What it is
Perimenopause
Perimenopause is the transition before your final period, usually starting in your 40s and lasting several years. Estrogen rises and falls unpredictably, then declines. Estrogen helps keep the tissues of the vagina, vulva, urethra and bladder thick, elastic and well supported, so as it changes many women notice new bladder, pelvic floor and sexual symptoms, often well before periods stop.
New pelvic symptoms in your 40s are common, and earlier care usually means faster progress.
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This isn’t a diagnosis. If something feels urgent, see the list below.
How Katrina helps
A plan built around you
- 1
Strength and coordination
Pelvic floor and whole-body strength for the adventures ahead.
- 2
Bladder strategies
Practical tools for urgency and night-time trips.
- 3
Work with your provider
Hormone therapy stays with your doctor; we help your body make the most of it.
In Katrina’s words
Shifting hormones in perimenopause can change how your pelvic floor and pelvic tissues feel and support you—often years before your last period. New leakage on the trail, urgency, heaviness, or discomfort with intimacy are common and treatable.
We work on strength, coordination, and load tolerance so you can keep hiking, lifting, and adventuring with confidence. Hormone therapy stays with your medical provider; we coordinate with them when it helps.
You do not have to wait until symptoms are “bad enough.” Earlier care usually means faster progress.
Your first visit, your way
You’re in control the whole time
- We start by talkingYour story and your goals come first.
- Nothing without your okayEvery step is explained before it happens.
- Internal exam is optionalWe can learn a lot without one, and you decide.
- One-on-one with KatrinaUnhurried, private, and at your pace.
Free 15-minute call
Ready to start the conversation?
Send a quick note and I'll call you for a free 15-minute chat. No pressure, just clarity.
We don't bill insurance directly. Every plan is different, so we'll talk through cost and coverage on your free call. HSA/FSA cards often work for visits.
Common questions
FAQs
Can perimenopause cause leakage even if I never had it before?
Yes. Hormonal changes affect pelvic tissues and muscle, so new leakage or urgency in your 40s is common—and pelvic PT can usually help.
Do you prescribe hormones?
No. Hormone therapy is managed by your medical provider. We focus on the muscles, movement, and strategies that complement that care.