PGP: it’s not about hormones
Even though hormones are not the cause of PGP, it is surprising how many of us have been told by healthcare professionals that there is a link. Although this idea is now outdated, it is amazing how it still seems to continue. The Pelvic Partnership’s helpline regularly receives calls from women who are upset because they have just got the hang of breastfeeding and their GP has advised them to give it up in the (mistaken) belief that it will help their PGP to improve. The idea is that continuing to breastfeed keeps stimulating hormones to produce milk which also causes the PGP. Not only is this notion of a causal relation wrong, but it can be very upsetting if not deeply damaging when women then stop breastfeeding only to find that it makes no difference at all to their PGP symptoms which continue just as they did before they stopped. Clearly, the breastfeeding hormones are different from the main pregnancy hormones, which makes it difficult to understand the logic behind this particular myth!
Before we spill the beans on what really causes PGP, it might be a good idea to cover some basics about PGP and its common symptoms…
What is PGP?
PGP (Pelvic Girdle Pain) is a condition which affects up to 1 in 5 pregnant women. It was commonly known as SPD (Symphysis Pubis Dysfunction), but this implies that only the symphysis pubis is affected, which is not usually the case. This is one of the reasons why it is now known as ‘pelvic girdle pain.’
There is a wide range of symptoms and the severity also varies between women. So how you experience it may not mirror the symptoms of a friend although you might both have PGP. It is important to remember that PGP is a common, treatable condition. It can be safely treated at any stage during or after pregnancy (i.e. treatment won’t harm your unborn baby). The main symptom that women report with PGP is pain while walking, bending, climbing stairs and turning over in bed. This means that it affects virtually everything you do in a day, and therefore has a major impact on your life. This pain can be an ache, a sharp shooting pain or a deep muscle pain. You may also have a clicking or grinding feeling in your pelvic joints or in your hips.
Does PGP occur only during pregnancy?
Again your symptoms may differ from someone else’s. PGP may come on suddenly, or start gradually. Sometimes women are told that the symptoms will disappear as soon as the baby is born but sadly this is rarely the case. It can also occur during birth – usually this happens if you have a difficult birth or are in an awkward position for labour or birth. It may also start after birth, sometimes weeks or months later. Whatever the cause and whenever it started, PGP is assessed, managed and treated in the same way.
So if hormones don’t cause PGP, what does?
Instead of being caused by hormones, the root problem with PGP is biomechanical – the usual free movement and smooth functioning of your body is disrupted by a problem. Although women are often told that PGP is caused by their hormones, up-to-date research shows that it is usually caused by a pelvic joint problem. Ahead of looking at what goes wrong, it may be best to explain what happens when your pelvis is functioning normally.
The pelvis is made up of a ring of three bones. They join together at the sacro-iliac joints (at the back) and the symphysis pubis joint (at the front). These joints normally have a little ‘play’ between them so that they move a little bit to allow you to walk, turn over in bed, climb stairs, etc. However, the three bones in this ring should work together closely and in harmony. In PGP the usual unity between these joints goes wrong and they stop working together. Often, one joint becomes stiff or stuck and this causes irritation in the other joints (you may not even feel pain in the stiff joint). Sometimes PGP brings pain in one of the joints, sometimes it can be in all three. When one joint becomes stiff and stops moving normally, this causes irritation in the other joints which have to compensate. An associated asymmetry can arise in the joints and this can result in further pain and lack of free movement. As a result, muscles may also be tight and painful; mobility can also be affected.
The old name SPD (symphysis pubis dysfunction) implies that the condition affects only the symphysis pubis joint at the front, which is not true, as any or all of the three pelvic joints can be affected, and commonly the two sacroiliac joints at the back of the pelvis are the cause when pain and discomfort begins.
So why is a biomechanical cause better than a hormonal one?
If PGP were caused by hormones, it would suggest that no treatment would work while the pregnancy hormones are still present – in other words – the treatment would be useless until the baby was born. As hormones are not the cause of PGP but a biomechanical problem is, it means that it is possible to treat at any time during pregnancy or after the baby is born (even a long time after) because it is usually possible to resolve the biomechanical problems with appropriate treatment.
What is the most effective treatment for PGP?
PGP can usually be treated effectively by a ‘hands-on’ manual therapy from a physiotherapist, osteopath or chiropractor. The therapist gently uses their hands to reposition a joint which has moved out of its natural position and to help it work freely again. An individual assessment is important to look at the position and symmetry of movement of your pelvic joints, to find out which joints are causing the problem and to work out a suitable treatment plan. You should walk out of each treatment feeling some improvement in either pain or function and preferably in both. Often the joint causing the problem is not particularly painful, so treating the painful point is unlikely to sort out the underlying problem.
Last word on hormones
Although hormones are not the cause of PGP, some women find that there is a connection between PGP and hormones. In a very small minority of women, pelvic pain experienced after their baby is born seems to be influenced by their monthly cycle so the PGP pain feels worse at that time. This is a sign that the symmetry of the joints is still affected, and this cyclical pain will get better once the joints have been treated with manual therapy and are working normally again.
Anyone who experiences pregnancy-related PGP at any time before or after their baby is born can benefit from visiting an experienced physiotherapist, osteopath or chiropractor for relief through manual therapy. It’s also important to seek help as soon as symptoms arise.