Perimenopause age: when does it start, and how early?
Short answer: For most women perimenopause starts in the mid 40s, a few years before the final period. Menopause itself usually happens between 45 and 55, at around 51 on average. Starting in your early 40s is not unusual, and the late 30s happens but is less common. About 1 in 100 women reach menopause before 40, and symptoms at that age are always a reason to see a doctor.
What age does perimenopause start?
Perimenopause is the stage when your hormones begin to fluctuate and your cycle changes, and it runs until one year after your final period. There is no fixed starting age. This is what the official sources say:
- NHS: menopause and perimenopause usually affect women between 45 and 55, but can happen earlier.
- WHO: natural menopause generally occurs between 45 and 55 worldwide, and perimenopause can last several years.
- Dutch GP guidance (Thuisarts): the transition can begin anywhere between 40 and 60, with the final period at 51 on average.
Count back from that average of 51 and the first changes land in the second half of the 40s for most women. The early 40s are common enough. The late 30s are possible but less likely. More on that in perimenopause in your 30s.
What is normal at each age?
| Age | How common | What to do |
|---|---|---|
| Under 40 | About 1 in 100 women reach menopause this early | Always see a doctor, who can order blood tests |
| 40 to 45 | Possible, on the early side | Track symptoms and cycle, see a doctor if unsure. Periods stopping before 45 is what the NHS calls early menopause |
| 45 to 55 | The usual age | A doctor usually identifies it from your symptoms and cycle, without a blood test |
| Over 55 | Less common, but possible up to 60 | Any bleeding after a year without periods should always be checked |
What are the first signs of perimenopause?
The first thing most women notice is their cycle. It gets shorter or longer, periods turn heavier or lighter, and now and then a month is skipped. The NHS and Thuisarts also list:
- hot flushes and night sweats
- poorer sleep
- mood swings, low mood or irritability
- vaginal dryness
- trouble concentrating
Not every woman gets all of these, and many of them can have another cause. The full list is in all perimenopause symptoms at a glance. For how the two stages differ, read perimenopause or menopause.
What makes perimenopause start earlier?
Often there is no clear cause. The NHS and Thuisarts do name factors that raise the chance of an early menopause:
- Family: early menopause is more likely if it runs in your family. It is worth asking your mother or sister when theirs began.
- Smoking.
- Being underweight or having started your periods early.
- Chemotherapy or radiotherapy.
- Surgery to remove the ovaries. Menopause then starts straight away.
- Certain conditions, such as Addison's disease.
How long does perimenopause last?
Several years, and it varies a lot from woman to woman. The US National Institute on Aging puts the whole menopausal transition at about seven years on average, and up to fourteen. Perimenopause ends one year after your final period. Thuisarts notes that for most women symptoms ease around five years after that final period.
Can you still get pregnant in perimenopause?
Yes. Ovulation becomes less regular but still happens. The WHO recommends contraception until you have gone twelve months in a row without a period, if you do not want to become pregnant.
When should you see a doctor?
Make an appointment if:
- you have menopause symptoms and are under 40
- your periods are very heavy
- you bleed again after more than a year without periods
- hot flushes or other symptoms are getting in the way of daily life
No test can say for certain that you are in perimenopause. Under the NICE guideline, doctors usually identify it in women over 45 from symptoms and cycle changes. Under 45, a blood test can sometimes help. So what you track counts. In PERIOD. you choose perimenopause in your profile and log your cycle and symptoms, so you can bring a few months of history with you. The app logs and shows, a doctor diagnoses. Here is how to prepare: your GP appointment about menopause. More about this stage is on our menopause page.
Sources: NHS, Menopause and Early menopause; WHO, Menopause fact sheet; NICE NG23, Menopause: identification and management; National Institute on Aging, What is menopause; Thuisarts.nl (Dutch College of General Practitioners), Ik ben in de overgang. This article is general information, not medical advice.
Frequently asked questions
Can perimenopause start at 35?
It can, but it is rare. About 1 in 100 women reach menopause before 40. If you are under 40 and have symptoms such as missed periods or hot flushes, see your doctor. There may be other causes too.
What is the average age for perimenopause?
The final period comes at around 51 on average, and usually between 45 and 55. The years before it, when your cycle changes and symptoms can begin, start in the mid 40s for most women.
How do I know if I am in perimenopause?
The main clue is a changing cycle together with symptoms such as hot flushes or poor sleep. A doctor makes the call. Over 45 that usually happens without a blood test, based on what you describe and track.
Will I start menopause at the same age as my mother?
Not exactly, but there is a link. The NHS says early menopause is more likely if it runs in your family. Your mother's or sister's age is a useful clue, not a prediction.
Want your cycle and symptoms in one overview? Download PERIOD. on the App Store or Google Play.
