Sarah Edrie says she was about 33 when she started to occasionally get a sudden, hot, prickly feeling that radiated into her neck and face, leaving her flushed and breathless. "Sometimes I would sweat. And my heart would race," she says. The sensations subsided in a few moments and seemed to meet the criteria for a panic attack. But Edrie, who has no personal or family history of anxiety, was baffled.
She told her doctor and her gynecologist about the episodes, along with a few other health concerns she was starting to notice: Her menstrual cycle was becoming irregular, she had trouble falling asleep and staying asleep, and she was getting night sweats. Their response: a shrug.
It wasn't until Edrie went to a fertility clinic at age 39 because she and her partner were having trouble conceiving that she got answers. "They were like, 'Oh, those are hot flashes. It's because you're in perimenopause,' " she says.
If you haven't heard the term "perimenopause," you're not alone. Often when women talk about going through menopause, what they're really talking about is perimenopause, a transitional stage during which the body is preparing to stop ovulating, says Dr. Jennifer Payne, who directs the Women's Mood Disorders Center at Johns Hopkins University.
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"Technically, menopause is only one day in a woman's life, which is exactly when she has not had a period for 12 months," she says. "It's the period of time leading up to menopause that causes all the trouble."
And it can start earlier than you might think. Many listeners wrote to us in response to our call-out for individual experiences with menopause to say that they struggled to get medical support for perimenopause in their mid-30s and early 40s.
When Edrie went back to her OB/GYN with the fertility clinic's conclusion, she says the doctor shrugged again and told her that menopause is a normal part of life. She wasn't satisfied with that answer. "Yeah, it's a normal part of life, but it would be great if we could talk about it and figure out strategies."
With that spirit in mind, we reached out to endocrinologists, gynecologists and psychiatrists for advice about navigating this major life transition.
How early can perimenopause start?
It's quite possible for women to start to notice things changing in their mid-30s. Most women arrive at menopause between the ages of 45 and 55, but perimenopause can start as much as a decade beforehand. And about 1% of women in the U.S. reach menopause at age 40 or younger.
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How do you know if you're starting perimenopause?
The most telling symptom is changes in your menstrual cycle, says psychiatrist Hadine Joffe, the executive director of the Connors Center for Women's Health and Gender Biology at the Brigham and Women's Hospital in Boston.
"It's the menstrual cycle pattern that really defines this lead-up to menopause," she says. During perimenopause, periods "might be shorter, then a long one, or then a skipped one, or then the flow might be different," says Joffe.
There's no blood or hormone test that can "diagnose" perimenopause. Joffe says a hormone test isn't helpful because hormonal cycles become erratic and unpredictable during this stage.
"There's not really one point in time when a hormone test is done that can be definitive," she says. Even if you took several tests over time, "you might get a very different readout."
Surprisingly, sometimes doctors aren't prepared to help women recognize the start of this life phase. Edrie was upset at her doctors' responses — or lack thereof. "I felt so disappointed in the medical industry. How many women has my OB/GYN seen and not recognized the symptoms of perimenopause?"
What symptoms to expect
Be prepared for your PMS symptoms to possibly shift, becoming either more or less extreme, says Dr. Cynthia Stuenkel, a founding member of the North American Menopause Society and a professor and endocrinologist at the University of California, San Diego, School of Medicine. "Women might not get the same kind of breast tenderness or mood shifts that they may have noted in the past," she says.
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Mood problems like depression can spike during perimenopause, especially among women who have previously experienced them. Many of our listeners wrote in to say that during perimenopause, they felt incredibly irritable and quick to anger in a way that they had never experienced before.
And of course, many — but not all — women experience hot flashes, though they may not recognize them. "It's hard, because no one sits us down and teaches us, 'Here's what a hot flash feels like,' " Stuenkel says. "I've seen women who think they're having panic attacks, or heart palpitations. That can be frightening."
Other common symptoms include more frequent urinary tract infections, difficulty sleeping through the night, vaginal dryness that can make sex painful, night sweats and a decrease in libido.
What treatments are there for symptoms?
Some symptoms, like heavy or irregular periods, can be managed with an oral contraceptive, which can "shut down the body's own erratic hormonal fluctuations," says Stuenkel.
"This can kind of be a lifesaver," she says. Such medication may help with hot flashes, too.
In some cases, doctors may prescribe menopausal hormone therapy, or very low doses of hormones to supplement estrogen levels. Stuenkel says it's not a fit for everyone, but it doesn't deserve the bad reputation it has in some circles. She says there was an "exodus" from the use of hormone replacement therapy after the Women's Health Initiative trial halted a study over safety concerns in 2002. But many clinicians now feel much more comfortable using hormone therapy again and usually recommend low doses, selectively, for shorter periods of time.
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For people who cannot take estrogen therapy, or choose not to, Stuenkel says some drugs in the antidepressant family, such as SSRIs and SNRIs, can help with hot flashes. Stuenkel says, "While they're not perfect, they can take the edge off and help enough so that women can get a better night's sleep."
There are an abundance of nonhormonal, nondrug treatment options for managing symptoms, some of which have significantly more evidence backing them than others. In 2015, a North American Menopause Society panel found that cognitive behavioral therapy and hypnosis were significantly effective in treating hot flashes. The same panel also found that popular herbal remedies (like black cohosh, dong quai and evening primrose) are "unlikely to help," although some NPR listeners who wrote in said they got relief from some of those treatments.
For depressive and anxiety symptoms, women may want to seek out professional counseling or a psychiatrist.
When do I need to see a doctor?
You might not need to at all. Some people sail right through menopause with little trouble. But if you are experiencing symptoms that are interfering with your life, it's worth making an appointment. Some of these symptoms could indicate other problems that need treatment, such as fibroids or even cancer.
Ways to cope with symptoms
For people approaching this stage of life or who are already going through it, here are four steps for making this transition more manageable.
1. Get educated
"Information is key," says Joffe. She suggests that people approaching perimenopause age empower themselves with knowledge.
The Massachusetts General Hospital Blum Center has a curated list of suggested books. The National Women's Health Information Center has a section on menopause and perimenopause. The American College of Obstetricians and Gynecologists also has a perimenopause FAQ.
2. Monitor your health
Joffe encourages people to track symptoms: "menstrual patterns, hot flash patterns, mood issues, major life triggers." Using a paper calendar or an app to monitor symptoms can make it easier to give your doctor details that can be otherwise hard to remember.
"Knowing that information, somebody can say, 'Well, over the last six months, I only had two periods or I had hot flashes almost every day,' " Joffe says, "or, 'My mood was as bad as it gets for only two days or for a third of the time.' "
And if you bring a thorough health history to your physician and they still give you a shrug, consider a specialist. "There are OB/GYNs that specialize in perimenopause and menopause," Joffe says.
3. Practice smart self-care
Joffe encourages women to protect themselves from things that might worsen their mood or well-being. This includes reducing stress when they can and making sure they get enough sleep.
"Sleep is critical," she says. "Getting a good night's sleep, and making sure it's not broken in the middle of the night."
There are lots of online tools and apps to help with sleep, she adds.
And familiar health advice like getting enough exercise, eating well and moderating alcohol consumption apply to perimenopause too, says Dr. Steven Goldstein who is the co-author of Could It Be ... Perimenopause? and a professor of obstetrics and gynecology at the New York University School of Medicine.
At her doctor's suggestion, Edrie developed a mindfulness practice. She says, "I thought it sounded a little 'woo-woo' at first, but being able to pay attention to what my body is doing and why helps me separate those symptoms from what I need to get through my day. So I'm not overwhelmed by what my body is putting me through."
4. Cultivate community
Most of the women who wrote to NPR about their experiences going through perimenopause said that they felt alone and isolated during this transition.
Having a community to talk to can make it easier to cope with the changes, says Payne, who's going through perimenopause herself. She says she has found support from a few close friends from college.
"To be able to reach out to a group of women who are our same age and say, 'Did you go through this? And, you know, it does provide support. I think that's another version of a coping skill," she says.
Edrie says she joined a few Facebook groups dedicated to perimenopause and found one in particular where she got tips on coping with one of her most troublesome symptoms: brain fog. The conversations made her feel understood and validated.
"I can post about it in this group, and, you know, 10 women will be like, 'Oh, last week, that totally happened to me,' or like, 'I forgot my kid's computer on the top of my car and drove away,' " she says.
She says that being able to commiserate helps her get through symptoms "that maybe don't have a magic pill." Some of her online friendships have even taken shape offline. Edrie has met up with some of the Facebook group members while touring the country with her band.
Now she's a big proponent of finding community and speaking out. "As we get older, we get more and more quiet about what's going on with our bodies and ourselves and our lives. We kind of just, buck up and deal with it."
"And I feel like if we talked more about the things that are happening to our bodies — even if we can't actually do anything about some of these things — it would just be better for society in general if we were more vocal about it."
FAQs
What is the youngest age for menopause? ›
What is the earliest age for menopause? Menopause can happen when a person is in their 20s, 30s or 40s. Premature menopause describes menopause that occurs any time before age 40. It's rare for menopause to happen before age 30.
What happens if you go through menopause too early? ›Women who experience premature menopause (before age 40 years) or early menopause (between ages 40 and 45 years) experience an increased risk of overall mortality, cardiovascular diseases, neurological diseases, psychiatric diseases, osteoporosis, and other sequelae.
What does the beginning stages of menopause look like? ›Some common, normal signs include irregular periods, hot flashes, vaginal dryness, sleep disturbances, and mood swings—all results of unevenly changing levels of ovarian hormones (estrogen) in your body.
Can a woman have an Orgasim after menopause? ›Orgasms — and great sex — are still absolutely possible, through menopause and beyond. A few small changes can go a long way toward increasing your pleasure during sex — solo or partnered — and boosting physical and emotional intimacy with your partner(s).
What are the benefits of early menopause? ›Starting menopause early can actually protect you from other diseases. These include estrogen-sensitive cancers such as breast cancer. People who enter menopause late (after age 55) are at greater risk of breast cancer than those who enter the transition earlier.
Does early menopause accelerate aging? ›“We discovered that menopause speeds up cellular aging by an average of 6 percent,” said Horvath, who is also a professor in the UCLA Fielding School of Public Health. “That doesn't sound like much but it adds up over a woman's lifespan.” Take, for example, a woman who enters early menopause at age 42.
Can stress bring on early menopause? ›Excessive stress, which leads to elevation of stress hormones, can also negatively affect reproductive ability, including by accelerating menopause.
Is early menopause rare? ›Early menopause, between the ages of 40 and 45, affects about 5 percent of women. Premature menopause, before age 40, affects about 1 percent of women. You are said to be in menopause if you have gone a full 12 months with no menstrual period.
Is it better to go through menopause early or late? ›While overall later menopause is probably healthier, it is associated with an elevated risk of developing breast, ovarian, and endometrial cancers. The average age for menopause is 51, and the women in this study were close to that number, with an average age at menopause of 50.5.
How can I prevent early menopause naturally? ›Diets high in calories, fruits, and protein
One large British study found that eating oily fish and fresh legumes delayed menopause by several years. Another study found that consuming Vitamin D in dairy products lowers your risk of early menopause by up to 17 percent over women who consumed less.
What are the 3 stages of menopause? ›
- Perimenopause is the time leading up to menopause. ...
- Menopause occurs when you've stopped producing the hormones that cause your menstrual period and have gone without a period for 12 months in a row.
In postmenopause, symptoms of menopause may have eased or stopped entirely, but some women continue to have symptoms for longer. The change in your body's hormones however is a sign to keep looking after your health and wellbeing, and be mindful to listen to your body.
What is your last period like before menopause? ›What are periods like during perimenopause? Your body is producing less of the hormones that help you ovulate, so your periods can become irregular. Your menstrual cycle could become longer or shorter than usual. Your bleeding could also be heavier or lighter than normal.
What is the average age periods stop? ›Menopause is when your periods stop due to lower hormone levels. This usually happens between the ages of 45 and 55. It can sometimes happen earlier naturally. Or for reasons such as surgery to remove the ovaries (oophorectomy) or the uterus (hysterectomy), cancer treatments like chemotherapy, or a genetic reason.
Do you need lube after menopause? ›To remedy vaginal dryness and painful intercourse (dyspareunia) associated with the genitourinary syndrome of menopause, your doctor might recommend: Vaginal moisturizers (K-Y Liquibeads, Replens, others), applied every few days to moisturize and keep vaginal tissues healthy.
Do you need condoms after menopause? ›Do I still need to practice safe sex after menopause? Yes, you still need to use condoms after menopause if you are not in a monogamous relationship. In a monogamous relationship, you and your partner have sex only with each other and no one else.
Can menopause cause a sexless marriage? ›It's true that, for some women, their libido might be diminished by menopause, but that doesn't mean her need for intimacy is. Many post-menopausal women have active romantic lives with their husbands, even though intercourse might take more effort than before. Your non-sexual status has continued for eight years.
How can I increase my estrogen naturally? ›- Soy and other legumes. Soybeans and soy products are a rich source of isoflavones, one of the most important groups of phytoestrogens. ...
- Flaxseeds. ...
- Dark chocolate. ...
- Garlic oil supplements. ...
- Red clover. ...
- Vitamin D. ...
- DHEA.
Jowls, slack skin, and wrinkles
Studies show that women's skin loses about 30% of its collagen during the first five years of menopause. After that, the decline is more gradual. Women lose about 2% of their collagen ever year for the next 20 years. As collagen diminishes, our skin loses it firmness and begins to sag.
You can't prevent menopause. But you can take steps to enjoy good health into your later years. To help treat some of the symptoms of menopause and prevent possible complications, practice healthy habits. Maintain a healthy weight, eat a well-balanced diet, and exercise regularly.
What is menopause anxiety like? ›
Menopause and anxiety. A common symptom that leaves you feeling stressed, fearful or tense. It can cause physical symptoms, like palpitations, and can make symptoms like hot flushes worse.
Can emotional trauma trigger menopause? ›Higher Odds for Menopause Symptoms
“Stress related to emotional abuse and other traumatic exposures may influence the hormonal and physiological changes of menopause and aging, affecting biological susceptibility as well as the subjective experience of these symptoms,” she said.
Can You Get Pregnant in Menopause? No, women in menopause cannot get pregnant. After menopause, you do not produce eggs, and you can't get pregnant in a natural way. However, you might still get pregnant with the help of fresh or frozen donor eggs, or your previously frozen eggs.
Is 47 too early for menopause? ›Menopause can happen in your 40s or 50s, but the average age is 51 in the United States. Menopause is a natural biological process.
Why do breasts get bigger in menopause? ›The breasts can enlarge after menopause due to the hormone oestrogen levels going down. When the breasts go through an " involution " process, the milk glands shut down, and the tissue is replaced with fat.
What vitamins delay menopause? ›Higher daily intake of both vitamin B6 and zinc was similarly linked to delayed menopause. But complicating the matter, the investigators also found that vegetarian women experienced menopause about a year earlier than meat-eaters.
What vitamins are good for menopause? ›B vitamins are essential for energy and mood—“two things a lot of menopausal women struggle with,” says Dr. Petrucci. She suggests a B complex supplement, which often includes vitamin B12, methylcobalamin, folic acid and 5-methyltetrahydrofolate.
What vitamin gets rid of hot flashes? ›Vitamin E. Taking a vitamin E supplement might offer some relief from mild hot flashes. In high doses, it can increase your risk of bleeding.
What deficiency causes menopause? ›Any woman, at any age, can encounter a Vitamin B12 deficiency. There are certain groups of women, however, at increased risk of Vitamin B12 deficiency, including: Menopausal and postmenopausal women: The hormonal imbalances that occur during and after menopause can lead to Vitamin B12 deficiency in women.
What is the average weight gain during menopause? ›On average, women gain 5-8% of their baseline body weight during this time,” she says. For the sake of simple math, this means if you weigh 100 pounds, on average you will gain five pounds in the two years after your final period. If you weigh 200 pounds, you are expected to gain at least 10 pounds.
What are the 2 most common symptoms during the first 3 years of menopause? ›
Menopause is a natural and normal part of the aging process. Once you're in menopause, you've gone 12 months without a menstrual period. It's common to experience symptoms like vaginal dryness and hot flashes.
How do you feel with low estrogen levels? ›- Dry skin.
- Tender breasts.
- Weak or brittle bones.
- Trouble concentrating.
- Moodiness and irritability.
- Vaginal dryness or atrophy.
- Hot flashes and night sweats.
- Irregular periods or no periods (amenorrhea).
Perimenopause, also called the menopausal transition, describes the months or years leading up to menopause, when the body goes through vast changes. This transition can be more difficult for some than menopause due to dramatic fluctuations in reproductive hormone levels.
Why am I still having my period at 54? ›Usually beginning in the mid-40s, women enter a phase called perimenopause. During this phase, hormone levels and the menstrual cycle begin to change. Perimenopause may last from ages 45 to 55, although the timing varies from person to person.
Can you get menopause at 30? ›Premature menopause, or premature ovarian insufficiency (POI), is defined as being menopause that happens before the age of 40. Premature menopause is estimated to affect 1% of women under the age of 40 years and 0.1% of women under the age of 30 years.
Can you get menopause at 14? ›Primary ovarian insufficiency (POI), also known as primary ovarian failure or premature menopause, is a rare condition that affects teenagers and young women under the age of 40 years. Patients with this condition will have menstrual periods less often, or will not have menstrual periods at all for four months or more.
Can you start perimenopause at 35? ›Women start perimenopause at different ages. You may notice signs of progression toward menopause, such as menstrual irregularity, sometime in your 40s. But some women notice changes as early as their mid-30s.
Can you get perimenopause at 32? ›How early can perimenopause start? It's quite possible for women to start to notice things changing in their mid-30s. Most women arrive at menopause between the ages of 45 and 55, but perimenopause can start as much as a decade beforehand. And about 1% of women in the U.S. reach menopause at age 40 or younger.
What is the average age of natural menopause? ›It's diagnosed after you've gone 12 months without a menstrual period. Menopause can happen in your 40s or 50s, but the average age is 51 in the United States.
What are the symptoms of low estrogen? ›- Dry skin.
- Tender breasts.
- Weak or brittle bones.
- Trouble concentrating.
- Moodiness and irritability.
- Vaginal dryness or atrophy.
- Hot flashes and night sweats.
- Irregular periods or no periods (amenorrhea).
Can you reverse early menopause? ›
Is reversal really possible? Emerging research suggests that it could be, at least temporarily. Scientists are looking at two potential treatments, melatonin therapy and ovarian rejuvenation. Each therapy aims to reduce the symptoms of menopause and revive natural ovulation.
Is early menopause serious? ›Premature or early menopause is associated with numerous adverse health outcomes including cognitive impairment, dementia, parkinsonism, glaucoma, CHD, osteoporosis, mood disorders, sexual dysfunction, and increased overall mortality.
Can I get pregnant during menopause? ›Can You Get Pregnant in Menopause? No, women in menopause cannot get pregnant. After menopause, you do not produce eggs, and you can't get pregnant in a natural way. However, you might still get pregnant with the help of fresh or frozen donor eggs, or your previously frozen eggs.
Can stress cause early menopause? ›Excessive stress, which leads to elevation of stress hormones, can also negatively affect reproductive ability, including by accelerating menopause.
Can you still have periods at 53? ›Any woman still experiencing a menstrual cycle in her late 50s and 60s should see a doctor. However, it's important to note that each woman's reproductive system is different. Just as each young woman starts menstruating at a different age, menopause comes at a different age for each woman.
What vitamins are good for perimenopause? ›- Phytoestrogens. ...
- Calcium. ...
- Dehydroepiandrosterone (DHEA) ...
- Vitamin D. ...
- Bioidentical hormones. ...
- Vitamin E. ...
- B vitamins. ...
- Omega-3s.
During perimenopause, the hormonal fluctuations are more dramatic. It is also common for breasts to get bigger or smaller or to change in shape during this period.
Does early menopause run in families? ›“Menopause is strongly genetically linked, so you're very likely to fall within a few years either way of the age your mother was at menopause,” says Nanette Santoro, MD, director of the division of reproductive endocrinology and infertility at the University of Colorado-Denver School of Medicine.