Women experiencing prolonged perimenopause often wish they had recognized the symptoms earlier, experts say, as the transition can begin in the 30s and last a decade or more. Fiona Byrne, now 49, first noticed changes in her late 30s—cystic acne at 32, brittle nails, dizziness, and itchy skin—followed by night sweats and dry hair in her 40s. “It had been years and years of weird stuff before I had any clue that it was hormone-related,” she said.
Perimenopause Can Start Decades Earlier Than Expected
Most women assume perimenopause begins in their late 40s, but newer research indicates symptoms often start much earlier. Mariya Rozenfeld, DO, an ob-gyn and Menopause Society Certified Practitioner at NYU Langone, explains that perimenopause is marked by hormone fluctuations that can begin as early as the 30s. A 2025 study published in NPJ Women’s Health on 4,400 American women ages 30 and older found that roughly 55 percent of women 30 to 35 reported perimenopause symptoms that met the criteria for “moderate” or “severe” based on the Menopause Rating Scale. That number rose to just over 64 percent for women 36 to 40 years old.
“If you think about when perimenopause symptoms really start and when they might start to wane, for most people, that probably takes about 10 years,” says Rajita Patil, MD, MSCP, an ob-gyn and director of the Comprehensive Menopause Program at UCLA. In other words, long-term symptoms are more common than many realize. Yet most women didn’t seek treatment until they were 56 or older, according to the report.
Mood and Sleep Changes Often Go Unnoticed
Early signs of perimenopause can include disrupted sleep, irritability, and intensified PMS, symptoms often dismissed as stress or life phase changes. Dr. Patil notes that women may experience anxiety or mood shifts before noticing menstrual irregularities. “Those rapid hormonal shifts can oftentimes throw the neurotransmitters in the brain off that regulate mood,” she explains.
Emma Peterson, 39, described feeling “like a 14-year-old boy” in her mid-30s due to severe PMS, ovulation pain, and constant restlessness. Laura Standard, now 60, experienced migraines so debilitating she had to isolate herself in a dark room, missing work for eight years. “One of the worst things for me was bone-crushing fatigue: I felt like someone was pushing an anvil on my head as I was walking around,” she recalled.
Lifestyle Adjustments and Treatment Options
Dr. Patil emphasizes that maintaining 150 minutes of weekly exercise, avoiding smoking and alcohol, and prioritizing social connections can mitigate symptoms. “The magic recipe to healthy aging is really in how we live our life: it’s what we eat, how we move, how we sleep, what we employ for stress reduction,” she says.
For many, hormone replacement therapy (HRT) offers significant relief. Wendy Wiseberg, 55, initially avoided HRT due to fears of breast cancer and heart risks, which she says were overstated in outdated studies. After learning that the FDA removed the black box warning in 2024, Wendy began treatment. She says had she known about HRT and its relative low risk of cancer, she might have been open to trying it, or other medications for her symptoms, sooner.
Finding the Right Care: The Role of Trained Specialists
The Menopause Society offers a certification for physicians who specialize in menopause care, providing a gold standard for training. Patients can use their online search tool to locate certified specialists in their area or access telehealth providers. This resource helps women connect with doctors who understand the complexities of hormonal transitions and can provide individualized treatment plans.
Many women face challenges when seeking care, as general practitioners often lack the necessary expertise. Byrne, after encountering resistance from her ob-gyn, sought out a specialist who validated her concerns. “There’s no one way that women go through this transition,” says Susan Loeb-Zeitlin, MD. A trained menopause provider can offer the personalized care needed to address symptoms effectively.
