Symptoms of the Perimenopause Symptoms of the Perimenopause

Perimenopause is the transitional phase before menopause begins. During perimenopause, your levels of oestrogen decrease and your periods become irregular. You might experience symptoms such as hot flashes, worsening premenstrual syndrome (PMS) and even urine leakage.1, 2

Perimenopause can last from a few months to several years. It ends and menopause begins when you go 12 months without a period.1

What is perimenopause?

Perimenopause is the time from the start of your oestrogen levels decreasing to the definitive end of your periods. It can begin as early as your 30s or as late as your 50s and it can vary in length from a few months to a few years. But for the majority, it lasts four to eight years and begins in your 40s.1

During this transition, your ovaries begin producing lower levels of female hormones and stop releasing eggs. Periods become irregular and unpredictable. Perimenopause, therefore, is a sign of your fertility declining.1, 2

During perimenopause, your body is adjusting to different hormone levels, so you can experience some physical changes and symptoms.1, 2

Symptoms of perimenopause

The first sign of perimenopause is usually irregular or skipped periods. Other typical symptoms of perimenopause include:1, 2

  • Worse premenstrual syndrome (PMS)
  • Heavier or lighter periods than usual
  • Hot flushes and night sweats
  • Sleeping problems
  • Vaginal dryness
  • Mood changes
  • Fatigue
  • Lower sex drive
  • Urine leakage, usually when coughing or sneezing.3

Perimenopause and incontinence

Urine leakage due to bladder weakness is a frequent symptom during perimenopause, affecting more than 50% of women4. This is because the female hormone that decreases during perimenopause – oestrogen – also has a role in the normal functioning of the tissues related to urinary function, such as the urethra and pelvic floor muscles that support both your urethra and bladder3. As these tissues weaken, they are less able to work normally.
As a consequence, women can experience symptoms including:3

  • Stress incontinence: losing a few drops of urine when coughing, sneezing, laughing, lifting something heavy or doing other activities that put pressure on the bladder. In advanced stages, it may also occur when walking or changing position from lying down to standing up.
  • Urge incontinence: the fast and unexpected need to pee. This is also called “irritable” or “overactive” bladder.
  • Nocturia: the urge to pee several times in the middle of the night.
  • Painful urination: a burning sensation while peeing that also can be caused by an infection, so consult your doctor if you experience this.

Difficulties with bladder control: are they always related to perimenopause?

Hormonal changes during perimenopause are not the only cause of urine leakage in middle-aged women. Some other factors can have a role too:3, 4

  • Natural weakening of muscles due to age
  • Pelvic floor injuries after giving birth
  • Conditions such as diabetes, multiple sclerosis or Parkinson’s disease
  • The use of some medicines, such as antidepressants or painkillers
  • Sedentary lifestyles and obesity.

How can I stop incontinence during perimenopause and menopause?

Incontinence can be treated. Talk to your GP about your problems and concerns so you can find the most appropriate therapy together.

International Continence Society guidelines indicate that treatment of urinary incontinence should begin with conservative therapy, such as physiotherapy or pharmacotherapy. If needed, however, there are surgical treatments that can bring positive results.4
Nevertheless, your first step should be to try lifestyle changes that can help to prevent and control your urine leakage.

Changes in habits4

Lifestyle change is recommended for most patients regardless of the type or severity of their disease. Treatment for people with obesity should start with weight reduction. It is also important to limit the consumption of caffeine, alcohol or carbonated drinks.

Sports that adversely affect the pelvic floor, such as heavy weightlifting or running, should be avoided. But other sports may be recommended. For example, swimming is an excellent activity for taking care of your pelvic floor.


Your specialised physiotherapist may recommend exercises with pessaries or other physical therapies as biofeedback. Reports indicate good outcomes in up to 80% of patients in the early stages of urinary incontinence. It is also a good idea for older women, pregnant women and new mothers to use pelvic floor physiotherapy as a preventative measure.


You can receive treatments, such as oestrogen or adrenergic medicines, that enhance the elasticity and strength of your bodily tissues and help maintain bladder function. In addition, anticholinergic drugs can reduce bladder hyperactivity.


Surgical treatment should be introduced only after exhausting all of the possibilities of conservative therapies. There are different surgical methods available depending on the type and stage of urinary incontinence. Talk to your doctor about which is the most suitable treatment for your problem.

MoliCare®, by your side for urine leaks

If you are looking for a product for your incontinence, use MoliCare® Premium Lady Pads for light to moderate urinary leakage. Their anatomical shape provides a comfortable fit, while three layers of absorbent materials assure reliable protection and dryness. The pad is also gentle on your skin due to its soft top layer and pH-neutral value.


Choose the product that’s best for you by looking at the packaging: the higher the number of drops, the greater the absorption.

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1 Perimenopause. Cleveland Clinic Health Library.
2 Perimenopause Guide. WebMD
3 Menopause and Bladder Control Management. Women Guide. WebMD
4 Kolodynska G, Zalewski M, Rozek-Piechura K. Urinary incontinence in postmenopausal women – causes, symptoms, treatment. Menopause Rev 2019; 18(1): 46-50.

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