Perimenopause & Your Pelvic Floor: Time for TLC

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.

What exactly is perimenopause?

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:

• Mood changes
• Hot flashes and night sweats
• Trouble with sleep
• Changes in sexual desire
• Joint and muscle aches

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:

• Vaginal dryness or burning
• Painful sex
• Urinary frequency
• Pain with urination

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.

How perimenopause impacts your pelvic floor

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.

Getting serious about self-care

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:

• Find a validating, trustworthy primary care provider. It’s key to have a primary healthcare provider who is familiar with perimenopause, listens to your concerns, and takes a problem-solving approach to symptoms. Many providers will dismiss perimenopause and its associated symptoms as “natural,” and suggest that you get used to them. Look for a provider who specializes in women’s health or consider asking your OB/GYN for a recommendation.
• Connect with a pelvic floor physical therapist. Having a pelvic floor physical therapist evaluate your pelvic floor in your 40s can be game-changing. Through education, a therapeutic exercise plan, and lifestyle and behavioral strategies, a PT can help you strengthen and condition your pelvic floor, which will significantly improve your sexual, bladder, and bowel function.
• Keep track of your symptoms. Tuning into your body and writing down your symptoms — it can be as easy as jotting them down in your calendar — is an underrated way to support your health. Too hot to sleep? Constipated? Was sex uncomfortable? Keeping track will allow you to tell your primary care provider and physical therapist exactly what’s going on, which will make it easier for them to diagnose and treat you.

Get more insight into how physical therapy can help you prepare for and thrive through perimenopause by checking out our menopause & perimenopause treatment page.