You’re Not Alone in Perimenopause: Treatments and Guidance
Perimenopause may be among the most misunderstood life stages women undergo – particularly for those living through it.
Of those ages 45 to 54 – the prime range in which women enter perimenopause and transition to menopause – 39% are not familiar at all or only slightly familiar with perimenopause and its symptoms.
This means many women in the throes of the unpleasant side effects of perimenopause don’t know what is occurring, why it is occurring, and what it means to their overall lifestyles. It’s well past time to change that, because perimenopause alters not only a woman’s hormonal balance and moods; it also can distress a woman’s urinary and sexual (urogynecologic) health.
Watch Our Webinar Replay Video: Navigating Vaginal Changes as You Age, Reclaim Your Comfort
This is why more doctors are advocating for women’s sexual-health awareness. Because when women anticipate and understand how perimenopause is changing their bodies, and why, they gain a good measure of control.
What Happens When Your Body Enters Perimenopause
Perimenopause marks a multi-year phase in a woman’s life when her menstrual cycle slowly tapers off, often irregularly, until she stops getting her period. This occurrence is 100% natural: the ovaries just make less of the female hormones estrogen and progesterone until they make so little estrogen that your ovaries no longer release eggs.
Over time, her menstrual cycle becomes irregular, then infrequent, until it ends. A woman is deemed menopausal after 12 months without her period (on average that’s at age 52).
During this transition from perimenopause to menopause, the fluctuation of female hormones can trigger severe mood swings, weight gain, brain fog, and other symptoms that can be confusing and unsettling.
These symptoms of perimenopause include:
- Hot flashes and night sweats
- Longer menstrual cycles
- Breast tenderness
- Bone loss
- Vaginal dryness (painful sex)
- Changes in sexual desire
- The urgent need to urinate, and more frequently
- Leaking urine when you sneeze or cough.
The lack of awareness of these symptoms can be understandable, because they can build slowly and at a time when many women are busy with kids, careers, and consider themselves young – typically their mid-40s. For this reason, most women do not seek care for perimenopause symptoms, research shows.
But you can treat perimenopause’s effects, including on urinary and sexual wellness. It begins with body awareness.
How Urinary and Sexual Wellness Change with Perimenopause
The hormones a woman’s body makes serve other functions beyond sexual reproduction, which can lead to unexpected ramifications.
Notably, estrogen and other hormones also support bladder function and vaginal lubrication. And because the bladder, vagina, uterus, and urethra are all nestled pretty tightly together, disruptions in one of these body parts can affect the others.
Following are some of the conditions our female health physicians discuss and treat regularly:
Painful intercourse – Estrogen lubricates the vaginal walls, so as production declines during perimenopause, the vagina becomes thinner, dryer, and loses elasticity. In these conditions, sexual intercourse can be painful and some women avoid it. Lack of intercourse in turn can lead to vaginal atrophy (further weakening). Find more information about painful intercourse here.
Pelvic prolapse – The muscles and connective tissue in the pelvic floor support several organs, including the upper vagina, bladder, uterus, and rectum. These pelvic tissues rely on hormones for collagen, elasticity, and blood flow. When their hormone supply decreases, the muscles weaken, enabling the organs to shift and protrude, or prolapse, into the vagina. Up to half of all women develop pelvic organ prolapse over their lifetimes. Find out how pelvic prolapse is diagnosed.
Incontinence – Twice as many women as men experience an urgent or hard-to-control need to pee, due in part to pregnancy, childbirth, and menopausal-related hormonal changes. It can develop in three forms:
Stress incontinence – Involuntary leakage is forced by sudden pressure to the bladder from sneezing, coughing, and athletic activities. Estrogen loss can contribute by leading to weakened urethra and pelvic muscles. Visit our overview of urine incontinence.
Urge incontinence – Also called overactive bladder (OAB), this urinary leakage results from a hard-to-control need to pee.Urge incontinence often results from a miscommunication of the nerves that signal the brain to empty the bladder. There’s more to learn about OAB here.
Urinary tract infections (UTIs) – Infections caused by bacteria entering the urinary tract and working up to the bladder, UTIs are characterized by burning urination and the need to go more frequently. Dips in hormone production can make women susceptible to recurrent UTIs because the lack of lubrication (the dryness) disrupts the vaginal microbiome that fights infection. Read all about urinary tract infections here.
Bladder pain – With lower levels of estrogen during perimenopause and menopause, mucus membranes in the bladder become dry and more sensitive which can lead to bladder pain. While not a cause of interstitial cystitis (IC) or painful bladder syndrome, changes during menopause can contribute to IC symptoms. Our website explains more about Interstitial cystitis.
Treatment Options for Easing the Symptoms of Perimenopause
An estimated 2 million U.S. women enter perimenopause every year, so you are not experiencing the symptoms and their potentially sidelining effects alone. Share your stories. Talking about the symptoms with your doctor should bring a sense of relief and lead to a treatment plan that suits you.
Among the treatments your doctor can offer for perimenopausal symptoms:
Vaginal moisturizers or lubricants – Moisturizers adhere to the vaginal walls to provide sustained moisture, while lubricants are used during intercourse to reduce friction and pain.
Vaginal exercises – Some exercises can relax and strengthen the vagina. Certain yoga positions, such as the child’s pose, can help stretch the pelvic floor, as can deep breathing (sometimes called belly breathing). And Kegel squeezes, or pelvic-tightening exercises, can strengthen the pelvic floor and vagina.
Hormone therapy – Hormone-replacement therapies like vaginal estrogen, which come in self-applied creams, pills, inserts, and patches, can help replace hormones that the body is no longer producing naturally.
Laser therapy – For vaginal dryness, our Redeem Sexual Wellness and Aesthetic Center offers an outpatient treatment called MonaLisa Touch®. This is a painless approach wherein a laser stimulates vaginal collagen production to generate lubrication. Read how MonaLisa Touch works here.
Other pelvic-support approaches – Ask your doctor about Botox injections (for OAB), which can relax the bladder muscles to curb involuntary contractions. Other options include nerve stimulation and the Emsella Chair, a seat that delivers pelvic-strengthening electromagnetic currents.
We Understand Perimenopause, and We Can Help
If you believe you are experiencing signs of perimenopause and want relief, call your doctor. In addition to treatment options, your physician can offer counsel on what to expect and how to adapt your lifestyle.
You don’t have to “just live through it.”
To read our blog about urology’s role in a woman’s sex drive, click here. If you’d like to consult a doctor about perimenopause, menopause, and other urogynecological issues, click here to find a specialist near you.
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