Experts warn that women in their late 30s and 40s who suddenly need to rush to the restroom or struggle to complete workouts they once handled comfortably may be experiencing signs of perimenopause—not simply stress, burnout, or aging.
New research showing that one in three U.S. women over 35 are unsure whether they are experiencing perimenopause has prompted experts to call for greater awareness of the condition’s lesser-known symptoms.
Tia Dankberg, PT, DPT, PWCS, board-certified Pelvic and Women’s Health Clinical Specialist at Brooks Rehabilitation, explains that several symptoms women attribute to an overloaded schedule may warrant a closer look, including increased fatigue levels or low energy, joint and muscle pain, brain fog, difficulty concentrating, migraines, and changes in mood.
“The biggest myth is that perimenopause and menopause are simply inconveniences that women have to endure,” says Dankberg. “In reality, menopause is a significant biological transition that can affect nearly every aspect of health, including physical function, mental health, sleep, sexual health, pelvic floor function, bone health, and cardiovascular risk.”
Perimenopause affects every woman differently, and one symptom alone does not necessarily mean a woman is in perimenopause. However, new combinations of symptoms, noticeable changes from your usual baseline, or issues that persist despite rest may be worth discussing with a healthcare professional. Here are five surprising perimenopause signs women may be overlooking.
1. You suddenly need to rush to the restroom
A noticeable increase in urinary urgency or frequency can be easy to blame on drinking too much fluid or simply getting older. However, changes in estrogen can affect the tissues and muscles responsible for supporting the bladder and controlling urination.
“One of the most surprising physical changes we see in women during perimenopause is how the decline in estrogen can affect the pelvic floor,” says Dankberg. “As estrogen levels decrease, the tissues that support the bladder, uterus, vagina, and colon become thinner and less elastic, reducing their ability to meet the demands of daily activities and contributing to commonly reported symptoms such as urinary urgency, frequency, and incontinence.”
2. Your usual workout suddenly feels much harder
A familiar fitness routine may begin to feel more challenging during perimenopause. Women may also need longer recovery times or find that high-impact movements begin to trigger pain, pressure, or bladder leakage. But rather than abandoning exercise, Dankberg emphasizes that perimenopause is a great time to start incorporating a variety of movements or workout programs into your exercise routine.
She recommends different forms of movement to support the body’s changing needs, such as strength training to preserve muscle mass and support bone density, cardiovascular exercise, and balance and flexibility training to help maintain mobility, reduce injury risk, and support long-term function.
3. You feel more injury-prone than you used to
Recurring tendon irritation, muscle pain, joint aches, and slower recovery may seem like unavoidable signs of aging. However, Dankberg highlights that perimenopause can change how the body tolerates and recovers from physical activity.
“During perimenopause, the loss of estrogen can contribute to increased joint and muscle aches, tendon irritation, and pelvic floor dysfunction,” explained Dankberg. “It is also important not to skip warm-ups and cool-downs, including stretching, as this can place sudden demands on the muscles and increase the risk of injury. Taking rest periods of at least 30 to 60 seconds between repetitions and sets can help reduce muscle fatigue and lower the likelihood of overworking the muscles.”
4. You leak when you cough, laugh, or exercise
“Urinary leakage or incontinence is one symptom women should stop accepting as a normal part of aging,” said Dankberg. “Many women assume it’s simply the result of childbirth or getting older, but it often reflects changes in pelvic floor muscle strength, coordination, or hormonal support. Urinary incontinence is highly treatable, and pelvic floor physical therapy can be an effective, evidence-based treatment that helps regain bladder control and improve quality of life.”
5. You can’t shake the fatigue, brain fog, or irritability
Fatigue, difficulty concentrating, migraines, anxiety, depression, and irritability can easily be attributed to burnout, particularly when women are balancing work, caregiving, relationships, and household responsibilities. However, when several of these symptoms appear together or represent a significant change from normal, they may warrant a conversation with a healthcare professional.
“Recognizing these changes early allows women to seek appropriate care and improve their long-term health and quality of life,” says Dankberg.
Pelvic health physical therapy may help women experiencing urinary urgency, frequency, incontinence, pelvic heaviness, pelvic organ prolapse, pelvic pain, and other changes affecting everyday movement and quality of life.
