Lactation (GSL).
Much like Genitourinary Syndrome of Menopause, these hormonal changes can affect comfort, bladder function, sexual function and the health of the vaginal tissues.
What are the symptoms of Genitourinary Syndrome in Lactation?
Symptoms can vary from person to person, but commonly include: vaginal dryness, pain with penetrative sex, bleeding or spotting after sex, changes in vaginal pH, increasing the risk of thrush, urethral irritation and urinary tract infections, urinary incontinence, bladder urgency and frequency, and feeling like the vulval or vaginal tissues are fragile, overly sensitive, or experiencing burning or tearing sensations
Many people assume these symptoms are simply “part of breastfeeding”, but they don’t have to be something you just put up with.
How can Genitourinary Syndrome in Lactation be treated?
The best management is usually a multimodal approach, depending on your symptoms and stage of breastfeeding.
Hormonal support
Topical oestrogen is one of the most effective treatments for improving vulvovaginal tissue health. It is applied directly to the vulva or vagina and comes in several forms, including creams and pessaries. There are two commonly prescribed types: oestriol, and oestradiol.
Another option is DHEA (dehydroepiandrosterone), a vaginal preparation that helps convert natural hormones into oestrogen and androgens within the tissues, supporting vulvovaginal health in a similar way to topical oestrogen.
Non-hormonal support
For women who aren’t ready for hormonal treatment, or who would like additional support, vaginal moisturisers and lubricants can help improve tissue hydration and comfort. Think of these as skincare for the vulval and vaginal tissues.
Functional support
Pelvic floor physiotherapy can also play an important role. Treatment may include helping to improve vulvovaginal tissue health, pelvic floor function, bladder control and symptoms such as painful sex or urinary leakage.
Will topical oestrogen to manage GSL affect my milk supply?
This is probably the question we get asked most often.
Some older research suggested topical oestrogen may reduce milk supply if used in the early postpartum period. What we now understand is that timing matters.
Before your milk supply is established (generally within the first six weeks postpartum), topical oestrogen may have the potential to affect milk production. However, once milk supply is established, there is growing evidence to suggest that low-dose topical oestrogen has little to no impact on milk supply.
Oestriol preparations are also gentler on the body’s circulation, making them less likely to affect tissues outside the vulva. Current evidence also suggests that oestriol does not transfer into breast milk. While small amounts of modern low-dose oestradiol preparations can be detected in breast milk, current research has shown no evidence of harm to infant health or development.
If you have any concerns about using hormonal treatments while breastfeeding, it’s important to discuss these with your healthcare professional so you can make an informed decision together.
Will Genitourinary Syndrome in Lactation go away?
For most women, yes.
These symptoms are closely linked to the hormonal changes that occur during breastfeeding. As breastfeeding reduces and oestrogen levels naturally recover, symptoms often improve as well.
That said, you don’t need to simply wait it out.
While genitourinary symptoms are very common in women who are breastfeeding, they are not normal, and they are certainly not something you have to put up with. There are safe and effective treatment options available, and a pelvic floor physiotherapist can work alongside your GP or women’s health specialist to help you feel comfortable again.
You don’t have to just “wait until you’ve finished breastfeeding”
Many women are told that vaginal dryness, bladder symptoms or painful sex are simply part of breastfeeding. While these symptoms are certainly common, they aren’t something you just have to put up with.
With the right support, there are a range of safe and effective treatment options that can help you feel more comfortable while you continue your breastfeeding journey. If you’re experiencing symptoms, a pelvic floor physiotherapist can work alongside your GP or women’s health team to help you find the approach that’s right for you.
References:
Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Estradiol. [Updated 2025 Feb 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501296/
Other Blogs in the Pre/Post-Natal Series
Deep dive into education written by our pelvic physiotherapists, all about your pregnancy and post-natal journey – including symptoms across a range of pelvic health areas, support & management options & emerging research in the pelvic health space.
Genitourinary Syndrome in Lactation
Perineal Massage in Pregnancy: Does It Really Help?
