Menopause Symptoms Can Begin in Your 40s – Or Even Earlier

A variety of hormone-related changes are experienced by women over a lifetime, starting with puberty and the onset of periods through the effects of pregnancy and childbirth. There are multiple sources of information to prepare patients for these physical and psychological journeys integrated into both educational settings and routine healthcare. Not so much for the transition to menopause.

Many people associate menopause with old age, hot flashes, and moodiness. But there is much more to know about the path to menopause, including that symptoms can start as early as your late 30s and frequently in your early 40s.

The Stages and Ages of Menopause

Perimenopause is when your body starts to make the natural transition to menopause. It can last for several years, and some people are still having regular periods even as they begin to undergo changes.

Menopause is technically the final menstrual period, when menstrual cycles cease. This typically occurs between your mid-40s to mid-50s. According to the North American Menopause Society (NAMS), the average age for menopause is 51. However, the word “menopause” is often used to refer to the several-year period as one transitions from regular periods to none and for a period of time thereafter.

Postmenopause refers to the years after 12 consecutive months without a period.

What Should I Expect?

The menopausal transition is different for each of us. While some experience their perimenopausal and postmenopausal years with no symptoms, others notice hormone-related physical and mental changes that can interfere with day-to-day living.

Although there are no reliable tests to determine where you are in your menopause journey or when you will have your final menstrual period, perimenopause typically starts in one’s early 40s. One of the first symptoms is menstrual changes. Periods often start coming closer together. That is, cycles start shortening. So instead of 28 days, a cycle could be 26 days. The amount of bleeding may change too (heavier or lighter), and bleeding may last for more or fewer days than before.

Other symptoms of perimenopause are variable and range in intensity from person to person. Possible symptoms that could be related to hormones during perimenopause include the following:

• Hot flashes and night sweats
• Sleep disturbances, including waking and not being able to go back to sleep
• Weight gain
• Fatigue
• Vaginal dryness
• Decrease in libido (sex drive)
• Mood swings, including irritability, anger, or rage
• Brain fog
• Anxiety/panic attacks
• Heart palpitations
• Depression
• Dry skin/loss of elasticity
• Joint pain
• Urine incontinence
• Headaches
• Feeling a loss of the “old me” or “not feeling like myself”

If you start to experience any of the symptoms above, regardless of your age, it’s worth a discussion with your healthcare provider. Keeping track of your periods and symptoms will be helpful in sorting them out. Either grab a notebook or find an app and track what you’re experiencing, its severity, when it happens, and how often. This will help your provider rule out other medical concerns and help determine if your symptoms are related to the menopausal transition.

Symptom Management

Menopause is not an illness but rather a normal life transition. There is no universal treatment, but there are options to help manage symptoms.

Along with your PCP and OB/GYN, the Atrius Health Menopause Consultation Service is available to help Atrius Health patients understand current information about menopause and assist them in making informed choices about lifestyle, self-care, and available treatments as they navigate this life stage. Talk to your provider and get a referral if you think you need it.

The bottom line is that you are not alone, your symptoms are usually normal and temporary, and there is help.

Preparing for Menopause

You can’t stop menopause from happening, and the best advice I have is to ensure that you are in the best health before you start the menopause transition.

• Consume a healthy diet. Eat whole foods, including fruits, vegetables, whole grains, lean protein, and healthy fats. Your metabolism changes, and weight gain can creep up on you slowly if you’re not paying attention.
• Regular sessions of moderate aerobic activity at least three times a week and strength training twice weekly are good for both your physical and mental state. As women age, they lose muscle mass, so weight-bearing exercise is especially important to keep your body as strong as possible.
• Getting adequate sleep. Sleep is essential to allow your mind and body to repair and renew. Getting enough sleep can lower your risk for many health problems, reduce your stress, and help you maintain a healthy weight. Sometimes getting enough sleep requires a special commitment such as giving up the quiet late evening hours to go to bed.
• Stress management and self-care. Chronic stress can damage your health and increase your risk for health-related issues (sleep, anxiety, high blood pressure, high blood sugar, heart disease, obesity, depression – the list goes on). Know your limits and know when to say “no.” Taking time to care for yourself is crucial. If you’re having trouble managing your stress levels, talk to your provider or a therapist so they can help you develop a plan.
• Quit smoking. Smoking is the leading cause of preventable death in the United States. Smoking causes cancer, heart disease, stroke, lung diseases, and diabetes. Smoking can also increase the risk of early menopause.
• Get regular checkups and screenings. Optimizing your health as you enter this phase of your life is important. As women age, their risk for breast cancer, osteoporosis, and cardiovascular disease increase. Understanding your personal risk profile can help you find the best path forward.
• Seek support from friends and relatives. Everyone goes through menopause, albeit differently, and you shouldn’t feel embarrassed about it. It can be helpful to have an open discussion and ask questions. Some find online support valuable.

Looking on the Bright Side

I don’t want only negative symptoms and experiences to be associated with menopause. The transition can be liberating! Once you’re postmenopausal, there are no periods, no concerns about pregnancy, no cramps, and no need for menstrual products. It is important to note that while you no longer have to be concerned about getting pregnant, you still need to protect yourself from sexually transmitted infections. Many people find that as they age, they gain confidence and begin to focus on themselves for the first time in a long time.

Resources

Books
Mayo Clinic The Menopause Solution by Stephanie Faubion
The Menopause Manifesto by Dr. Jen Gunter

Websites
The North American Menopause Society (NAMS), www.menopause.org
Women Living Better, www.womenlivingbetter.org

About Dr. Marcie Richardson

Dr. Marcie Richardson joined Atrius Health in 1988. She is a board certified obstetrician and gynecologist and practices at Harvard Vanguard Copley. She is also part of our Menopause Consultation Services team and offers personal consultations for women about menopause. Dr. Richardson completed her internship at Cambridge Hospital and her residency at Beth Israel Deaconess Medical Center. Her clinical interests include menopause, breastfeeding, and women’s health education.

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