Perimenopause Explained: Symptoms, Changes, and How to Support Your Pelvic Floor
If you’ve started noticing changes in your body—maybe your cycle is different, workouts feel harder, or symptoms like urgency, leaking, or discomfort have crept in—you’re not imagining things.
You might be in perimenopause.
And while this phase of life is completely normal…
many of the symptoms women experience are not something you just have to live with.
Let’s break it down.
What Is Perimenopause?
Perimenopause is the transitional phase leading up to menopause (when your period has stopped for 12 consecutive months).
It can start as early as your mid-30s to early 40s and may last several years.
During this time, your hormones—especially estrogen—begin to fluctuate, not just decline. That fluctuation is what creates many of the symptoms you feel.
Common Signs & Symptoms
Perimenopause doesn’t look the same for everyone, but some of the most common symptoms include:
Irregular periods
Heavier or lighter bleeding
Hot flashes or night sweats
Sleep disturbances
Mood changes (anxiety, irritability)
Brain fog
Decreased energy
Vaginal dryness
Pain with intercourse
Increased urinary urgency or frequency
Leaking with coughing, sneezing, or exercise
A feeling of heaviness or pressure in the pelvis
Many women are told these symptoms are “just part of aging.”
But here’s the truth:
They’re common—but they’re absolutely treatable.
How Perimenopause Affects Your Pelvic Floor
Your pelvic floor is highly influenced by hormones—especially estrogen.
As estrogen fluctuates and eventually declines, you may notice:
1. Decreased Tissue Elasticity
The pelvic floor muscles and vaginal tissues can become thinner, drier, and less resilient.
2. Changes in Strength & Coordination
It’s not just about being “weak”—your pelvic floor may lose its ability to react and respond to pressure (like when you cough, jump, or lift).
3. Increased Urinary Symptoms
Urgency, frequency, and leaking often increase during this time.
4. Prolapse Risk
Changes in tissue support can contribute to feelings of heaviness or pressure.
What We Actually Work On in PT
At Empower, we look at the whole picture—not just your pelvic floor.
Your care may include:
Breathing mechanics
Core and pelvic floor coordination
Strength training for hips, glutes, and core
Pressure management (so your pelvic floor isn’t overloaded)
Movement patterns for daily life and exercise
Manual therapy when needed
Education so you understand your body—not just follow instructions
Because your pelvic floor doesn’t work in isolation—and your treatment shouldn’t either.
What You Can Do to Support Your Pelvic Floor
In addition to pelvic floor PT, there are a few key strategies that can make a big difference:
1. Address Vaginal Tissue Health
As estrogen declines, vaginal tissues can become dry and irritated.
Options to discuss with your provider include:
Vaginal estrogen cream
Estrogen suppositories
These are low-dose, localized treatments that can improve:
Tissue health
Comfort with intercourse
Urinary symptoms
Many women don’t even know these exist—and they can be a game changer.
2. Don’t Just Do Kegels
More isn’t always better.
Your pelvic floor needs to:
Contract
Relax
React
Overdoing Kegels without proper coordination can actually make symptoms worse.
3. Focus on Strength Training
Strength training helps:
Support your pelvic floor
Improve bone density
Maintain muscle mass during hormonal changes
Think: squats, hinges, lunges—with proper form and breath.
4. Learn How to Manage Pressure
One of the biggest things we teach is how you can help your breath work for you. If your diaphragm and pelvic floor work together it can help reduce pressure to your pelvis.
5. Pay Attention to Early Signs
Don’t wait until symptoms become severe.
Early signs like:
Occasional leaking
Increased urgency
Mild discomfort
…are your body’s way of asking for support.
You’re Not “Just Getting Older”—Your Body Is Changing
And with the right support, you can:
Stay active
Exercise without fear of leaking
Feel strong and in control
Enjoy intimacy without pain
Avoid unnecessary medications or surgery
You Don’t Have to Navigate This Alone
If you’re in perimenopause—or think you might be—and noticing changes…
This is your sign to stop brushing it off.
Pelvic floor physical therapy gives you:
Clarity
A plan
And real solutions
Ready to feel like yourself again?
We’re here to help you understand what’s going on—and what to do about it.
Your Pelvic Floor Deserves Lifelong Care
Your body is strong, adaptive, and always capable of healing. You don’t need to settle for discomfort, hide symptoms, or assume it’s “just part of being a woman.”
Pelvic floor therapy is a powerful tool for lifelong wellness, not just during pregnancy and postpartum.
If you’re curious, concerned, or simply want to feel more connected to your body, we’d love to support you.
This year, let’s go beyond pregnancy and postpartum and embrace pelvic health as an essential part of a woman’s entire life story.
Hi! We are Dr.Aimee and Dr. Lauren
We are the owners of Empower Physical Therapy and Wellness. We are pelvic floor physical therapists who specialize in helping women from pregnancy, into postpartum and through perimenopause, menopause and then beyond! We believe all women deserve to do all of the things they love without symptoms!
You can contact us via our website, email at hello@weempowerpt.com or social media!
The information provided in this blog is for educational and informational purposes only and is not intended as medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or symptoms. Never disregard professional medical advice or p in seeking it because of something you have read on this blog.
If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately. The opinions expressed in this blog are those of the author and do not necessarily reflect the views of any medical or healthcare institutions.
