Perimenopause and Menopause
Perimenopause and menopause are natural life stages that bring significant hormonal, physical, and emotional changes. These transitions can influence many aspects of health — including energy, mood, sleep, bladder and bowel control, pelvic floor strength, and sexual function. Understanding perimenopause and menopause helps individuals prepare, adapt, and access the right support.
Definition
Perimenopause and menopause mark the gradual shift from the reproductive years into the next stage of life.
Perimenopause refers to the years leading up to menopause, when oestrogen and progesterone levels fluctuate. This phase can last several years and is often when symptoms first appear.
Menopause is reached once 12 consecutive months have passed without a menstrual period, typically between ages 45 and 55. After this time, the body enters post-menopause, where hormone levels remain consistently lower.
During perimenopause and menopause, these hormonal shifts can bring changes to the bladder, bowel, pelvic floor, sexual health, and overall wellbeing.
Symptoms
Common symptoms experienced during perimenopause and menopause include:
Menstrual changes – irregular, heavier, or lighter cycles
Hot flushes and night sweats
Sleep disturbances and fatigue
Mood changes, anxiety, or low mood
Vaginal dryness, itching, or irritation
Bladder symptoms – urgency, frequency, or recurrent infections
Pelvic floor changes – heaviness, prolapse, or weakness
Sexual changes – reduced desire, arousal difficulties, or discomfort
Bone and joint stiffness, or increased risk of osteoporosis
Cognitive changes – reduced concentration or memory lapses
Who is Most Affected
Perimenopause and menopause typically occur between ages 45 and 55, but can happen earlier in some cases. People who experience surgical menopause (such as ovary removal) or early menopause (before age 40) may have more abrupt symptoms. Those with a family history of early perimenopause and menopause, or existing pelvic floor, bladder, or bowel issues, may notice these symptoms intensify during this stage.
Common Causes and Contributors
The main contributor to perimenopause and menopause symptoms is fluctuating and declining oestrogen and progesterone levels. Other contributing factors include:
Thinning and reduced elasticity of vaginal and pelvic tissues
Pelvic floor weakness or overactivity
Stress, poor sleep, and low physical activity
Smoking, alcohol, or poor nutrition
Medical treatments such as hysterectomy or chemotherapy
Management Approaches
Pelvic Floor Osteopathy can play a supportive role throughout perimenopause and menopause by:
Assessing and optimising pelvic floor function — improving strength, coordination, or relaxation as needed
Using manual therapy to enhance pelvic circulation, tissue mobility, and comfort
Guiding bladder and bowel retraining strategies for urgency, leakage, or constipation
Supporting sexual health — addressing pain, tension, and tissue changes
Providing education on posture, breathing, and lifestyle adjustments during perimenopause and menopause
Offering holistic care for musculoskeletal pain, stiffness, or posture changes
Other helpful approaches during perimenopause and menopause include:
Medical care: hormone replacement therapy (HRT), local vaginal oestrogen, or non-hormonal options
Lifestyle support: regular exercise, balanced nutrition, stress management, and adequate sleep
Allied health input: psychological support, dietary advice, or acupuncture
Bone health management: calcium and vitamin D intake, bone density checks
Community support: education programs, peer groups, and counselling
Key Point
Perimenopause and menopause are transformative life stages that can bring a variety of symptoms — but support and treatment options are available. With pelvic floor osteopathy, medical care, and lifestyle strategies, individuals can navigate perimenopause and menopause with comfort, confidence, and improved quality of life.
