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Can Perimenopause Start in Your Thirties?

Learn about the signs and symptoms of early perimenopause that can start in a woman’s thirties.
Can Perimenopause Start in Your Thirties?
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You’re in your thirties, and for some reason, your periods have become irregular. Maybe your PMS has gotten significantly worse. Or you frequently wake up in the middle of the night, feeling overheated. You’re feeling more tired and moody than usual. What is going on? You may say, “I’m too young for ‘menopause,’ right?” Or, “Menopause is at least ten years away, isn’t it?” 

There’s a lot of confusion around the term “menopause.” What we commonly think of as menopausal symptoms are actually the symptoms of perimenopause – the time before our periods stop. Perimenopause usually starts in a woman’s late 40s or early 50s. But -- surprise! – in some cases, perimenopause can begin much earlier, in a woman’s 30s. This early onset can bring about a range of physical and emotional changes, prompting questions and concerns about fertility, health, and overall well-being. This article will explore early perimenopause, its signs and symptoms, and how to navigate this phase of life with vitality and good health.

Understanding perimenopause

Perimenopause is the transitional time leading up to menopause, which is the point when it’s been a whole year without a menstrual period. During perimenopause, hormone levels –particularly estrogen and progesterone – fluctuate irregularly, leading to a variety of physical and emotional symptoms. These symptoms can vary widely from woman to woman and may include hot flashes, night sweats, irregular periods, mood swings, fatigue, and changes in libido.

On average, women start perimenopause at age 47 and stop menstruating around age 50, putting the average age of menopause at 51. However, some women are discovering that perimenopause can actually start much earlier (and last longer!) Women in their 30s may not even realize that their symptoms are signs of what’s known as “early perimenopause,” and this situation can catch you off guard, leading to confusion and uncertainty about what you’re experiencing.

Early perimenopause prevalence and risk factors

In general, some studies suggest that as many as 11 to 12% of women will begin perimenopause before the age of 41.

Some risk factors for early perimenopause include:

  • Cigarette smoking
  • Taller height
  • Longer use of hormonal contraceptives, like the birth control pill

Other studies report that you’re also at increased risk of early perimenopause if:

  • your mother smoked during her pregnancy
  • you were breastfed for one month or less
  • you don’t get regular exercise
  • you have had cancer treatment
  • you have autoimmune disorders, including Hashimoto’s thyroiditis

Signs and symptoms of early perimenopause

The signs and symptoms of early perimenopause are similar to those experienced during the traditional perimenopausal period.

Irregular menstrual cycle

One of the hallmark signs of perimenopause is an irregular menstrual cycle. While irregular periods are common during perimenopause, they can be particularly pronounced in women experiencing early perimenopause. In the first stage of early perimenopause, you may notice that your period comes earlier than usual. For example, if you have a 28-day cycle, it may change to a 25- or 21-day cycle -- or even less. Over time, you may notice that your cycle becomes longer, and cycles may be 32, 35, or even 40 days. You can also have an erratic cycle, where periods come early or late, some last two days, some five days, and some seven or more days, and you may skip some periods entirely.

You may also notice that your PMS symptoms worsen or improve during this time. You may also fluctuate between heavy and lighter flow and see a color change or increased clots in your menstrual blood.

Difficulty conceiving

An irregular menstrual cycle can make it challenging to predict ovulation and may impact your fertility if you’re trying to conceive.

Other symptoms of early perimenopause

You may also experience physical symptoms like hot flashes, night sweats, vaginal dryness, fatigue, and low libido. There are also some other surprising symptoms of perimenopause discussed here on the Paloma blog.

In addition to physical symptoms, early perimenopause can also bring about emotional changes. Mood swings, irritability, anxiety, and depression are common during this time as hormone levels fluctuate. These emotional symptoms can be incredibly challenging for women in their 30s who are often juggling career, family, and other responsibilities.

For additional information, read our Paloma blog post on the Signs You’re in Perimenopause.

Impact of early perimenopause

The early onset of perimenopause can have an impact on your health and well-being. One concern is the impact on your fertility. While you are still technically capable of conceiving during perimenopause, fertility declines as hormone levels fluctuate and ovulation becomes less predictable. If you’re considering starting or expanding your family, early perimenopause may prompt you to make decisions about fertility preservation (like egg harvesting) or alternative family-building options.

Another consideration is the potential long-term health effects of early perimenopause. Research suggests that women who experience early menopause may have a higher risk of certain health conditions, including heart disease, osteoporosis, and cognitive decline. These risks highlight the importance of proactive health management and preventive care for women entering perimenopause at a younger age.

Treatments for early perimenopause

In some women, the symptoms of early perimenopause are bothersome or debilitating enough to warrant medical treatment. Prescription treatments include:

  • Estrogen and estrogen/progesterone therapy: This involves taking low doses of estrogen to help stabilize hormone levels and relieve symptoms like hot flashes, night sweats, vaginal dryness, and mood changes. Estrogen can be taken transdermally (patches, gels), vaginally, or orally. For women with a uterus, estrogen is usually combined with progesterone to protect against endometrial cancer. This is often given as a capsule or patch. (Paloma’s practitioners who manage perimenopause typically recommend bioidentical hormones for best results and safety.
  • Low-dose birth control pills: These can help regulate menstrual cycles and hormone levels during early perimenopause.
  • Antidepressants: Low doses of certain antidepressants like paroxetine (Paxil) or venlafaxine (Effexor) may help reduce hot flashes and night sweats in some women
  • Gabapentin (Neurontin): This anti-seizure medication can relieve hot flashes when taken off-label.
  • Clonidine (Catapres): This blood pressure medication may be prescribed off-label to reduce hot flash frequency and severity.

Supplements for early perimenopause

Some women find that supplements can help relieve some of their perimenopausal symptoms. These supplements include maca, melatonin, black cohosh, red clover, soy, and evening primrose oil. You can find a more detailed discussion of these supplements in Paloma’s article, Natural Treatments for Perimenopause and Menopause.

Lifestyle changes for early perimenopause

Making specific lifestyle changes can help ease perimenopausal symptoms and improve overall health. Here are some ideas to consider.

Diet and nutrition

  • Healthy eating: A balanced diet rich in nutrients is crucial during perimenopause. Incorporate plenty of vegetables, fruits, whole grains, legumes, nuts, seeds, fish, and lean meats into your meals. These foods provide essential vitamins, minerals, and fiber that support overall health and help manage symptoms like weight gain and mood swings.
  • Protein and omega-3 fatty acids: Lean protein is essential for maintaining muscle mass and managing weight. Aim for 20-30 grams of protein per meal, which can come from sources like lean meat, poultry, fish, yogurt, eggs, or beans. Omega-3 fatty acids, found in fish like salmon and mackerel, can help reduce inflammation and support heart health, which is particularly important as estrogen levels decline.
  • Calcium and vitamin D: Bone health becomes a concern during perimenopause due to decreasing estrogen levels. Ensure adequate intake of calcium and vitamin D to support bone density. Good sources of calcium include dairy products, leafy greens, and fortified foods. If necessary, vitamin D can be obtained from sunlight exposure, fortified foods, and supplements.
  • Avoid certain foods: Limit the intake of alcohol, caffeine, and sugary or ultra-processed foods, as these can exacerbate symptoms like hot flashes and mood swings. Reducing spicy foods and caffeine can also help manage hot flashes and night sweats.
## 5-day meal plan


  • Functional strength training: Engage in functional strength training with heavy weights to build muscle mass and improve overall strength. This type of exercise helps counteract the muscle loss that occurs during perimenopause and supports daily activities.
  • Cardiovascular exercise: Incorporate cardio exercises that you enjoy and that do not overly stress your body. Activities like walking, swimming, or cycling can improve cardiovascular health without increasing cortisol levels, which can worsen perimenopausal symptoms.
  • Mindfulness and relaxation: Combine exercise with mindfulness practices to reduce stress. Activities like yoga, tai chi, or even mindful walking can help manage stress levels and improve mental well-being.

Sleep and rest

  • Sleep hygiene: Maintaining good sleep hygiene is essential. Establish a regular sleep routine, keep your bedroom cool, and avoid screens before bedtime. If hot flashes or night sweats disrupt your sleep, consider using a fan, taking a cool shower before bed, or wearing light clothing.
  • Rest and relaxation: Ensure you get plenty of rest and engage in relaxing activities. This can help manage mood swings, anxiety, and overall stress levels.

Mental well-being

  • Social support: Talking to friends, family, or colleagues who are going through similar experiences can provide emotional support. Sharing experiences and coping strategies can be very helpful.
  • Therapy: Cognitive behavioral therapy (CBT) can also be beneficial for managing low mood and anxiety.

Avoid harmful habits

  • Quit smoking: Smoking can worsen hot flashes and increase the risk of osteoporosis and cardiovascular disease. Quitting smoking is one of the most beneficial changes you can make for your health during perimenopause.
  • Limit alcohol: Reduce alcohol consumption to within recommended limits to avoid exacerbating symptoms like hot flashes and mood swings.

Monitor your health

It’s also important to have regular check-ups with your healthcare provider to monitor overall health and address any concerns that may arise during perimenopause. Screening for conditions such as heart disease, osteoporosis, and breast cancer may be recommended based on individual risk factors.

* * *

By making these lifestyle changes, you can better manage the symptoms of perimenopause and support your overall health during this transitional phase. Each woman’s experience with perimenopause is unique, so it may be necessary to tailor these recommendations to your specific needs and circumstances.

For additional ideas, we recommend reviewing these 8 Healthy Habits for an Easier Perimenopause.

A note from Paloma

The onset of perimenopause in one’s 30s can be surprising and challenging, but it’s important to remember that every woman’s experience is unique. By educating yourself, prioritizing self-care, seeking support, considering treatment options, and monitoring your health, you can navigate early perimenopause with confidence and resilience. While the journey through perimenopause may have its ups and downs, it can also be a time of growth, self-discovery, and empowerment as you enter in the next chapter of your life.

Paloma Health members can access specialized care for perimenopause and menopause in addition to hypothyroidism. Consider scheduling a free intake call to learn more about how Paloma Health can support your hormonal health at every stage of life!

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Vatankhah H, Khalili P, Vatanparast M, Ayoobi F, Esmaeili-Nadimi A, Jamali Z. Prevalence of early and late menopause and its determinants in Rafsanjan cohort study. Scientific Reports. 2023;13(1):1847. doi:

Premature and Early Menopause: Causes, Diagnosis, and Treatment. Cleveland Clinic. Published September 6, 2022.

Johns Hopkins Medicine. Perimenopause.

Mayo Clinic. Perimenopause - Symptoms and causes. Mayo Clinic. Published May 25, 2023.

Menopause Can Start Younger Than You Think: Here’s What You Need To Know. NPR. Published January 18, 2020.

Mayo Clinic. Perimenopause - Symptoms and causes. Mayo Clinic. Published May 25, 2023.

I’m in My Late 30s With Menopausal Symptoms: Is That Possible?: Inga Zilberstein, MD: Gynecology. Accessed May 25, 2024.

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Mary Shomon

Patient Advocate

Mary Shomon is an internationally-recognized writer, award-winning patient advocate, health coach, and activist, and the New York Times bestselling author of 15 books on health and wellness, including the Thyroid Diet Revolution and Living Well With Hypothyroidism. On social media, Mary empowers and informs a community of more than a quarter million patients who have thyroid and hormonal health challenges.

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