Perimenopause, Menopause, & Post Menopause: Understanding the difference

It’s 3 a.m. again. You’re wide awake, staring at the ceiling, wondering why sleep feels impossible lately. Yesterday, you snapped at your family over something small, and this morning, you leaked a little when you sneezed. You catch yourself thinking: Is this just getting older?

If any of this sounds familiar, you might be in perimenopause—or moving through menopause into postmenopause. If you’ve ever felt confused about the difference between perimenopause, menopause, and postmenopause—you’re not alone. Most women I talk to use menopause as a catch-all term, when really it’s just one milestone along a much bigger journey. And understanding the difference can make a world of difference when it comes to your health, especially your pelvic floor.

Let’s walk through it together.

Perimenopause: The Transition

Think of perimenopause as the on-ramp to menopause. Your body is still cycling, but the ride starts to feel bumpier. Hormone levels rise and fall unpredictably, ovulation becomes irregular, and you may feel like you’ve lost your usual rhythm.

This is often when women say to me, “Something just feels off.”

• They’re waking up at 3 a.m. and can’t get back to sleep.

• They feel like their moods are all over the place.

• Their jeans don’t fit the same, even though nothing else has changed.

And for many, new pelvic floor symptoms creep in. With estrogen dipping, the bladder, vagina, and pelvic floor muscles don’t get the same level of support they used to. I often hear women describe:

• A little leaking when they sneeze, laugh, or run.

• A sudden urgency to find a bathroom.

• A heaviness in the pelvis that wasn’t there before.

• Pain or dryness during intimacy that feels surprising.

Perimenopause can last anywhere from 4 to 10 years, and for many, it’s the stage with the most bothersome symptoms.

Menopause: The Milestone

The cessation of monthly menstruation. Menopause itself isn’t a long phase—it’s actually just one day: the day you’ve officially gone 12 months without a period. The average age is 51, though it can happen earlier or later.

Some women arrive here gradually. For others—say, after surgery or certain medical treatments—the shift happens overnight, and the symptoms can feel especially intense.

What I often hear from women around this time:

• “I thought my bladder leaks would get better once my periods stopped—but they actually got worse.”

• “Sex feels completely different, and no one ever told me it might.”

• “I feel like my body is betraying me.”

Estrogen levels drop to a new, steady low. The tissues of the vagina, urethra, and pelvic floor become thinner and less elastic, which can mean less support for the bladder and pelvic organs.

Postmenopause: The Long Game

Once you’ve crossed that menopause milestone, you’re considered postmenopausal for the rest of your life. Some symptoms (like hot flashes) may ease up. But other changes—like bone health, heart health, and pelvic health—become more important than ever.

This is often when women finally reach out for support with things they’ve “just put up with” for years, like:

• Bladder leaks.

• Prolapse (that feeling of heaviness or bulging).

• Ongoing dryness or pain with intimacy.

Here’s the good news I share with my clients all the time: your pelvic floor is not doomed. Even years after menopause, your muscles and tissues can respond beautifully to the right kind of attention. With movement, breathwork, gentle exercise, and simple daily strategies, you can feel stronger and more supported.

The Bottom Line

Perimenopause, menopause, and postmenopause aren’t problems to be solved—they’re natural stages of life. But they do bring changes, and your pelvic floor deserves to be part of the conversation. When you understand what’s happening, you can make choices that help you feel supported and confident in your body for the years ahead.

We’re only scratching the surface when it comes to the conversation around perimenopause, menopause, and postmenopause. If you’re ready to take the next step, grab my Free Perimenopause & Menopause Guide—your simple starting point for pelvic floor & core health in perimenopause, menopause, and post menopause.

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Disclaimer: This post is educational and not a substitute for medical care. If you have concerning symptoms, please consult your healthcare provider.