How Estrogen Impacts Pelvic Floor Healing Postpartum
When we talk about postpartum healing, we often focus on things like sleep, perineal tearing, diastasis, or leaking with sneezing. And while those are all valid parts of the postpartum experience, there’s something deeper—something many women aren’t being told: your hormonal landscape after birth has a huge influence on your pelvic floor healing.
Let’s talk about estrogen.
Estrogen is a powerhouse hormone. It keeps our vaginal and vulvar tissues juicy, elastic, and resilient. It supports blood flow, tissue repair, and lubrication. But after birth? Estrogen drops like a rock. And if you’re breastfeeding, it stays low for months—sometimes even over a year.
So if you’ve had a vaginal delivery, a tear, stitches, or are experiencing burning, dryness, or discomfort with intercourse or pelvic exams—this blog is for you. We’re going to walk through how estrogen changes after birth, how that affects your pelvic floor, how breastfeeding plays a role, and how you can support your healing with both physical therapy and topical support.
As a pelvic floor physical therapist in Kansas City and founder of enCORE Therapy, I work with women every single day who are told their pain or symptoms are “just part of being a mom.” But that’s not true—and it’s time for better care.
The Biggest Hormonal Shift of Your Life
You’ve heard of menopause. You’ve maybe heard of perimenopause. But what most people don’t talk about is the most dramatic hormonal drop a woman will ever experience happens right after giving birth.
During pregnancy, your estrogen levels increase by over 100 times the pre-pregnancy baseline. Estrogen thickens the uterine lining, prepares the breasts for lactation, and supports the vascular system that keeps your baby nourished.
But as soon as the placenta is delivered, estrogen plummets—and fast. Your estrogen levels drop to near-menopausal levels within 24 hours postpartum [source].
And this isn’t just about mood or milk—it’s about tissue quality. The same hormone that helped plump and prepare your vaginal and pelvic floor tissues during pregnancy disappears just as your body begins the hard work of healing.
Breastfeeding and Low Estrogen: A Double-Edged Sword
Breastfeeding is beautiful. But it also suppresses estrogen through the hormone prolactin. This is the body’s way of naturally suppressing ovulation during the postpartum period (though not a reliable birth control method). The downside? Your estrogen stays very low while prolactin stays high.
This is why many breastfeeding moms feel like they’re in a mini menopause. You might notice:
Vaginal dryness
Burning or itching (especially around the vulva)
Pain with penetration, intercourse, or pelvic exams
Tissue fragility (tears more easily, bleeds, or feels “raw”)
Urinary urgency or frequency
Lingering perineal discomfort
So while your baby is thriving on breastmilk, your pelvic floor tissues may be starving for estrogen.
This low-estrogen environment makes it harder for your body to rebuild collagen and elastin—two major players in tissue repair. That means longer healing timelines, higher sensitivity, and increased risk of discomfort if nothing is done to support the tissue.
And here’s the kicker: this is not just a comfort issue. It’s a healing issue. Without enough estrogen, even small vaginal tears or abrasions may take longer to heal—and that can spiral into bigger pelvic floor problems down the line.
Why Pelvic Floor Therapy Needs to Include Hormones
Here’s the thing: you can do all the rehab exercises in the world, but if your tissues are dry, thin, or irritated because of low estrogen, you’ll keep hitting the same wall.
That’s why in my practice at Encore Therapy, we always screen for signs of low estrogen and vulvar tissue changes. It’s not just about muscles—it’s about the whole healing environment.
This is especially important if:
You had a second- or third-degree tear
You’re experiencing scar sensitivity or adhesions
You have pain with sex despite doing “all the right things”
You feel like your symptoms flare after feeding or pumping
You’re more than 8 weeks postpartum and still feeling fragile "down there"
And here’s the good news: we can support estrogen from the outside in.
How Topical Estrogen Can Help
Topical estrogen is a game-changer for postpartum women with vaginal or vulvar symptoms. Unlike systemic estrogen (like birth control or hormone replacement therapy), topical vaginal estrogen is applied directly to the tissues that need it most.
It’s FDA-approved, safe for breastfeeding, and incredibly effective at:
Improving vaginal and vulvar tissue thickness
Increasing lubrication and reducing dryness
Enhancing blood flow and tissue repair
Making sex and exams more comfortable
Supporting overall pelvic floor function
Studies have shown that vaginal estrogen significantly improved vaginal atrophy, lubrication, and comfort in breastfeeding women—even within just a few weeks of use.
And no, this is not “just for menopause.” If you’re 6 weeks postpartum and dealing with tissue pain or burning, it’s not too early to ask about this.
Talk to your OB, midwife, or pelvic floor PT about whether topical estrogen could be right for you. And if your provider dismisses your concerns? Time to find someone who won’t.
Vulvar Moisturizer: Your Daily Defense
Now let’s talk about vulvar moisturizers.
No, not scented lotions or generic “feminine” products. We’re talking about products specifically formulated to support vulvar tissue—free of fragrances, parabens, or irritants.
These moisturizers are not estrogen-based, but they support hydration and tissue elasticity. They’re especially helpful:
Between feeds (especially if symptoms flare after nursing)
Before and after intercourse
After a shower, when tissues can feel tight or dry
As daily maintenance for vulvar health
Think of it like a moisturizer for your face—but for your pelvic floor. When your estrogen is low, you have to support that tissue from the outside in. And pairing vulvar moisturizers with pelvic floor therapy and, if needed, topical estrogen, creates a holistic approach that actually works.
Here is my favorite vulvar moisturizer.
So... What Does This Mean For You?
If you’re postpartum (whether 6 weeks or 6 months) and struggling with discomfort, scar sensitivity, or just not feeling “back to normal,” I want you to know this:
You are not broken. You are not failing. You are healing in a hormonal environment that’s just... not very helpful.
This is why it’s critical to work with someone who understands the full picture—not just kegels and core work (though yes, those matter), but also the role of hormones, tissue quality, and nervous system regulation.
That’s exactly what we do at enCORE Therapy. Whether you’re in Kansas City, Overland Park, or working with us virtually, we look at all the layers of postpartum healing—from breath to bladder to vulvar skin.
The Bottom Line
Let’s recap what we now know:
Estrogen drops significantly after birth—more than in menopause
Breastfeeding keeps estrogen low, which can delay tissue healing
This hormonal shift can lead to burning, dryness, and pain
Topical estrogen (and vulvar moisturizers) can dramatically help
Pelvic floor physical therapy should always consider hormonal factors
If your provider hasn’t mentioned estrogen, it’s not because it doesn’t matter—it’s because this education is still missing from mainstream care. But you deserve better. You deserve healing that looks at the whole picture.
Ready to Take the Next Step?
At enCORE Therapy, we help moms across Kansas City and Overland Park heal smarter—not harder. Whether you’re recovering from tearing, struggling with painful intercourse, or just want to understand your pelvic floor better, we’re here to help.
✅ Evidence-based care
✅ Hormone-aware rehab
✅ Virtual options for busy moms
Don’t wait for your tissues to “bounce back.” Let’s support them now