Perimenopause and Your Body: Why Are My Joints, Muscles and Pelvic Floor Changing?
If you're in your 40s and suddenly wondering why your body appears to have developed a few new sensations, welcome to perimenopause.
Perhaps your knees are complaining when you climb the stairs. Your hips feel stiffer than they used to. Your muscles seem to ache for no obvious reason. Your recovery after exercise has gone from “I'll be grand tomorrow” to “Why am I still sore three days later?”
And then there's the pelvic floor.
Maybe you're leaking a little when you run, cough or sneeze. Perhaps you're experiencing more urgency or pelvic heaviness. Or maybe you've noticed changes that you weren't expecting and haven't quite known who to talk to about them.
You're not imagining it.
Hormonal changes during perimenopause and menopause can affect many parts of the body, including muscles, joints, bones and the pelvic floor.
The good news? There is plenty you can do to support your body through this stage. I like to think of Perimenopause as a wake up to how to really look after your health.
What actually happens during perimenopause?
Perimenopause with its fluctuating hormone levels, is the transition towards menopause. It can begin several years before periods stop completely, and symptoms can vary enormously from one woman to another.
As oestrogen levels vary and eventually decline, you may notice changes in areas that you wouldn't necessarily associate with hormones.
Hot flushes and changes in your menstrual cycle may be the symptoms everyone talks about.
But what about:
Aching joints
Muscle stiffness
Changes in strength
Increased fatigue
Changes in exercise tolerance
Pelvic floor symptoms
Bladder changes
Vaginal dryness
Sleep disruption
Changes in recovery after exercise
Yes — your hormones can have quite the CV.
Why do my joints hurt during perimenopause?
Joint aches and stiffness are commonly reported during perimenopause and menopause.
Oestrogen interacts with tissues throughout the body, including those involved in joint and muscle function. Hormonal changes can even influence how you experience pain and how your body responds to physical stress.
That doesn't mean that every sore knee or aching hip is “just menopause”.
There can be plenty of other reasons for joint pain, including previous injuries, changes in activity, muscle weakness, osteoarthritis or simply doing considerably more gardening than your body had agreed to.
But if you're noticing new or changing aches during perimenopause, it's worth considering the bigger picture.
Why do my muscles feel different?
You may notice that you're not feeling quite as strong as you once did, or that activities that used to feel easy now require more effort.
Ageing itself can contribute to changes in muscle mass and strength, and hormonal changes around menopause can add to this.
This is one reason strength training becomes particularly important during midlife.
Strength training can help support:
Muscle strength and mass
Bone health
Joint function
Balance
Everyday activities
Physical confidence
Long-term independence
And you don't need to start lifting enormous weights while listening to aggressive gym music.
Strength training can be adapted to your starting point, whether that means weights in the gym, resistance bands, bodyweight exercises or a structured physiotherapy programme.
“Why am I suddenly so sore after exercise?”
This is a common frustration.
You may have been happily running, walking, going to classes or playing sport for years, and suddenly your usual workout seems to require a much longer recovery period.
Again, there can be several factors involved.
Hormonal changes can effect the quality of tendon and soft tissue structure, sleep disruption, stress, changes in muscle strength and simply getting older can all influence how your body responds to exercise.
The answer isn't necessarily to stop exercising.
Often, it's about adjusting how you exercise.
You may need to think more carefully about:
Recovery days
Strength training
Training intensity
Gradually increasing activity
Sleep
Nutrition
Managing existing injuries
Your body hasn't become lazy.
It may just be asking for a slightly more sophisticated training plan.
What happens to the pelvic floor during perimenopause?
This is an area that isn't talked about nearly enough.
The pelvic floor is a group of muscles that support the bladder, bowel and pelvic organs and play an important role in continence and sexual function.
Hormonal changes around perimenopause and menopause can contribute to changes in pelvic floor and urogenital symptoms.
You may notice:
Leaking when coughing, sneezing or exercising
Needing to urinate more frequently
Urgency
Difficulty controlling your bladder
A feeling of heaviness or pressure
Changes in sexual comfort
Pelvic discomfort
And if you've previously had children, you may already have some pelvic floor symptoms that become more noticeable during this stage of life.
None of these symptoms are something you simply have to put up with.
Does everyone need pelvic floor exercises?
No — and this is an important one.
When women mention pelvic floor problems, the immediate response is often:
“Have you tried doing your Kegels?”
But the pelvic floor isn't simply an on/off switch.
Some women have weak pelvic floor muscles and need to work on strength and coordination.
Others have pelvic floor muscles that are already very tense or overactive. In these cases, doing endless strengthening exercises may not be the right approach.
A women's health physiotherapist can assess your individual symptoms and help determine what your pelvic floor actually needs.
Sometimes that means strengthening.
Sometimes it means learning to relax the muscles.
And sometimes it involves improving breathing, coordination, hip strength, movement patterns or how you manage pressure during exercise.
What about exercise and pelvic floor symptoms?
You shouldn't automatically stop exercising because you experience bladder leakage or pelvic heaviness.
In fact, staying active is an important part of looking after your health through perimenopause and beyond.
However, you may need to modify how you exercise while you address your symptoms.
For example, you might temporarily adjust:
Running volume
Jumping
High-impact classes
Heavy lifting
Training frequency
The aim isn't necessarily to give up the activities you love.
It's to help your body build the capacity to do them comfortably.
Perimenopause, bones and strength
One of the reasons strength and weight-bearing exercise become particularly important around menopause is bone health.
Bone density naturally changes as we age, and the hormonal changes associated with menopause can accelerate bone loss.
Resistance exercise and weight-bearing activity can form an important part of maintaining healthy bones and physical function. It temporarily boosts Testosterone levels (yes, we Women need it too!) which has a protective effect over our bones, energy, mood and libido.
This doesn't mean you need to suddenly become a powerlifter.
Walking, climbing stairs, resistance training and appropriately prescribed strength exercises can all have a role.
If you're unsure where to start, a physiotherapist can help you develop an exercise programme that is appropriate for your current fitness, symptoms and goals.
What can physiotherapy actually help with?
A women's health physiotherapist can help you understand how your symptoms relate to movement, strength, pelvic floor function and physical activity.
At BodyRight Physio in Drogheda, Co. Louth, we can assess issues such as:
Pelvic floor symptoms
Bladder leakage
Pelvic pain
Joint and muscle pain
Exercise-related problems
Reduced strength
Returning to exercise
Postnatal changes
Movement and musculoskeletal problems during midlife
The aim is not to blame everything on hormones.
It's to look at you as a whole person and work out what may be contributing to your symptoms.
You don't need to stop doing the things you love
Perimenopause can sometimes feel like your body is gradually handing you a list of things you're apparently no longer allowed to do.
Run? Maybe not.
Jump? Absolutely not.
Lift weights? Surely that's dangerous.
Sleep? Apparently your hormones have other plans.
But getting older doesn't mean becoming less active.
With the right approach, many women can continue running, lifting, cycling, playing sport, hiking, doing Pilates and enjoying an active life throughout perimenopause and beyond.
The goal is to adapt rather than avoid.
When should you see a physiotherapist?
Consider speaking to a physiotherapist if:
Joint or muscle pain is affecting your daily life
You're struggling to return to exercise
Your strength has noticeably reduced
You experience bladder leakage when exercising
You have pelvic heaviness or pressure
Pelvic symptoms are affecting your confidence
You keep getting injuries when exercising
You're unsure how to exercise safely during perimenopause
You're avoiding activities because of symptoms
You don't need to wait until symptoms become severe.
And you certainly don't need to accept “that's just what happens when you get older” as the only explanation.
Perimenopause isn't the end of an active life
Your body is changing — but changing doesn't mean breaking.
Perimenopause can be a really good time to become more aware of your strength, movement, recovery and overall health.
It may mean changing how you train. It may mean paying more attention to recovery. It may mean finally dealing with that pelvic floor symptom you've been quietly ignoring for five years.
And that's okay.
Your 40s and 50s aren't the time to stop looking after your body. They're a very good time to start looking after it differently.
Looking for Women's Health Physio in Drogheda?
At BodyRight Physio in Drogheda, Louth, our physiotherapists provide individualised support for women through different stages of life, including perimenopause and menopause.
Whether you're experiencing joint pain, muscle aches, pelvic floor symptoms or difficulties returning to exercise, we're here to help you understand what's happening and what you can do about it.
Your body’s needs may be changing, and we’re here to guide you through a change of plan!
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