Should You See a Women's Health Physio During Perimenopause?

If you've found yourself thinking, "Why does everything suddenly ache?" or "Why am I leaking when I never used to?", you're not alone.

Perimenopause can bring about changes that seem to appear out of nowhere. One day you're comfortably running, exercising or getting on with daily life, and the next you're dealing with stiff joints, slower recovery, bladder leaks or a feeling of heaviness.

Many women assume these changes are simply something they have to put up with. The good news is that they aren't.

A women's health physiotherapist can help you understand what's happening to your body and keep you active and confident through perimenopause and beyond.

What is perimenopause?

Perimenopause is the stage leading up to menopause, when hormone levels—particularly oestrogen—begin to fluctuate. It can last several years and often starts in your 40s, although some women experience symptoms earlier.

While hot flushes and irregular periods are well-known symptoms, many women are surprised by the changes they notice in their muscles, joints and pelvic floor.

Why do my muscles and joints suddenly hurt?

Oestrogen plays an important role in maintaining healthy muscles, tendons and ligaments. As levels fluctuate, it's common to experience:

• Achy or stiff joints, especially first thing in the morning

• New tendon problems such as tennis elbow, Achilles pain or plantar fasciitis

• Slower recovery after exercise

• Reduced muscle strength

• Feeling less stable or coordinated during exercise

  
  

These changes don't mean your body is "falling apart." They simply mean it may need a different approach to exercise, recovery and strength training.

How does perimenopause affect the pelvic floor?

Hormonal changes can also affect the tissues of the bladder, vagina and pelvic floor.

You might notice:

• Leaking urine when coughing, sneezing or exercising

• A sudden need to rush to the toilet

• Increased frequency of urination

• Vaginal dryness

• Pain during sex

• A feeling of heaviness or dragging in the vagina, which may indicate pelvic organ prolapse

  
  

These symptoms are common, but they are not something you should simply accept as part of ageing.

Exercise is one of the best treatments

Staying active is one of the most effective ways to manage many symptoms of perimenopause.

Regular exercise can help:

• Maintain muscle mass and strength

• Improve bone density

• Reduce joint stiffness

• Improve mood and sleep

• Support bladder and bowel health

• Maintain balance and confidence

  
  

Strength training becomes particularly important during this stage of life, helping to counter the natural loss of muscle and bone that occurs as oestrogen declines.

If you're a runner or enjoy high-impact exercise, you don't necessarily need to stop—but you may benefit from reviewing your training, recovery and pelvic floor function.

Why see a women's health physiotherapist?

Many women have an annual dental check-up or service their car every year, but rarely think about checking in on their own body.

Perimenopause is an ideal time for a physiotherapy "MOT."

During an assessment, we can:

• Assess your pelvic floor muscles

• Identify whether leaking is caused by weakness, overactivity or poor coordination

• Assess for pelvic organ prolapse

• Evaluate your posture, movement and strength

• Help manage joint or tendon pain

• Create an exercise programme tailored to your symptoms and goals

• Give you the confidence to continue doing the activities you love

  
  

The earlier problems are identified, the easier they often are to manage.

When should you seek help?

Consider booking an assessment if you notice:

• New bladder leaks

• A feeling of heaviness or bulging in the vagina

• Pain during sex

• Persistent hip, back or pelvic pain

• Difficulty returning to exercise

• Reduced confidence in your body

• Ongoing aches and pains that aren't settling

  
  

You don't need to wait until symptoms become severe.

The bottom line

Perimenopause doesn't mean giving up running, lifting weights or doing the things you enjoy. It does mean your body may need a different approach than it did ten years ago.

A women's health physiotherapy assessment can help you understand what's changing, manage symptoms early and build a plan that keeps you active, strong and confident for years to come.

If you're experiencing changes in your bladder, pelvic floor, joints or exercise tolerance during perimenopause, I'd love to help. Together we can create a plan that supports your body through this next stage of life—so you can keep doing the things that matter most to you.