Perimenopause

What You Need to Know

A physiotherapy-friendly guide

What the Condition Is and Why It Matters

Perimenopause is the transitional phase before a woman’s periods stop permanently (menopause). Hormonal fluctuations, especially falling oestrogen and progesterone levels, can influence many tissues, including bone, muscle, tendon, and pelvic structures.¹ These changes may lead to joint discomfort, loss of strength, and increased injury risk.²

Physiotherapists focus on helping women maintain movement, strength, bone health, and pelvic function during this time. Evidence shows that targeted exercise and early lifestyle changes can significantly reduce long-term musculoskeletal complications.³

Causes – Common Reasons

• Natural decline in ovarian hormone production.⁴
• Fluctuating oestrogen and progesterone levels (not a steady drop).⁵
• Surgical menopause (e.g., ovary removal) or early menopause.⁶
• Smoking, low body weight, or chronic stress accelerating hormonal changes.⁷
• Reduced activity levels, muscle loss, and altered collagen metabolism affecting joint and tendon health.⁸

Symptoms – What Patients Typically Feel

• Irregular periods or changes in menstrual pattern.⁴
• Hot flushes and night sweats.⁸
• Sleep problems and fatigue.⁸
• Muscle aches, joint stiffness, or new tendon pain (hips, shoulders, elbows).⁹
• Reduced strength or endurance.¹⁰
• Pelvic floor changes such as urinary leakage, urgency, or prolapse.¹¹
• Weight redistribution (often more abdominal fat).⁸
• Mood, memory, or concentration difficulties.⁹

Quick Self-Checklist

☐ I have irregular periods.
☐ I feel hot flushes or night sweats.
☐ My joints or tendons ache more than before.
☐ I notice less strength or fitness.
☐ I’ve had bone density concerns or a family history of osteoporosis.
☐ I experience bladder leakage, urgency, or heaviness.
☐ My posture or balance feels worse.

Ticking multiple boxes suggests it may help to discuss your symptoms with your physiotherapist or GP.

Diagnosis – How a Doctor Would Confirm the Condition

A GP reviews menstrual history, symptoms, and may order blood tests to exclude other conditions (thyroid, iron, or pituitary issues).⁵

Your physiotherapist does not diagnose perimenopause. However, they can assess and help manage its effects. Your assessment may include:

• Musculoskeletal assessment: muscle strength, flexibility, and endurance.
• Tendon and joint screening: detecting early tendinopathies or stiffness.
• Pelvic floor evaluation: for continence, prolapse, or sexual discomfort.
• Postural and balance assessment: identifying fall risk or coordination changes.
• Bone health review: considering risk factors for osteopenia or osteoporosis.¹²

How Hormonal Changes Affect Different Tissues

Bone

Oestrogen decline accelerates bone resorption, leading to osteopenia and potentially osteoporosis.¹²
Physiotherapy uses weight-bearing and resistance training to stimulate bone formation and reduce fracture risk.¹³
Typical exercises include squats, step-ups, deadlifts, hopping, or other safe impact drills.

Muscle

Reduced oestrogen can cause sarcopenia — loss of muscle mass and power.¹⁴
Physiotherapy programs target progressive strength training to maintain lean mass, focusing on major groups such as the glutes, quadriceps, hamstrings, and core stabilisers.

Tendon

Tendons become more prone to overload due to hormonal effects on collagen repair.¹⁵
Common perimenopausal conditions include gluteal tendinopathy (GTPS), rotator cuff pain, and Achilles tendinopathy.
Eccentric and isometric loading programs prescribed by physiotherapists help restore tendon resilience.

Joints

Cartilage and connective tissues can stiffen, leading to pain and reduced mobility.¹⁶
Manual therapy, stretching, and graded exercise improve movement and function.
Targeted strengthening enhances joint alignment and reduces discomfort in areas like the hips, knees, and spine.

Pelvic Floor

Lower oestrogen can weaken pelvic support structures.¹¹
Physiotherapy helps prevent or treat urinary leakage, prolapse, and sexual discomfort through tailored exercises and biofeedback.
Early pelvic floor retraining supports long-term outcomes.

Conditions Physiotherapy Can Assist During Perimenopause

Physiotherapists regularly assist with:

• Osteopenia and Osteoporosis – Strength and impact-based training to improve bone density.
• Gluteal Tendinopathy (GTPS) – Progressive loading for lateral hip pain.
• Shoulder or Rotator Cuff Tendinopathy – Postural correction and strength restoration.
• Achilles or Plantar Fascia Pain – Eccentric loading and mobility programs.
• Knee OA and Hip Osteoarthritis – Exercise and load management.
• Pelvic Floor Dysfunction – Strengthening, bladder training, and support devices.
• Posture and Balance Decline – Functional strength, stability, and coordination training.

Treatment Options

These are general guidelines — individualised assessment is essential as presentations vary widely.

Physiotherapy

• Resistance training 2–3 times weekly to maintain bone and muscle strength.¹³
• Eccentric tendon loading to improve tendon integrity.¹⁵
• Pelvic floor re-education and breathing retraining.¹¹
• Education on movement patterns, ergonomics, and load management.
• Manual therapy for pain and stiffness.
• Functional programs addressing mobility, posture, and balance.

Medical Options

• Menopausal Hormone Therapy (MHT) to relieve symptoms and support bone density.¹⁷
• Non-hormonal medication for hot flushes, mood changes, or sleep.
• Supplements (calcium, vitamin D) if recommended by your doctor.

Prevention & Self-Care Strategies

• Regular strength training targeting hips, spine, and legs.
• Include impact activities (hopping, skipping, or light jogging) if safe and appropriate.
• Maintain posture and practise balance drills to prevent falls.
• Continue pelvic floor exercises daily.
• Keep vitamin D levels adequate through diet and sunlight.
• Stay mobile — avoid prolonged sitting.
• Manage stress with relaxation and regular activity.
• Prioritise sleep and recovery.

Always discuss these strategies with your healthcare team.

Emerging Research – Recent Findings

• Exercise combining resistance and impact training slows bone loss and improves quality of life in perimenopausal women.¹³
• Eccentric tendon loading reduces gluteal pain and improves hip function in women aged 40–60.¹⁵
• A 2025 systematic review confirmed that strength and balance training lowers fall risk in women during and after menopause.¹⁴
• Studies show MHT combined with exercise produces greater bone mineral density gains than either approach alone.¹⁷
• Ongoing research supports early physiotherapy involvement for tendon and bone adaptation throughout this life stage.¹⁵

Book Your Appointment

To book an appointment with your physiotherapist regarding best management of perimenopausal conditions please call us or book online 24-hours.

References

1. Pyne Y et al. Towards a more accurate global picture of perimenopause. PMC 2024.
2. Australian Physio. Five facts about physiotherapy and menopause. 2025.
3. Physio-Pedia. Menopause. 2024.
4. Panay N et al. Menopause and MHT in 2024: addressing the key controversies. Climacteric 2024; 27(5): 441-457.
5. Cunningham A C et al. Perimenopause symptoms, severity, and healthcare seeking in women. npj Women’s Health 2025.
6. GREM Journal. Hormonal contraception and menopausal transition: a short review. 2024.
7. Kuck M J et al. Stress, depression, and anxiety across menopausal stages. Front Psychiatry 2024.
8. North West Healthy Women. Perimenopause symptoms and how a physio can help. 2025.
9. Coslov N et al. “Not feeling like myself” in perimenopause — what does it mean? Menopause 2024.
10. Xu H et al. Effects of mind-body exercise on perimenopausal and postmenopausal women. Menopause 2024.
11. Platt O et al. Impact of hormone therapy, exercise, and combination on bone mineral density. Reproductive Health 2025.
12. Greendale G A et al. Physical activity and bone density during menopause. Lancet Am Health 2023.
13. Xiaoya L et al. Exercise types and bone mineral density in postmenopausal women. Sci Rep 2025.
14. Fang Y et al. Global prevalence of menopausal musculoskeletal symptoms. BMC Public Health 2024.
15. Ganderton C L et al. Eccentric loading for gluteal tendinopathy in women aged 40–60. Br J Sports Med 2024.
16. Daly R M et al. Strength and balance training for fall prevention in mid-life women. J Bone Miner Res 2024.
    
17. Iyer T K et al. Recent trends in menopausal hormone therapy use. JAMA Health Forum 2024.

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