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Navigating Perimenopause: How Pelvic Floor Physical Therapy Can Help

Updated: 6 days ago

Perimenopause is a natural phase in a woman’s life, typically occurring in the years leading up to menopause. It’s a time of significant hormonal changes that can bring about a variety of symptoms, some of which can be quite challenging. Pelvic floor physical therapy (PT) offers valuable support during this transition, helping women manage symptoms and maintain their quality of life.


Understanding Perimenopause

Perimenopause is the transitional period before menopause when a woman’s body begins to produce less estrogen. This phase can start as early as a woman's late 30s or early 40s and can last several years. During this time, women may experience a range of symptoms, including:

  • Irregular menstrual cycles

  • Hot flashes and night sweats

  • Mood swings and irritability

  • Sleep disturbances

  • Vaginal dryness and discomfort

  • Decreased libido

  • Urinary incontinence

  • Pelvic pain



Changes During Perimenopause

During perimenopause, several physiological changes occur in a woman's body due to fluctuating and gradually decreasing hormone levels:

  • Hormonal Fluctuations: The primary change during perimenopause is the fluctuation and eventual decline in estrogen and progesterone levels. These hormones regulate many functions in the body, and their decrease can lead to various symptoms.

  • Changes in Menstrual Cycle: As estrogen levels decline, menstrual cycles become irregular. Periods may become lighter, heavier, shorter, or longer, and eventually, they will stop altogether, marking the onset of menopause.

  • Vaginal and Urethral Changes: Decreased estrogen levels can lead to thinning and drying of the vaginal and urethral tissues. This can cause vaginal dryness, discomfort during intercourse, and increased susceptibility to urinary tract infections (UTIs).

  • Bone Density Reduction: Estrogen plays a critical role in maintaining bone density. Lower estrogen levels can lead to decreased bone density, increasing the risk of osteoporosis and fractures.

  • Changes in Fat Distribution: Hormonal changes can lead to a shift in how the body stores fat, often resulting in increased abdominal fat. This change can be frustrating and can also affect overall health.

  • Pelvic Floor Muscle Weakness: The decline in estrogen affects the pelvic floor muscles, potentially leading to weakness and a higher risk of urinary incontinence, pelvic organ prolapse, and other pelvic floor disorders.

  • Skin and Hair Changes: Lower estrogen levels can result in thinning skin, decreased elasticity, and changes in hair texture and growth patterns.


pelvic floor therapy for perimenopause symptoms like hot flashes, pain, fatigue, brain fog, weakness, leakage, incontinence, bowel problems,

The Role of Estrogen

Estrogen plays a crucial role in maintaining the health and function of the pelvic floor muscles. As estrogen levels decline during perimenopause, women may experience weakening of these muscles, leading to symptoms such as urinary incontinence, pelvic pain, and vaginal dryness. Understanding the impact of estrogen is essential for effective management of these symptoms.


How Pelvic Floor Therapy Can Help

Pelvic floor PT can be a game-changer for women navigating perimenopause. Here’s how:


  • Managing Urinary Incontinence: Hormonal changes during perimenopause can weaken pelvic floor muscles, leading to urinary incontinence. Pelvic floor PT can help strengthen these muscles, improving bladder control and reducing leaks during activities like coughing, sneezing, or exercising.

  • Alleviating Pelvic Pain: Some women experience pelvic pain during peri-menopause due to hormonal fluctuations and muscle tension. Pelvic floor PT provides pain management strategies, including manual therapy and exercises to relax and strengthen the pelvic muscles, alleviating discomfort.

  • Addressing Vaginal Dryness and Discomfort: Vaginal dryness and discomfort can be a common issue during perimenopause, making sexual activity uncomfortable or painful. Pelvic floor PT can teach relaxation techniques and recommend products that enhance comfort, improving sexual health and overall well-being.

  • Improving Bowel Function: Hormonal changes can also affect bowel function, leading to constipation or other issues. Pelvic floor PT can help by teaching proper bowel habits, relaxation techniques, and exercises to improve pelvic floor coordination, promoting regular and comfortable bowel movements.

  • Enhancing Sexual Health: Decreased libido and discomfort during sex are common concerns during perimenopause. Pelvic floor PT can address these issues by improving pelvic floor function, increasing blood flow, and enhancing muscle tone, making sexual activity more enjoyable.


Collaborative Care: Working with Other Providers

Effective management of perimenopausal symptoms often requires a multidisciplinary approach. Pelvic floor PTs frequently collaborate with other healthcare providers to ensure comprehensive care. Some of the key collaborators include:


  • Gynecologists: Gynecologists can provide hormonal treatments, such as estrogen therapy, to address the underlying hormonal changes causing pelvic floor dysfunction. They can also perform necessary exams and provide additional medical support.

  • Primary Care Physicians: Primary care physicians can offer a broad perspective on a woman’s overall health, ensuring that all aspects of her well-being are considered in the treatment plan.

  • Endocrinologists: Endocrinologists specialize in hormonal health and can provide expert guidance on managing hormonal imbalances that affect the pelvic floor.

  • Mental Health Professionals: Mood swings, anxiety, and depression can be part of the peri-menopausal experience. Mental health professionals can offer counseling and support to help women navigate these emotional challenges.

  • Nutritionists/Dietitians: Proper nutrition can play a significant role in managing perimenopause symptoms. Nutritionists or dietitians can provide dietary recommendations to support pelvic health and overall well-being.

  • Functional Medicine or Practitioners of Homeopathy: These providers have a deep understanding of the multi-system approach and use natural remedies, supplements, and herbs to support your body the way it specifically needs


What to Expect from Pelvic Floor Physical Therapy

Pelvic floor PT for peri-menopausal women is tailored to address the specific symptoms and challenges of this life stage. Here’s what you can expect:


  • Comprehensive Assessment: A thorough evaluation of pelvic floor function, posture, and overall health to identify specific issues and create a personalized treatment plan.

  • Education: Detailed information about pelvic floor anatomy and function, empowering women to understand and take control of their pelvic health.

  • Customized Exercises: Specific exercises designed to strengthen or relax the pelvic floor muscles, depending on the identified issues. These exercises can be done at home and are easy to integrate into daily routines.

  • Manual Therapy: Hands-on techniques to address muscle tension, improve mobility, and reduce pain. This can include gentle stretching and massage to release tight muscles and enhance blood flow.

  • Lifestyle and Nutrition Advice: Guidance on proper nutrition, hydration, and lifestyle habits that support pelvic health. This holistic approach ensures that all aspects of a woman’s lifestyle contribute to her overall well-being.


Benefits of Pelvic Floor PT During Perimenopause

Starting pelvic floor PT during perimenopause offers numerous benefits, including:


  • Improved Bladder and Bowel Control: Strengthening pelvic floor muscles can significantly improve bladder and bowel control, reducing the frequency and severity of incontinence.

  • Enhanced Sexual Health: Improved muscle tone and blood flow in the pelvic region can enhance sexual health and enjoyment.

  • Reduced Pelvic Pain: Effective pain management strategies can alleviate pelvic pain, improving overall comfort and quality of life.

  • Better Quality of Life: Managing symptoms like incontinence, pain, and sexual discomfort can significantly enhance daily life and overall well-being.


How Pelvic Floor Therapy at Gaia Women’s Physical Therapy Can Help


Perimenopause is a natural but often challenging phase of life. Pelvic floor physical therapy offers valuable support to women during this transition, helping them manage symptoms and maintain their quality of life. By addressing issues early and collaborating with other healthcare providers, pelvic floor PT can promote long-term pelvic health and empower women with the knowledge and tools to navigate perimenopause with confidence.


If you’re experiencing perimenopause symptoms and want to learn more about how pelvic floor PT can help, please contact us at info@gaiawomenspt.com. We’re here to support your journey to better pelvic health, read more about our services HERE.




Want a better understanding of the transition through menopause and beyond? Be sure to check out our free webinar, happening July 31. In the Menopause Masterclass, Dr. Maggie will be debunking the 5 most common menopause myths to help you feel more confident as you approach this season of life. Register for the webinar here.



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