Peri-menopause is the transition period leading up to menopause, which marks the end of a woman’s menstrual cycles. It can be a scary feeling when anything ends, even the periods we may have dreaded for years! Know that peri-menopause is a natural stage that all women go through, and that you can continue to thrive in your changing body.

What is peri-menopause?

Peri-menopause is the time period leading up to menopause. During this period, women experience fluctuations in hormone levels (primarily estrogen and progesterone), which can lead to a variety of symptoms. Peri-menopause is a gradual transition – there is no “AHA” moment that signals you’ve entered it. You will likely notice symptoms and changes in your body that start to become more consistent.

Women start peri-menopause at different ages – typically around their mid-to-late 40’s or early 50’s. But, some women experience peri-menopause in their 30s. Peri-menopause lasts, on average, 6-8 years.

Menopause is medically defined as when a woman has had at least 12 consecutive months without having a period.

What are the symptoms of peri-menopause?

The gradual hormonal changes of peri-menopause leads to a range of symptoms – some subtle, some not so much. Common symptoms include:

  • Irregular periods. They can be shorter, longer, heavier, lighter or less frequent. You may even miss a period altogether.
  • Night sweats, hot flashes, fatigue and sleep issues
  • Weight gain
  • Mood swings
  • Memory issues
  • Local symptoms (within the pelvis and vulvovaginal area), such as vaginal dryness, changes in vulvar skin texture, burning, itching and skin irritation
  • Urinary incontinence

How does the pelvic floor come into play?

During peri-menopause, estrogen and progesterone levels decrease over time. Both hormones are vital to collagen production and building muscle mass. So as levels lower, muscles in the pelvic area (and elsewhere in the body) start to thin and the surrounding collagen (which supports our muscles) weakens. This can lead to pelvic floor dysfunction, which can cause urinary incontinence, increased urinary frequency or urgency and vaginal dryness. Seeking help from a trained Pelvic Health Physiotherapist can help treat pelvic floor dysfunction and its associated disorders.

What about sex?

It is quite common for women entering peri-menopause to experience a decrease in libido. Vaginal dryness can play a significant role, as it can cause discomfort, irritation, and painful intercourse.

 If you’re experiencing a change in sexual desire or function, know you’re not alone. A study by the North American Menopause Society (NAMS) found that:

  • 58% of women avoided intimacy due to vaginal discomfort
  • 64% of women experienced loss of libido due to vaginal discomfort
  • 64% of women experienced pain associated with sex
  • 30% of men & women ceased having sex altogether due to vaginal discomfort

What treatments are available?

Medications are commonly used to treat the symptoms of peri-menopause. Lifestyle modifications can also be helpful. Treatment options include:

  • Hormone replacement therapy (HRT). HRT comes in many different forms, from pills to patches, and works by replacing the estrogen you’ve lost. HRT can be quite effective at treating symptoms like hot flashes and irregular periods. Your doctor will consider your medical history, as a low dose or alternative treatment may be considered in some women (e.g., breast or endometrial cancer survivors).
  • Vaginal estrogen. This is applied locally to the vagina, so is often used to treat vaginal dryness and discomfort.
  • Non-hormonal treatments. Vaginal lubricants and moisturizers are excellent non-hormonal options to treat vaginal dryness and pain related to sexual activity. Learn more 
  • Diet and lifestyle changes. Certain modifications may help you manage symptoms, such as eating calcium-rich foods to prevent bone density loss, avoiding processed foods to boost energy and exercising regularly to improve strength and flexibility. You may want to consult a nutritionist or naturopath for guidance.
  • Stress management/counselling. It’s common to have mood swings and anxiety during peri-menopause. Practicing mindfulness, engaging in relaxing hobbies, and/or seeking the help from a counsellor may help improve your mental well-being.


 Understanding Menopause

Deep dive into all things peri-menopause in this candid and informative video led by our founder, Pelvic Health Physiotherapist Angelique Montano-Bresolin.

If you, a friend or family member is struggling with vaginal dryness or other peri-menopausal symptoms, please seek out medical advice. Let’s keep the conversation going and reduce the stigma associated with this natural transition in life. 

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