The menopause never arrives overnight. It is preceded by a transition phase of varying length called the perimenopause. During this time, the ovaries gradually slow down: oestrogen and progesterone levels fluctuate, which changes the menstrual cycle and can cause a range of physical and emotional symptoms.

In this article, you will find out:

  • Understanding the hormonal transition: at what age the perimenopause starts, how long it lasts and what happens in your body.
  • Recognising the symptoms: physical, cognitive and emotional signs, far beyond hot flushes, and tips to ease them.
  • Looking after your pelvic floor: why urinary leaks become more common, and how pelvic floor strengthening can help.

What is the perimenopause and at what age does it start?

The perimenopause is the hormonal transition phase that comes before your periods stop for good. It ends 12 months after your last period: only then can the menopause be confirmed. To find out more about the next stage, read our article on menopause symptoms.

On average, the first signs appear at around 47. They can, however, start earlier, from your early forties, for example because of an early decline in ovarian reserve or a family history.

How long does the perimenopause last?

The perimenopause usually lasts a few years, often 2 to 4, but it can go on longer for some women. Healthcare professionals distinguish two main stages (Harlow et al., 2012):

  • The early transition: cycle length starts to vary, with differences of 7 days or more from one cycle to the next. Falling progesterone can also make premenstrual syndrome worse.
  • The late transition: oestrogen production becomes unstable, ovulation becomes less frequent and gaps of 60 days or more without a period appear, sometimes alternating with heavy periods.

What are the symptoms of the perimenopause?

There are hormone receptors throughout the body, which is why this transition can affect both physical health and mental wellbeing. The most common signs are:

  • Hot flushes and night sweats: hormonal changes disrupt the temperature control centre in the brain. Clothes made from natural fibres (cotton, linen) and cutting down on stimulants (coffee, alcohol, spicy food) can help.
  • Irregular periods and premenstrual syndrome: these are linked to hormonal imbalance during your cycle. A healthcare professional can discuss whether a suitable treatment might help.
  • Sleep problems and tiredness: night sweats and insomnia disturb your rest. A cool bedroom (around 18°C) and switching off screens before bed help you sleep better.
  • Mood swings and brain fog: difficulty concentrating, irritability and anxiety are common. Gentle physical activity (walking, yoga) and relaxation exercises can ease these feelings.
  • Vaginal dryness and lower libido: reduced vaginal lubrication can make sex uncomfortable. A vulval moisturiser and a lubricant help reduce discomfort during sex.
  • Urinary leaks and bladder discomfort: falling oestrogen weakens the mucous membranes and the tissues of the pelvic floor. Regular pelvic floor strengthening can help reduce urinary leaks.

Not every new symptom is necessarily due to the perimenopause. If you have unusual or severe symptoms, see a healthcare professional.

Do you have leaks day to day? Read the story of an Emy Trainer user during the perimenopause.

Why do urinary leaks happen during the perimenopause?

Urinary leaks are largely linked to hormonal changes. Lower oestrogen levels affect the tissues and mucous membranes of the intimate area and urinary tract: specialists call this the genitourinary syndrome of menopause, which can include vaginal dryness, painful sex, frequent urges to pass urine and recurrent urinary tract infections (Portman et al., 2014). With more fragile mucous membranes, the risk of urinary tract infections increases.

Urinary leaks often have several causes: as well as hormones, previous pregnancies and births, physical strain and the strength of the pelvic floor muscles all play a part.

Important: urinary leaks can affect women of any age and should not be a taboo subject. A healthcare professional can advise you and suggest pelvic floor rehabilitation. According to a Cochrane review, pelvic floor muscle training is a well-studied first approach for stress urinary incontinence (Dumoulin et al., 2018).

How can Emy Trainer support you?

At first, it is often hard to feel whether you are really contracting your pelvic floor. Emy Trainer, a connected biofeedback pelvic floor trainer and CE-marked medical device, shows you in real time in the app whether you are activating your pelvic floor and then relaxing it. Mini-games that adapt to your level keep training varied, discreetly at home.

A clinical study carried out at Strasbourg University Hospital assessed Emy Trainer with more than 50 patients experiencing stress urinary incontinence: after 3 months of using Emy Trainer, 98% of participants reported an improvement in their quality of life, and 91% an improvement in their urinary symptoms (Jochum et al., 2021).

Find out more about Emy Trainer

What about contraception and medical support?

Even though fertility declines, ovulation is still possible. There is a risk of unplanned pregnancy until you have gone a full year without a period, so effective contraception should be continued. Talk to your gynaecologist, GP or midwife to adapt it.

If your symptoms are troublesome, an appointment allows a full review and, if needed, a treatment suited to your situation.

Key takeaways on the perimenopause

  • A natural hormonal transition: the perimenopause starts on average at around 47, lasts a few years and ends 12 months after your last period.
  • Varied symptoms: irregular cycles, hot flushes, sleep problems, mood swings, vaginal dryness and urinary leaks. A healthcare professional can help you find the right solutions.
  • Looking after your pelvic floor: if you have urinary leaks, pelvic floor rehabilitation is a first approach; Emy Trainer uses biofeedback to show you whether you are activating your pelvic floor.

 

Sources

  • Périménopause (préménopause) : symptômes et contraception, Assurance Maladie (ameli.fr), Février 2024 – ameli.fr
  • Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging, Siobán D. Harlow et al., April 2012, Menopause 19(4):387-95 – pubmed.ncbi.nlm.nih.gov/22343510
  • Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society, David J. Portman, Margery L. S. Gass, October 2014, Menopause 21(10):1063-8 – pubmed.ncbi.nlm.nih.gov/25160739
  • Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women, Chantale Dumoulin, Licia P. Cacciari, E. Jean C. Hay-Smith, October 2018, Cochrane Database of Systematic Reviews 10(10):CD005654 – pubmed.ncbi.nlm.nih.gov/30288727
  • Prospective evaluation of the connected biofeedback EMY Kegel trainer in the management of stress urinary incontinence, Jochum F et al., February 2022, Journal of Gynecology Obstetrics and Human Reproduction 51(2):102280 – pubmed.ncbi.nlm.nih.gov/34861424
  • Pelvic Floor Muscle Rehabilitation Using Biofeedback, Diane Kaschak Newman, July 2014, Urologic Nursing 34(4):193-202 – pubmed.ncbi.nlm.nih.gov/25233622

Pelvic Floor and Intimate Health FAQ

What is the pelvic floor and what does it do?

The pelvic floor is a group of muscles and tissues that closes off the bottom of the pelvis, between the pubic bone and the tailbone. It supports the pelvic organs (bladder, womb, rectum), helps you control your bladder and bowel, and plays a role in sex. Like any muscle, it can weaken (pregnancy, childbirth, menopause, repeated strain) or, on the contrary, become too tight.

How can you strengthen your pelvic floor?

To strengthen your pelvic floor, you need to voluntarily contract the pelvic muscles (as if trying to hold in gas or the urge to urinate) only when you exhale. Do progressive exercises lying on your back or on all fours, making sure not to hold your breath or tense your buttocks. You can combine these contraction exercises with a connected biofeedback device used at home, such as Emy Trainer. This device, inserted into the vagina, tracks your muscle contractions in real time and lets you do fun exercises on your smartphone while measuring your progress.

How can you tell if you have a weakened pelvic floor?

A weakened pelvic floor is mainly recognized by urinary leaks or involuntary gas during an effort such as laughing, coughing, or jumping. It can also cause a feeling of heaviness or pressure in the lower abdomen, as well as reduced sensation or discomfort and pain during sex. These topics are common in consultations: there is no need to feel embarrassed about bringing them up. Only a manual assessment by a midwife or physiotherapist will make it possible to accurately assess the tone of your muscles and confirm the need for rehabilitation.

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