Perimenopause: What You Probably Don’t Know

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Most people in their 20-30’s don’t even think about menopause or perimenopause, but you may be surprised to know that hormonal shifts can begin earlier than you expect!

The word menopause might conjure images of postmenopausal symptoms, including night sweats, hot flashes, and the end of ovulation altogether. However, perimenopause is also an important facet of women’s health to be aware of. This article will run you through what you should know about the symptoms of perimenopause as well as what simple lifestyle changes can help you maintain a high quality of life.

Perimenopause: Hormonal changes cause early menopausal symptoms

For those with ovaries – testosterone starts to decline in the body at the age of 35. As with any changes in hormone levels, some changes are to be expected. Common symptoms can include:

  • Decreasing muscle strength
  • Fatigue
  • Changes in libido
  • Sexual dissatisfaction
  • Vaginal dryness

Progesterone is another hormone that starts to decline shortly after testosterone around the age of 40. Signs of this hormonal change can include:

  • Breast tenderness
  • Irregular periods or breakthrough bleeding outside the menstrual period
  • Vaginal dryness
  • Depression, anxiety and mood swings
  • Sleep disturbance
  • Hot flashes
  • Bone density loss

Estrogen also plays an important role

Estrogen is the last of our hormones we’ll look at, which declines over time and eventually results in the onset of menopause. Menopause is defined as the “absence of menses (menstrual cycles) for greater than 12 months.” Reductions in estrogen results in a weakened pelvic floor which can increase symptoms of prolapse in this population.

Low estrogen is also one of the main causes of the hot flashes and associated sleep problems in early menopause.

If you are concerned about your estrogen levels, you can consult your primary healthcare provider or doctor; they may recommend low dose hormone therapy or supplements to support improved hormone levels.

women walking outside

Common symptoms you may experience during perimenopause

Perimenopause is a good time to check in with your pelvic floor and yourself – whether you’re looking to strengthen your pelvic girdle musculature, or are looking to deal with a new onset of symptoms.

Your pelvic floor therapist can recommend exercises to prevent incontinence, prolapse, back pain and hip pain, as well as suggest treatment options to make this transition as comfortable as possible.


Osteoporosis can occur in people of all ages, but is most common in older adults, particularly women (thanks, hormones). Osteoporosis is a condition that weakens the bone structure resulting in worsened strength and quality that results in a higher risk for fracture or broken bones. The most commonly affected bones in the body are the spine, wrist, and hip.

Around the age of 30, bone mass stops increasing, and the goal is to maintain bone health as best as possible across the lifespan. There is an acceleration in bone loss in late perimenopause and menopause in which our bone tissue is broken down faster than it can be replaced.

People at a higher risk of developing osteoporosis are those with a family history, those who had early menopause, were/are smokers, have a long history of corticosteroid use, those who were more sedentary and those who did not get enough calcium and vitamin D throughout their lives.

Bone health can be preserved by ensuring your diet has calcium rich foods, and that you get sufficient vitamin D. Engaging in regular weight bearing or resistance exercise is also a great way to reduce the loss of bone mass across the lifetime. Healthy lifestyle choices such as these and smoking cessation if you are a smoker are some of the best ways to reduce your risk of osteoporosis.

[Note: if you have been diagnosed with osteoporosis and are unsure how to best manage your physical activity safely, please contact your trusted physiotherapist for more guidance]


Uterine fibroids are benign (non-cancerous) tumors in the uterus arising from the muscular walls. Often the symptom that prompts people to check in with their gynecologist is that fibroids often occur in conjunction with with abnormal uterine bleeding or flooding periods. However, the symptoms and severity that people experience depends on the size and location of the fibroid(s).

Fibroids are estimated to be present in up to 70% of women at some point across the lifespan and remain asymptomatic in about half of those affected. Fibroids demonstrate an overwhelming dependency on ovarian hormones (namely estrogen and progesterone). Since perimenopause is full of unpredictable hormonal alterations, this seems to be the time in which symptomatic fibroids are found.

If your fibroids cause symptoms that impact your quality of life, it is best to discuss your treatment options with your gynecologist. While hysterectomy has typically been the treatment of choice in the past, there are now a number of treatment options available to ameliorate symptoms and decrease the size of fibroids without jumping right to surgical intervention.

Painful sex during perimenopause

Painful intercourse is common and very rarely random. As many as 28% of people with vulvas will experience painful sex at some point in their reproductive years and many have no idea why. Painful sex, or dyspareunia, can present as pain with initial penetration, deep penetration and even just pressure or touch on the outside of the vulva. If you have a new onset of pelvic pain during this season of life, it could be a result of hormonal change and you could benefit from discussing this with a pelvic floor physiotherapist. Pain can be persistent, intermittent or recurrent, and may occur during or even after intercourse.

Bladder changes

Bladder changes begin in the perimenopausal period as changes in estrogen levels occur. Reduction In estrogen can lead to thinning of urethral and vaginal tissue as women age which can result in a number of symptoms arising in this period. These symptoms may include increased frequency and urgency of urination, vaginal dryness and associated itching, increased urinary tract infections, incontinence and bladder irritation. Among strengthening exercises and pelvic floor physiotherapy treatment, some people find making dietary changes ae also helpful for reducing this symptoms.

There are a number of foods and beverages that have been found to be associated to worsening of urinary frequency, urgency, urge incontinence and bladder pain.

If you are one of the many people that are living with one of these conditions, especially as your body is adapting to changes in hormone levels, it might be helpful to eliminate some of these foods from your diet for a minimum of 10 days to see if they are impacting the severity of your symptoms. It should be noted that not all of the following substances are likely to be irritating to everyone.

  • Alcohol
  • Fruits, including: apples and apple juice, cantaloupe, citrus fruits, cranberries and cranberry juice, grapes, guava, peaches, pineapple, plums, and strawberries
  • Carbonated beverages
  • Chocolate
  • Chili and spicy foods
  • Coffee (including decaf) and tea
  • Milk products (milk, cheese, cottage cheese, yogurt, ice cream)
  • Sugar (particularly artificial sweeteners, saccharin, aspartame, honey, fructose, sucrose, etc.)
  • Tomatoes
  • Vitamin B complex supplements
  • Vinegar

*Some low acid fruit substitutes include apricots, papaya, pears and watermelon.

*Tea drinkers may want to try non citrus herbal teas.

*Coffee drinkers may want to give up their left leg rather than coffee – we feel you.

Managing perimenopause symptoms with contraception

Often, people wonder if birth control can be used not only to prevent pregnancy through perimenopause (when tracking your cycle might not be as easy as it was once was), but also to help manage some of the symptoms.

Some of the proposed benefits of hormonal birth control are assisting to maintain bone strength, prevent acne, lower risk of ovarian and uterine cancers, reduces hot flashes, eases period pain and bleeding and may make your periods more regular.

However, hormonal birth control may not be appropriate for everyone – your past medical history and current health are both factors your doctor will consider before helping you decide which contraception options may be best for you.

There are hormonal and non-hormonal contraceptives. These include:

  • Birth control pills
  • Hormonal injection
  • Hormonal patches
  • Vaginal ring
  • IUD’s
  • Condoms
  • Tubal ligation or vasectomy

Take charge of your health during perimenopause

Stay active and eat healthy

While perimenopause brings about a number of inevitable physical, psychological, emotional and hormonal changes – many of them can be managed with good lifestyle habits and choices. Putting time aside to exercise daily will not only help stave off unwanted weight gain, but helps reduce stress, improve mood swings and decreases the severity of hot flashes. If that isn’t motivating enough, it can also reduce your risk of developing osteoporosis and fractures later in life.

Being mindful about your diet and optimizing your nutrition is also a good way to help forgo some of the more unpleasant symptoms that perimenopause and menopause can bring on. Eating a diet with sufficient calcium, protein, omega-3 and fibre can all help you maintain good general health and reduce your risk for other diseases such as diabetes and cancer. Consider reducing your intake of caffeine and alcohol as they can contribute to sleep disruption and disturbance. Alcohol in particular seems to be problematic alcohol consumption has been positively associated with breast cancer risk as well as having a tendency to pack on the pounds.

Be proactive about any concerns you may have

A proactive approach is always the best to prevent problems from arising down the line. If you have a family history, or think you’re at a higher risk of developing one of these less pleasant side effects of perimenopause, it is a great time to consult with your team of health care providers to take a preventative approach. If you have already developed some of these unwanted symptoms, one of our experienced pelvic floor physiotherapists can help you navigate this stage of life, and set you up for success in the future with our client-centered and holistic approach to treatment.

Still have questions? Contact us at 780 395 9170 or at

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