What age does perimenopause start and what can I expect?

If you’re in your late 30s or 40s and starting to feel… different, you’re not alone.

Perimenopause can be confusing, overwhelming, and even a little frightening at times. It’s not just about irregular cycles or hot flashes; it’s the sleep that suddenly eludes you, the anxiety that creeps in out of nowhere, and the way your body sometimes feels unfamiliar. This stage, where oestrogen and progesterone levels begin to dip and shift, is the start of a whole new chapter. But with the right knowledge, tools, and support, this journey can become one of strength and self-discovery.

The first steps: getting to know perimenopause

Perimenopause may feel like an enigma wrapped in a hormonal rollercoaster. But here’s the truth: it’s more common - and more varied - than you might think. Some of us may experience only subtle changes, while others feel as if our bodies and moods are on a daily carousel of surprises. During this time, establishing habits that support you - like a balanced, nutrient-rich diet, regular weight-bearing exercise, and time for self-care - can help you feel steady and strong.

And just as importantly, finding a clinician who listens, understands, and truly gets the nuances of perimenopause is invaluable. Not all doctors receive in-depth training on menopause, but those who do can make a world of difference in guiding you through.

Why perimenopause can feel so complex

If you’ve ever felt dismissed, second-guessed, or even gaslit about your symptoms, you’re not alone. Many women find their concerns brushed aside simply because perimenopause isn’t fully understood by all healthcare providers. From brain fog to mood swings to seemingly random aches, perimenopause symptoms can be frustratingly easy for doctors to misinterpret. This lack of recognition means that many women find themselves on a patchwork of medications, without ever addressing the hormonal shifts causing these symptoms.

5 myths you shouldn’t believe about perimenopause

• Hot flashes happen to everyone. Hot flashes are often the “poster symptom” of menopause, but they don’t happen to all women. There are dozens of other symptoms, like joint pain and mood changes, that are equally part of the journey.

• You need a hormone test to know for sure. Hormone levels in perimenopause change constantly, and while blood tests may be helpful, they’re often not definitive. The best “test” is a doctor who understands your symptoms.

• Perimenopause only starts in your 40s. Many of us start noticing changes in our late 30s. This is perfectly normal, and even doctors can be surprised by how early perimenopause can begin.

• You can’t start hormone therapy if you’re still having periods. Low-dose hormone options, including Menopause Hormone Therapy (MHT), can be suitable during perimenopause for some women, depending on your individual needs.

• Any doctor can help you through this transition. Not all clinicians specialise in perimenopause. Seeking a menopause-trained clinician can make a huge difference in receiving the right guidance and support for your unique experience.

Preparing for life beyond perimenopause

After perimenopause, as oestrogen settles at new levels, you may still find ways to feel energetic, clear-minded, and confident. The focus here is less on trying to “replace” what’s changed and more on creating a sustainable, feel-good lifestyle: weight-bearing exercises to keep muscles and bones strong, balanced meals that give you energy, and practices that support your mental well-being. Some women find that Menopause Hormone Therapy (MHT) can also help ease symptoms and provide additional health benefits.

Embracing support and solidarity

Perimenopause can sometimes feel like a lonely road. But you’re not alone. So many women across Europe are facing the same questions, the same highs and lows, and the same determination to feel whole and empowered. Whether it’s through telehealth options, support groups, or online communities, we’re in this together. There’s a growing wave of awareness and advocacy that’s helping women access the care they need to thrive during this time.

You don’t have to figure it all out by yourself. With the right information, supportive clinicians, and a community of women cheering you on, perimenopause can become a powerful season of transformation - one where you gain confidence, resilience, and a renewed sense of self. The best is truly yet to come.