Attn Girls in Your 20s: Menopause Starts Earlier Than You Think

In your 20s and 30s, you’re likely focused on your career, relationships, and planning for big milestones like getting married, buying a home, or starting a family. Chances are menopause and perimenopause (the transition to menopause when the body’s hormone production begins to decline) aren’t anywhere on your radar. But although perimenopause is often perceived as a concern for people with ovaries in their 40s, perimenopause can start in your 30s or earlier.

“One of the biggest myths I hear is that perimenopause means menopause is right around the corner,” said Dr. Shweta Patel, a board-certified OB-GYN and founder of Gaya Wellness. “Perimenopause can last for years before you officially hit menopause, which is when you haven’t had a period for 12 months straight.” Recognizing and understanding the symptoms of perimenopause can help you feel prepared and confident as you navigate your body’s changes and empower you to manage your health effectively. Keep reading to learn what perimenopause is exactly, including the signs to look out for.

What is Perimenopause?

Perimenopause (AKA menopausal transition) refers to the time when the body starts making the natural transition to menopause and the end of reproductive years. During this transition, the ovaries begin producing fewer hormones—namely estrogen—which plays a vital role in maintaining the reproductive system. As estrogen production decreases, it throws off the balance with progesterone, another hormone the ovaries produce. The fluctuation in hormone levels causes your menstrual cycle to become erratic or irregular (but it’s still possible to get pregnant in perimenopause, FYI). While it’s a natural and normal progression, it comes with both physical and emotional symptoms (more to come on that).

Once you’ve experienced 12 consecutive months without a menstrual period, you’ve officially reached menopause, and the perimenopause period is over. While perimenopause most often occurs between ages 40 and 44, The Menopause Society says that three in 100 women will go through menopause before age 40. Because each body is unique, perimenopause varies greatly from one woman to the next. Some women may notice signs of progression toward menopause in their 40s, but other women notice related changes as early as their mid-30s. And while the average duration of perimenopause is three to four years, it can range from just a few months to as long as a decade. Periods may end abruptly for some, but for others, menstruation can occur erratically for years. During the perimenopausal phase, the more well-known symptoms like hot flashes, night sweats, and mood changes are typical, but some women can remain completely asymptomatic.

What Are the Symptoms?

So, how do you know if you’re experiencing perimenopause? Here are some signs and symptoms to look out for:

• Hot flashes
• Night sweats
• Irregular periods
• Mood swings
• Sleep disturbances
• Vaginal dryness
• Bladder changes, including having to urinate frequently
• Weight gain
• Low libido
• Anxiety
• Hair thinning or loss

Dr. Patel pointed out that a common misconception about perimenopause is that it’s solely characterized by hot flashes and mood swings. “While those symptoms can occur, others, such as difficulty sleeping, anxiety, and changes in sex drive, are also quite common,” she said. “Many women may not even recognize they are in perimenopause because these symptoms can easily be mistaken for stress or PMS.”

According to the Mayo Clinic, your doctor will likely consider many things when determining whether you’re experiencing perimenopause, including your age, menstrual history, and what symptoms or body changes you’re experiencing. Because perimenopause is a gradual transition, no one test or sign is enough to determine if you’ve entered perimenopause. Some doctors may order tests to check your hormone levels; however, other than checking thyroid function (which can affect hormone levels), hormone testing is rarely necessary or useful to evaluate perimenopause. While diagnosing perimenopause is not black and white, if you suspect you’re experiencing symptoms, it’s best to consult your doctor.

How Do You Treat Perimenopausal Symptoms?

There’s a preconceived notion that nothing can be done about perimenopausal symptoms, which is wrong, according to Dr. Patel. “There are plenty of ways to manage the symptoms, whether through hormone replacement therapy, lifestyle changes, or other treatments like antidepressants or anxiety meds if mood swings are getting the best of you,” she explained.

One 2024 review published in Nutrients found that maintaining a well-rounded diet rich in vital nutrients such as calcium, vitamin D, omega-3 fatty acids, and protein while limiting added sugar and saturated fats can help minimize perimenopause and menopause symptoms. Additionally, prioritizing quality sleep, incorporating strength training exercises, and cutting back on alcoholic beverages can further promote your well-being and help you thrive during this transition.

Why Should I Care About Perimenopause Now?

You deserve to feel familiar with your body

Getting to know your body is so important, especially when it comes to perimenopause. Dr. Patel highlighted how vital it is to start with the basics: “Track your periods. Get yourself a period app or, if you’re old-school, a calendar. Watch for patterns. If you’re noticing irregular cycles, heavier or lighter flows, or more intense PMS, it’s a sign to check in with your doctor.” Next, she suggested considering discussing hormone testing with your doctor and adopting healthy lifestyle habits to manage any symptoms. “Good sleep, regular exercise, and balanced nutrition help keep those hormone fluctuations from wreaking total havoc,” she said. By paying attention to your cycle, you’ll more easily recognize changes that can signal perimenopause. It comes down to noticing the signs early—whether it’s a shift in your flow or more intense PMS—and reaching out to your doctor when needed.

To be proactive about your reproductive health

“Your 20s and 30s are a great time to be very mindful and proactive about your health,” Dr. Patel emphasized. Beyond your annual exam, Dr. Patel said you can ask your doctor about testing your thyroid, vitamin D, testosterone, estrogen, LH (luteinizing hormone), and FSH (follicle-stimulating hormone). For women considering becoming pregnant, she also recommended an AMH (anti-mullerian hormone) test, a blood test that shows your ovarian reserve (how many good quality eggs you have left) and can be useful if you plan to have kids later or want to monitor potential fertility concerns. Dr. Patel stressed that perimenopause itself does not cause changes in fertility, and there’s no need for alarm, but it’s wise to be mindful of your childbearing goals and explore strategies to optimize them.

Early perimenopause is real

While perimenopause usually starts after 40, it can happen much earlier—sometimes as early as your late 20s or 30s. One factor that can contribute to early perimenopause is primary ovarian insufficiency (POI), where ovaries produce insufficient estrogen and genetic predisposition (if your mother or close female relatives experienced early menopause, you may be at a higher risk). Autoimmune disorders like thyroid disease and rheumatoid arthritis may also affect ovarian function and decrease estrogen production. Additionally, cancer treatments such as chemotherapy and radiation targeting the pelvic region may harm ovarian health, and lifestyle factors like smoking can accelerate ovarian aging.

Misdiagnosis is more common in women

Women are already more likely to be misdiagnosed: According to The Connecticut Health Foundation, women and racial minorities are 20–30 percent more likely to be misdiagnosed than white men, and a 2024 survey found that 66.1 percent of women reported receiving a misdiagnosis in the last two years. Symptoms of perimenopause, in particular, are often misdiagnosed, leading women to not be able to receive a diagnosis or proper care. Dr. Mary Claire Haver, a board-certified OB-GYN and author of The New Menopause, told Vogue that doctors aren’t traditionally trained to recognize perimenopause symptoms, making it both underrecognized and unlikely to be treated. Because of this, women often go to doctor after doctor for multiple issues and are prescribed a variety of medications without addressing the root cause of the symptoms: hormones.

There’s a lot of stigma around perimenopause and menopause

Every year, more than one million American women begin menopause, but perimenopause and menopause continue to be stigmatized topics women dismiss, avoid, or don’t fully understand. There are many reasons why: the cultural taboo surrounding aging, where women feel pressure to maintain a youthful appearance, making perimenopause and menopause a shameful phenomenon; a lack of public awareness means many women may feel underprepared for and embarrassed about the symptoms they experience (in fact, more than 80 percent of women say they either have “no knowledge” or just “some knowledge” of menopause); and the miscommunication around menopause (i.e., menopausal symptoms are inevitable) can make women feel alone and suffer in silence or, on the other hand, can leave women overmedicated.

Normalizing conversations around perimenopause and menopause can help break the silence and encourage more open dialogue. This helps change the narrative from something secretive and negative to a normal, accepted part of life. By being informed, you can help yourself and other women navigate this natural stage with confidence and without shame. If you’re looking for more resources on perimenopause, I like Perry, an app and online community dedicated to providing women with the resources, tools, and support groups to support this phase of your life.