Why It Matters to Know Early
There are important psychological and physical reasons to recognize perimenopause early.
The most immediate reason is psychological. When a woman experiences these changes without a framework for them, she does not simply endure the symptoms. She searches for a cause, and when none is offered, she often locates it in herself: her coping, her character, her marriage. In my experience, the women who suffer most emotionally in this transition are often those who do not know which changes in their bodies are normal. As I wrote in the book, The Fifth Decade, “it helps significantly to be able to put a name and a reason to the chaos.” Recognizing the transition early does not make the symptoms disappear, but it changes her relationship to them. What felt like a confusing concern becomes a physiological process with a name, a course, and an end.
There is a physical reason as well. The years surrounding menopause are a period of accelerated change in the body. As estrogen declines, age-related bone loss speeds up; on average, a woman can lose up to 10 percent of her bone mass in the first five years after menopause. Muscle mass declines with age, and the hormonal shifts of this period can alter how weight is distributed, often toward the abdomen. A woman who understands at forty what is ahead has a decade in which to build the foundations that will serve her on the other side.
Finally, there is the matter of being heard. It is critically important that women be given clear information about the stages of menopause, its common symptoms, the lifestyle changes that can help, and the benefits and risks of available treatments. I would add only that this conversation should begin earlier than it usually does.
What to Do With This Knowledge
If you are in your late thirties or forties and something in this description feels familiar, there are a few places to begin.
Notice the pattern. Keep a simple record of your cycle, your sleep, and your mood over two or three months. Patterns that are invisible day to day often become clear on paper, and that record will be valuable to any clinician you see.
Bring it to your providers by name. Ask directly whether perimenopause might be part of what you are experiencing. A gynecologist can evaluate the physiological picture. Thyroid function is worth checking, since its symptoms overlap considerably with those of this transition. If your emotional experience has changed, a psychologist can help you make sense of it in context.
Tend to the foundations. Honor your body’s increased need for sleep, even if that means a daytime nap. Regular physical activity, including strength training at least twice a week and practices that support balance, helps protect bone and muscle and supports mood. Adequate calcium, vitamin D, magnesium, and protein from a well-rounded diet matter more in these years than they did before. Some women find that alcohol, caffeine, or spicy foods make sleep or hot flashes worse, and that reducing them helps.
Consider mind-body practices. Yoga has been found helpful for perimenopause-related anxiety and low mood, and mindfulness-based practices have a solid record for improving anxiety, stress, and sleep quality in other populations. Neither is a cure, but both can offer steadiness during an unsteady time.
Not Too Early, Simply Early
When I talk with a woman of forty about perimenopause, I am not handing her a diagnosis or a forecast of decline. I am offering her a frame, one that may make sense of experiences she has been quietly struggling to explain. And I am offering her a destination. The final stage of this transition, which I call Quietude, is an endpoint every woman can anticipate with relief and even joy. We exit this passage, as I wrote in my book, The Fifth Decade, not as “old” but as reinvented.
Forty is not too early to have this conversation. It is, for many women, exactly the right time.
Continue the conversation
For more reflections on life's transitions, emotional well-being, and navigating change, follow Managing Life's Transitions, my newsletter on Substack.
