What is "The New Perimenopause" and how does PT help you avoid the zone of chaos?

The book club event was inspired by The New Menopause by Dr. Mary Claire Haver. Our discussion was designed to encourage women to look beyond their menstrual cycles and understand the broader impact of hormonal changes on their health. Perimenopause and menopause are not simply reproductive milestones. They are important transitions that can influence bone health, muscle strength, cardiovascular risk, pelvic floor function, sleep, and overall quality of life. Knowledge is key to understanding these changes creates opportunities to take a more proactive approach to health, movement, and aging.

Perimenopause is the transition leading up to menopause. During this time, ovarian hormone production changes, and estrogen and progesterone levels may fluctuate considerably. Menopause itself is defined retrospectively after 12 consecutive months without a menstrual period, when there is no other identifiable cause. The transition leading up to it can last several years, and the experience varies significantly from woman to woman. This transition effects all body systems and can lead to an array of symptoms. Hot flashes and night sweats are well-known symptoms, but they are not the only ones. Women may also experience sleep disturbances, changes in mood, difficulty concentrating, vaginal and urinary symptoms, changes in sexual function, and musculoskeletal discomfort. Some women notice changes in exercise tolerance or body composition. Others find that their joints feel stiffer or that recovery from physical activity takes longer than it used to. Not every symptom is caused by menopause, and persistent or concerning changes deserve individualized medical evaluation. However, recognizing the range of possible symptoms can help women advocate for themselves and seek appropriate care rather than assuming they simply need to tolerate feeling different.

One of the most important investments a woman can make during midlife is developing and maintaining muscular strength. Muscle supports far more than appearance. It contributes to mobility, balance, metabolic health, physical independence, and the ability to perform everyday tasks. Age-related changes in muscle mass and strength can occur over time, and the menopausal transition is an important opportunity to reassess exercise habits. Resistance training challenges muscles in ways that help maintain or increase strength. It can also support bone health, improve physical function, and make daily activities feel easier. This does not mean every woman needs to lift extremely heavy weights or follow an advanced fitness program. The appropriate starting point depends on her current fitness, medical history, symptoms, and goals.The goal is to build a body that can meet the demands of life now and in the decades ahead. If you are not currently strength training, start with a manageable plan and build gradually. If pain, significant weakness, osteoporosis, or other medical concerns affect your ability to exercise, an individualized assessment can help determine the safest and most effective approach.

Bone health deserves particular attention during the menopausal transition. Estrogen helps regulate the process of bone remodeling. As estrogen levels decline, bone breakdown can outpace bone formation, accelerating bone loss in some women. Over time, this can contribute to osteopenia and osteoporosis, conditions that increase the risk of fractures. The challenge is that bone loss is often silent. A woman may not know that her bone density has declined until she experiences a fracture or undergoes a bone density assessment. Weight-bearing activity, progressive resistance training, adequate calcium and vitamin D, and attention to other risk factors all contribute to a comprehensive bone-health strategy. Bone density screening, including a DEXA scan, may be appropriate depending on age, risk factors, and clinical guidance.

Bladder leakage, pelvic pressure, constipation, and discomfort during sexual activity are concerns that many women experience but rarely discuss openly. Pregnancy and childbirth can affect pelvic floor function, but these concerns are not exclusive to mothers. Hormonal changes associated with menopause can also affect the tissues of the genitourinary system, contributing to vaginal dryness, discomfort, urinary urgency, and other symptoms. The pelvic floor is a group of muscles and connective tissues that supports the pelvic organs and contributes to bladder and bowel control, sexual function, and core coordination. Like other muscles, the pelvic floor needs to function with appropriate strength, flexibility, endurance, and coordination. Pelvic floor physical therapy can help identify these issues and develop an individualized treatment plan. Urinary leakage, pelvic pain, and pelvic pressure are not problems women should automatically accept as inevitable consequences of aging.

Heart health is another essential part of the conversation. Cardiovascular risk changes as women age, and the menopausal transition can coincide with changes in cholesterol levels, body composition, blood pressure, and other risk factors. Menopause is not the sole cause of these changes, but it provides an important opportunity to reassess cardiovascular health. Regular aerobic exercise, strength training, nutritious eating patterns, adequate sleep, and appropriate medical screening can all contribute to a long-term prevention strategy. Preventive care is not just about responding to a problem. It is about identifying opportunities to protect your future health before symptoms or disease limit your choices.

Perimenopause and menopause can bring real challenges, but they can also be an opportunity to become more intentional about your health. You deserve accurate information about what is happening in your body, access to appropriate care, and a plan that supports the life you want to continue living. As a physical therapist specializing in women’s health, I encourage women to think beyond their immediate symptoms. Building strength, protecting bone health, addressing pelvic floor dysfunction, and maintaining physical activity can all contribute to better function and independence as you age. You do not have to wait until something hurts, leaks, or limits your daily life to seek guidance. Midlife is not the end of your physical potential. It is an opportunity to invest in the strength, confidence, and health you want for the years ahead.

References

Haver, M. C. (2026). The new perimenopause: An evidence-based guide to surviving the zone of chaos and feeling like yourself again (1st ed.). Penguin Random House. https://www.penguinrandomhouse.com/books/777456/the-new-perimenopause-by-mary-claire-haver-md/

Meet the Blog Author

Dr. Jadyn Crooch, PT

APTA Pelvic Health's Oklahoma State Representative

Dr. Jadyn Crooch, PT is the owner of an outpatient clinic build with women in mind and serves as a physical therapy assistant program chair for Connors State College/Indian Capital Technology Center. She has practiced within the specialty of pelvic health for the last seven years. She has a passion for improving visibility to women's health topics and inspiring other physical therapists to learn more about serving our female patients across the lifespan.