When their periods restart, some women find that their PGP pain comes back. This may be because you are more sensitive to pain during your periods or due to hormone changes with underlying joint problems. Most women find that if they take this as a signal that they still have a bit of an alignment/joint asymmetry problem, manual therapy will sort it out.

If you had PGP during one pregnancy, you may have it again in your next pregnancies. The PGP may start earlier and be more painful if you did not have treatment last time. However, you can use a range of tools alongside manual therapy to manage your PGP symptoms during and after pregnancy. 

Planning future pregnancies

Try and see a manual therapist as soon as the symptoms start. This can make a big difference to your pain levels during pregnancy and your recovery after your baby is born.  

If you had severe problems last time and think this may happen again, you can proactively plan what help you may need and arrange it in advance. Think about:

• how old your existing child/children will be when the new baby arrives
• how independent they will be for nappies, walking etc 
• how you will manage this during a pregnancy if you are not very mobile.

There are no hard and fast rules on the time you should leave between pregnancies, but it is helpful to recover as much as possible from one pregnancy before starting another. For example, being pain-free, back to previous fitness and mobility levels can help you manage your PGP well in your next pregnancy. 

Treatment

It is worth seeking treatment as soon as you become pregnant again or even while you are planning your pregnancy. We suggest keeping your PGP under control as much as possible rather than waiting to see if it starts again. This can also help you to feel in control of your PGP rather than the other way around.

If you have had PGP it can seem that everyone has an opinion on whether or not you should have another baby. Whilst this concern is often well-meaning, it is not for other people to comment. 

Remember, the decision whether or not to have another baby is yours and your partner’s only – nobody else counts. Having a baby is not only about pregnancy, birth and the early months. Babies grow into children and adults, and are part of your whole family unit. 

You may find it helpful to talk over your decision with somebody neutral, such as the Pelvic Partnership helpline. Call and leave a message for one of our volunteers on 01235 820921.

From time to time you may find that you have a setback in your progress to recovery, a sudden return of pain or immobility. 

Usually it is because you have simply pushed yourself a little too hard, undertaken a particularly strenuous activity or simply contorted your body into an awkward position (playing on the climbing frame in the park seems to be a common culprit!). Sometimes there is no reason for the setback – it just happens. 

There is no need to panic – it does not mean that you have permanently damaged your pelvis or that you are back to square one on the road to recovery. Try to see a physiotherapist, osteopath or chiropractor and expect to return to your previous level of activity.

If you have had PGP you may need to take extra care when undergoing gynaecological treatments or interventions, including:

• D&C
• smear tests
• internal examinations
• termination of pregnancy
• anything else where you are asked to open your legs wide apart. 

You will know your own body and its limitations or when you feel particular pain or a flare-up in symptoms. It is important to explain this to healthcare professionals so they can take extra care.

Here are some points to bear in mind:

• make sure they take care if placing your legs in stirrups or moving you while you are anaesthetised, like when you give birth (avoiding moving your legs apart if this causes you pain)
• make sure everyone is aware of your previous PGP history, how badly affected you were, and how concerned you are about the possible consequences if this is not taken seriously. 

If you continue to experience severe pain around your periods despite manual therapy, it is worth exploring further. Please talk to your GP about a referral to a gynaecologist or the pain clinic to explore this further. 

It is also important to remember that PGP is not the only cause of chronic pain. 

Other health conditions

There are many women with PGP who respond well to treatment initially, but struggle to get that last 10% of ‘normal’ back.

There are a few common reasons why progress slows, including:

• You may have an overactive or tight pelvic floor. 
• You may be overdoing things at home/work. Try to slow down and pace your activities and be realistic about what you can and cannot do while you allow your treatment to take effect. Many of us suddenly get more active when we feel better, and then have a setback. Aim to build up gradually, increasing your activity by no more than 10% at a time. For example, if you walked for 20 minutes today, increase to 22 minutes tomorrow.
• Your pain levels may be impacting on how you respond to hands-on treatment. You may need to explore ways of managing your pain before you can respond well to manual therapy.
• You may need to re-educate the muscles around your pelvis so they can support your joints in the correct position. You will need to work harder at this the longer you have experienced PGP, as your muscles will have been working incorrectly for a long time. But, if you are in a lot of pain, it doesn’t matter how much exercise you do, the pain will stop the muscle from working normally. Find your balance between pain and exercise and how much you can achieve.
• If you are particularly hypermobile, this can slow recovery.

You may need to ask for a second opinion from another experienced manual therapist to help you to progress further.

It is important to remember that we are all different, what works for one woman may not work for another.

Treatment is not helping