For many women, the years leading up to menopause can bring changes that are difficult to recognise and even harder to discuss. During perimenopause, hormonal fluctuations can affect sleep, concentration, mood and energy, but they can also influence pelvic health, contributing to symptoms such as urinary leakage, increased urgency, frequent urination and discomfort during sexual intercourse.

The issue is particularly relevant in Brazil, where women in their 40s and 50s represent a significant proportion of the workforce and increasingly occupy leadership positions. For women experiencing perimenopause while managing demanding careers and family responsibilities, symptoms that are rarely discussed can have consequences far beyond physical health.

The experience of a 46-year-old marketing executive, referred to here as Mariana Costa*, illustrates how easily the signs can be overlooked. She initially attributed poor sleep, difficulty concentrating and increasingly frequent trips to the toilet during working hours to stress. During business travel, she began planning her journeys around access to bathrooms. It was only after a medical consultation months later that she learned she was experiencing perimenopause.

According to The Menopause Society, formerly known as the North American Menopause Society, perimenopause can begin during the 40s and may continue for several years before menopause. Hormonal fluctuations during this transition can be associated with a wide range of symptoms, including changes affecting urinary and sexual health.

At the same time, this period often coincides with an important stage of women's professional lives. Data from the Brazilian Institute of Geography and Statistics (IBGE) show the increasing participation of women in the Brazilian labour market over recent decades, with women aged 40 to 59 representing an important part of the workforce.

When pelvic symptoms are mistaken for stress or ageing

Recognising perimenopause remains a challenge for many women. Research published in the scientific journal Menopause found that approximately one-third of women over the age of 35 were unable to identify whether they had entered perimenopause.

Fatigue, memory changes, irritability and difficulty concentrating can easily be attributed to workload, stress or the natural ageing process. However, specialists say that urinary and pelvic symptoms may also be overlooked for similar reasons.

Regiane Migliorini, a pelvic health physiotherapist specialising in pelvic floor dysfunction, says women frequently assume that urinary leakage or discomfort is simply an inevitable consequence of getting older.

"It is common for women to seek care believing that urinary leakage, urgency or even discomfort during sexual intercourse are natural consequences of ageing. In reality, many of these changes are associated with what happens during perimenopause and can be treated."

How perimenopause can affect pelvic health

As ovarian hormone levels fluctuate and gradually decline during the menopausal transition, changes can occur in tissues, collagen production and pelvic floor function. These changes may contribute to urinary and genital symptoms in some women.

The International Urogynecological Association (IUGA) recognises urinary symptoms, increased urinary frequency, urgency, pelvic pressure and sexual discomfort among the issues that may occur around the menopausal transition. These symptoms can also be associated with genitourinary syndrome of menopause (GSM), a condition involving changes to genital and urinary tissues related to reduced oestrogen exposure.

Although individual symptoms may initially appear minor, their cumulative effect can substantially alter everyday life.

"Many women stop exercising, avoid long journeys, start looking for toilets more frequently or reorganise their day around these symptoms. This directly affects autonomy and quality of life," explains Regiane.

The impact can also extend into the workplace. Needing frequent toilet breaks, worrying about urinary leakage during meetings or avoiding travel can create additional stress and affect confidence in professional environments.

Why employers are beginning to discuss menopause

The growing scientific understanding of perimenopause has also prompted organisations to examine its implications for workplace wellbeing. In the United Kingdom, government reports have highlighted the potential effects of menopausal symptoms on productivity, employee retention and wellbeing. Research by the Fawcett Society has also reported that some women leave employment because of menopause-related symptoms.

Although these findings come from the UK, they contribute to an increasingly international conversation about how workplaces can better support women during the menopausal transition. In Brazil, the discussion is becoming increasingly relevant as women remain active in the workforce during the years when perimenopausal symptoms commonly emerge.

For Regiane, pelvic health should form part of that conversation.

"When we talk about quality of life during perimenopause, pelvic floor health needs to be included. Many women silently live with symptoms that can be prevented or treated, but which end up affecting self-esteem, confidence and even professional performance."

The role of pelvic floor physiotherapy

Conservative approaches are widely used in the management of several pelvic floor disorders. The International Continence Society (ICS) and International Urogynecological Association recognise pelvic floor physiotherapy as an important component of care for various urinary and pelvic floor symptoms.

Depending on the individual diagnosis, physiotherapy may focus on improving pelvic floor muscle function, coordination, bladder habits and movement strategies. A healthcare professional can determine which approach is appropriate based on the woman's symptoms and clinical history.

Early assessment is particularly important because urinary leakage, urgency, pelvic pressure and sexual discomfort should not automatically be dismissed as unavoidable consequences of ageing.

As women in Brazil live longer and remain professionally and socially active for more years, specialists argue that healthcare discussions around menopause must become broader. The transition involves far more than hot flushes and mood changes; it can affect multiple systems, including pelvic health.

"Women's life expectancy in Brazil has increased significantly. This means that women will spend around a third of their lives after menopause. Looking after pelvic health is not simply about treating symptoms; it is about preserving autonomy, function and quality of life for many years," concludes Regiane.

Greater awareness among women, healthcare professionals and employers could help ensure that perimenopause is recognised as a significant stage of health rather than a condition women are expected to manage silently.