Nov 10, 2023 Robin Zabiegalski 7 min
When you’re in your 40s, the body that you’ve come to know so well can start surprising you again. From mood swings and night sweats to bladder issues and uncomfortable sex, it’s like a box of chocolates — except instead of chocolates, it’s a not-delightful variety of distressing symptoms. And it can be hard to tell what’s causing them. Is it perimenopause? A pelvic floor issue? Or the side-effects of stressing too much and sleeping too little for twenty plus years?
We’re here to help clear up confusion and connect the dots between perimenopause and your pelvic floor. Read on for some tips on understanding this transition and making sure you have the support you need to feel good in your body, even when your hormones are going haywire.
Technically, you’re not “in menopause” until you’ve gone a full year without a period. At that point, your ovaries are considered to be on a permanent vacation and you can no longer get pregnant. Perimenopause refers to the stage beforehand — when your ovaries are winding down.
Estrogen, as you know, is the female hormone that regulates your reproductive system. But it also impacts your urinary tract, bones, breasts, skin, hair, and brain, among other things. During perimenopause, estrogen and other hormones can fluctuate unpredictably, which is why symptoms can be so inconsistent.
The average duration of perimenopause is three to four years, but this timeline varies significantly from person to person. Some women have severe symptoms, while others have none at all, making it even harder to know when or if you’re going through it. The most common and well known symptoms of perimenopause include:
Less well known are the symptoms of Genitourinary Syndrome of Menopause (GSM), the medical term for the effects of estrogen deficiency on your reproductive and urinary system. Those symptoms include:
While hot flashes and night sweats (aka vasomotor symptoms) will thankfully resolve over time and your inconsistent period will eventually go away completely, genitourinary symptoms tend to stick around, especially if you don’t seek treatment.
When sexual or urinary dysfunction comes up in your 40s, it’s often due to fluctuating estrogen. When your body’s supply of estrogen drops, it leads to decreased blood flow (and size of) the clitoris, which can translate to reduced sensation and arousal. Vaginal tissues can become thinner and less flexible, and you'll produce less natural lubrication, making sex potentially painful. And changes in bladder function may have you running to the bathroom more often or peeing when you sneeze, cough, or exercise.
At the same time, age-related muscle and sensory changes in the blower and bladder can occur, leading to weakness in some of the muscles that surround the vagina, bladder, and bowels. This can contribute to urinary leakage, constipation, sexual dysfunction, and even pelvic organ prolapse. We know. It's a lot. But it can be helpful to know that these symptoms are real and you can do something about them.
One of the best things about being over 40 is that you’ve done and dealt with so much, you can now pretty much do anything. By making self-care a priority and getting the right team of healthcare providers on your side, you can not only quickly treat symptoms of perimenopause and aging, you can prevent others from becoming an issue in the first place.
Here are a few things to add to the top of your to-do list:
Get more insight into how physical therapy can help you prepare for and thrive through perimenopause by checking out our menopause & perimenopause treatment page.