It's Not Only Normal To Enter Perimenopause In Your 30s—It May Be More Common Than Even Doctors Realized

Yahoo

17-07-2025

Welcome to the Perimenopause Playbook—your guide to navigating the most overlooked and misunderstood phase of the menopausal transition. Read the rest of the stories, from how to get a diagnosis to treatment options to where to actually find good care, here.
Lindsay Welch knew something was up when she began waking in the middle of the night sweating, her body radiating a heat that made zero sense in San Francisco's chilly climate. The problem followed the 36-year-old when she moved to Austin, where her overheated body continued to fight sleep despite the constant blast of the air conditioner.
Throughout the day, her mind felt foggy, as if a thick cloud cover were obscuring her thoughts. She gained about 20 pounds in six months; meanwhile, her libido fell off a cliff. But what really drove her over the edge was her strangest symptom yet: a persistent itchiness in her ears. What started as an uncomfortable dryness progressed into an itch so strong that she fantasized about taking a wire brush to her ear canal. 'It was insane,' says Welch, who's now 41. 'There was no Q-tip strong enough.'
Again and again she described her symptoms to a variety of health care providers—general practitioners, ob-gyns. Maybe she just drank too much coffee, some of them suggested. Maybe she was depressed, others said.
Meanwhile, her symptoms intensified, like the volume on a stereo being turned up louder and louder until it's impossible to ignore. At one point, she felt so low that she didn't even want to get dressed in the morning. 'You start to just be like, Well, maybe I really am depressed,' she says. 'There was a gray filter on everything.'
Years passed this way, until she was 40 years old. As she continued to search for answers, she began receiving content on Instagram and TikTok about perimenopause. For Welch, the term was new, but the symptoms were all too familiar. She watched as her peers described what they were going through, and she thought, I have that, I have that, she says. 'And it was just like, I'm not crazy.' She made an appointment at Midi Health, a telehealth clinic specializing in perimenopause and menopause care. There, the clinician confirmed that Welch was in perimenopause. 'I just felt like a weight lifted off my shoulders,' she says. 'Somebody actually listened to me.'
Today, Welch and millions of other millennial women are already in or entering perimenopause, an often overlooked phase of the menopausal transition. (Lately, some have attempted to rebrand this stage as 'Millenopause'; the less said about this new term, the better.) During perimenopause, the ovaries gradually produce less estrogen and progesterone, causing a fluctuation in hormones. This hormonal roller coaster is associated with, deep breath, 60 symptoms, including but not limited to hot flashes, night sweats, vaginal dryness, recurrent UTIs, depression, anxiety, heart palpitations, insomnia, and, yes, itchy ears, as Welch experienced. Though some lucky women may not experience any symptoms at all.
And while a cohort of millennials may think they're too young for perimenopause, new evidence suggests a surprising number of women in their 30s are in this stage now. In a recent study of 4,500 women in the U.S., more than a quarter of 30- to 35-year-old respondents had been told by a medical professional that they were perimenopausal. More than half of them reported experiencing moderate to severe symptoms, including hot flashes. Hot flashes and night sweats can actually start 11 years before your final period and can last up to 14 years total. Yet when you ask 30-year-old women at what age they expect to experience menopause-related symptoms, most will tell you the effects won't hit until they're 50.
That's probably because young women have no clue that a whole phase before menopause even exists, let alone that it could begin in their 30s. Scroll through the r/Perimenopause subreddit and you'll find 66,000 Reddit users trading stories about odd symptoms they're experiencing and the seemingly endless search for a diagnosis. 'About to turn 39 and having some 'changes.' Is this perimenopause?' writes one user. Another: 'Started peri at 32. How to make people believe me?' And another: 'It all happened so quickly.'
All of which raises a larger question: Are we heading toward menopause earlier than our mothers and grandmothers did, or have women started the menopausal transition this young all along?
If perimenopause is easily misunderstood, that's in part because the language of menopause itself is confusing. Although menopause is often spoken about as if it were a phase of life, 'menopause refers to the time when ovulation has ceased 12 consecutive months prior,' says Samantha M. Dunham, MD, an ob-gyn and codirector of the Center for Midlife Health and Menopause at NYU Langone. Perimenopause is the time leading up to and through menopause. Some women will experience this stage for only a couple of years, while others may linger in it for up to 10 years. After women have gone one full year without a period, they're in postmenopause for the rest of their lives.
In the United States, the average age of menopause is 52, which means perimenopause typically begins in the early to mid-40s. But this depends largely on race and ethnicity. Black, Asian, and Latina women tend to enter menopause earlier than white women, according to research—which would suggest, then, that these women experience perimenopause earlier too. 'Every person comes in with their unique genetic predisposition, their own health factors, and their own lifestyle practices,' says Rajita Patil, MD, an ob-gyn and the director of the Comprehensive Menopause Program at UCLA. 'It's not a cookie-cutter sort of situation at all.'
Since hormone levels are constantly fluctuating in perimenopause, there's no single blood test for diagnosis. Instead, health care practitioners rely on a series of questions about a patient's cycle and symptoms. 'I'm usually asking, number one, has there been a change in your periods, like timing, flow, or frequency?' says Tara Iyer, MD, medical director of the Menopause and Midlife Clinic at Brigham and Women's Hospital. 'And then I also discuss symptoms. Is there a change in symptoms that you've had, or a progression of symptoms?' If the patient answers yes and is in her late 30s to mid-40s, that usually indicates to Dr. Iyer that it's perimenopause.
She acknowledges that women can start to experience symptoms even before their cycle becomes irregular—due to hormonal shifts. Dr. Iyer cautions, however, that having symptoms associated with perimenopause doesn't necessarily mean you are in perimenopause. Joint stiffness and mood changes are hallmarks of perimenopause, but they are also symptoms of vitamin D deficiency. Hypothyroidism and perimenopause share many symptoms, including depression and changes to the menstrual cycle. Women with premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), which can be exacerbated as we age, may also mistake these symptoms for peri.
Due to the transparent volume of peri symptoms and a lack menopause education, women like Welch are often dismissed when seeking answers from their health care practitioners, including their own ob-gyns. Even though women make up half the population—and 1 billion globally are currently experiencing perimenopause or menopause—menopause education and training are practically nonexistent. 'There was no curriculum around menopause when I was going through med school and residency,' says Dr. Patil, who's been practicing for 20 years. 'This is not unique to my own experience.'
Dr. Patil is right. Ninety-three percent of graduating residents in internal medicine, family medicine, or obstetrics and gynecology do not feel comfortable managing menopause-related symptoms, per a 2019 study, likely because they received little to no education on menopause throughout their entire residency training. Even Mary Claire Haver, MD, a menopause influencer and New York Times bestselling author with over 2.9 million followers on Instagram, admitted she had previously 'missed things and dismissed things' due to a lack of training and education.
Now, physicians like Dr. Haver, Sharon Malone, MD, and Alicia Robbins, MD, are trying to fill the menopause education gaps online. Others, like Dr. Patil, Dr. Iyer, and Dr. Dunham, are making menopause care more accessible by establishing specialized programs for it. The Menopause Society, a leading authority on menopause, recently announced a $10 million comprehensive menopause training program that aims to reach 25,000 professionals within the next three years.
'I'm grateful it's getting so much attention,' Welch says. The conversation on social media was, after all, how she finally figured out an explanation for her many and varied symptoms. 'It's good that it's not these corny jokes about hot flashes anymore.'
Even with all the discourse around perimenopause, most experts won't go as far as to say that perimenopause is occurring at higher rates than usual in younger women. Rather, between a growing call for menopause education, millennials' track record of breaking taboos (see: mental health, postpartum depression, and infertility), and a little thing called the social media algorithm, we're simply hearing more stories about perimenopause. It's not only normal for some women in their 30s to enter perimenopause—it might be more common than we realized. 'Because doctors haven't been really addressing this properly, and the patients also haven't been more aware of what to look for until recently, there's a lot we're learning,' says Dr. Patil.
It's easy to spiral about all the possible symptoms associated with perimenopause, but Dr. Patil wants women to think of perimenopause as a window of opportunity. It's a time when we can evaluate our current health and optimize our bodies for the next part of our lives. 'We need to address the symptoms that are going on with you that affect your quality of life in the short term,' she says. 'But we also have to remember that natural estrogen is protective for the whole body. So when we lose that, it makes the organ systems more predisposed to chronic diseases.'
To prevent chronic disease, the goal is to address the cause by decreasing inflammation in the body. That means focusing on lifestyle interventions, such as eating a high-protein and fiber-rich whole foods diet, prioritizing strength training, eliminating smoking and alcohol intake, sleeping at least seven hours per night, and managing stress. It could also mean considering hormone therapy, which can be an effective treatment for symptoms like hot flashes, night sweats, and vaginal dryness, which may be contributing to inflammation.
The best course of treatment, if any, depends on your symptoms, how much they're impacting your life, and any risk factors you may have. Welch is currently on hormone therapy and a GLP-1, and the combination is working for her. 'I feel like I am able to be a more productive human, and probably a nicer human,' she says. Reflecting on her age and symptoms sometimes makes her think about her mom, who at 40 experienced weight fluctuation and mood changes, just like Welch.
Her mom may not have had the word to describe what was going on with her, but she emphasized to Welch the importance of speaking up for yourself. 'I just want women—and anybody, actually—to continue to advocate for themselves in the health care space,' Welch says. 'I'm so lucky I had a mom who had a take-no-prisoners approach. It really instilled that same attitude in me.'
This story appears in the Summer 2025 issue of Women's Health.
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