When Does Menopause Start? Signs, Timing, and What to Expect

We all know that menopause is a natural part of aging. But when exactly does it start? And how can we prepare ourselves?

In this article, we’ll cover everything you need to know about the transition to menopause – including when it’s most likely to begin, common signs and symptoms to be mindful of, and what your hormones look like throughout the transition. 

What Is Menopause? 

Menopause is the point in time that marks the end of a woman’s reproductive era. Once you have reached menopause, you will no longer have a period. You will also no longer be able to conceive. 

If you know anything about reproduction and the menstrual cycle, you can probably already guess what drives menopause. (Here’s a little hint… it’s your hormones!)

As the female body ages, ovulation becomes increasingly irregular and key reproductive hormones (i.e. estrogen and progesterone) decline. In turn, this disrupts the menstrual cycle. Eventually the body can no longer ovulate and menstruation completely stops. 

Menopause does not happen immediately. Instead, hormones gradually decline and fluctuate for a period of around two to eight years before menopause has ‘officially’ been reached. This transition to menopause is called perimenopause. During this time, cycles become irregular and more difficult to track. This is also when the ‘tell-tale’ symptoms of menopause begin. 

When you have not had a period for at least 12 consecutive cycles, you have ‘officially’ reached menopause. 

What Is the Average Age for Menopause?

In the United States, the average age of menopause is 52. However, individual timelines can vary. The globally accepted guideline is that menopause typically occurs between the ages of 45 and 55. 

The transition to menopause (i.e. perimenopause) can begin much earlier than that though. Some women experience early symptoms of menopause as early as their mid-30s. 

Factors Influencing When Menopause Starts

Genetics, Family History, and Ethnicity

When it comes to the timing of menopause, genetics plays a big role. In fact, research suggests genetics contributes to the variation in menopause age by around 50%. This is why individuals with a family history of early menopause have an increased chance of experiencing early menopause, too. 

Ethnicity can also influence the timing of menopause. For example, research suggests African American and Latina experience menopause earlier than white women. This is also true for South Asian women. Japanese women, on the other hand, are more likely to experience menopause later than the global average. 

Lifestyle and Environment

Your lifestyle and environment can also influence when you experience menopause. For example, research suggests that certain healthy habits (such as exercising and eating lots of fruits and vegetables) can prolong the reproductive lifespan. This in turn delays menopause. 

Alternatively, severe weight loss, being underweight, vigorous exercise, smoking, and low levels of lifelong sun exposure can cause menopause to occur on the early side. 

Medical History, Conditions, and Treatments

Your medical history and experiences with certain treatments can also influence menopause timing. For example, current guidance from the NHS suggests you’re more likely to experience early menopause if you started your period before the age of eight. It’s also more likely if you’ve never given birth or if you’ve given birth fewer than two times. 

Certain medical treatments can also increase the likelihood of experiencing menopause earlier than average. This includes radiation therapy, chemotherapy, and hormone therapy drugs such as GnRHa, goserelin, and leuprolide. The Office on Women’s Health also lists thyroid disease, rheumatoid arthritis, HIV, AIDS, and chronic fatigue syndrome as conditions that can lead to early menopause. 

Surgical procedures that remove the ovaries or uterus can also cause menopause to occur early. 

Early Menopause vs Premature Menopause: What’s the Difference? 

If you’ve been reading up on the timing of menopause, you may have come across the terms ‘early menopause’ and ‘premature menopause’. These two terms are not the same and cannot be used interchangeably. To clarify, here’s a quick explanation of what differentiates these terms. 

• Early menopause: When menopause is reached before the age of 45. 
• Premature menopause: When menopause is reached before the age of 40. 

Both early and premature menopause are rare. The NHS estimates around 5% of women naturally experience early menopause and only 1% experience premature menopause. 

Symptoms of early and premature menopause are exactly the same as the common symptoms of menopause, with the primary symptom being irregular and/or absent periods. Because the period is irregular, this can make it very difficult to plan a pregnancy. Early and premature ovulation can also increase the risk of osteoporosis and cardiovascular disease. 

What is Primary Ovarian Insufficiency?

Another term you may come across is ‘primary ovarian insufficiency’. This condition is abbreviated as ‘POI’. 

POI is a medical condition that affects ovarian functioning. It can occur at any age. It is characterized by irregular periods, absent periods, low estrogen levels, and elevated follicle-stimulating hormone (FSH) levels. 

Sometimes POI is confused with premature menopause. This is because the symptoms can overlap. However, unlike premature menopause where the menstrual cycle never returns, it is possible to treat POI and resume menstruation. 

Potential causes of POI include genetic disorders, autoimmune disease, chemotherapy, radiation therapy, metabolic disorders, and environmental toxins. However, in the vast majority of cases (90%), the underlying cause(s) of POI cannot be determined. 

Navigating the Transition to Menopause: Perimenopause Explained

Perimenopause is the transitional period of time when reproductive hormones gradually decline ahead of menopause. This transition can last between two to eight years. 

During this time, you may experience irregular periods and anovulatory cycles. This indicates a natural decline in fertility. Even though pregnancy may still be possible during perimenopause, it will be much, much more difficult to conceive. 

In addition to irregular menstrual cycles, other common symptoms of perimenopause include:

• Periods that are lighter and/or heavier than normal
• Hot flashes
• Night sweats
• Sleep difficulties and insomnia
• Mood changes
• Increased irritability
• Low libido
• Vaginal dryness

When you haven’t had a period for at least 12 consecutive cycles, you have officially reached menopause. However, you don’t need to wait until this milestone before seeking treatment. Remember – perimenopause symptoms can begin as early as your mid-30s. It’s never too early to prepare yourself by tracking your cycle and symptoms ahead of time.

Many of the symptoms of menopause can be managed at home. If certain symptoms begin to interrupt your ability to work or live your day-to-day life, speak with your doctor. 

What’s Going on With Your Hormones

The transition to menopause is quite a chaotic time for your hormones. 

Estrogen and progesterone levels gradually decrease, while FSH and luteinizing hormone (LH) levels gradually increase. None of these changes happen in a perfectly straight line though and hormones fluctuate all over the place! 

These fluctuations are what cause many of the uncomfortable perimenopause symptoms. They also explain why you may still ovulate or have an occasional period during the menopause transition.

Menopause and Hormone Testing

Blood Testing at the Doctor’s Office

Depending on your age and medical history, your doctor may or may not require blood testing to diagnose perimenopause or menopause. If they do, they will often test for estradiol (the active form of estrogen that controls reproduction), progesterone, FSH, and/or LH. If estradiol and progesterone levels are low while FSH and LH levels are elevated, this indicates perimenopause. 

Urine Testing with Mira’s Menopause Transitions Mode

For even more clarity on what’s going on inside your body, it’s also possible to monitor your exact hormone levels at home.

This is possible with the Mira Hormone Monitor, Fertility Max Wands, and Ovum Wands. Together with the Mira App in Menopause Transitions Mode, you can test and track up to four key fertility hormones that change throughout the transition to menopause.

This includes:

• Luteinizing Hormone (LH)
• Estrogen-Estradiol Metabolite (E3G)
• Pregnanediol Glucuronide (PdG)
• Follicle-stimulating Hormone (FSH)

When tested consistently over a few months, you can:

• Define your stage of menopause. 
• See if you’re still fertile.
• Pinpoint any significant changes in your menstrual cycle.
• See how your symptoms correlate with your hormonal fluctuations. 

You can also monitor the effects of hormone replacement therapy (HRT) with your doctor or fertility practitioner. 

To learn more, check out our Menopause Transitions Kit.

Managing Your Wellbeing During Perimenopause and Menopause

Consider Making Lifestyle Adjustments

As your hormones fluctuate and change, certain lifestyle habits can help protect your mental and physical health. Healthy habits relevant to menopause include:

• Getting plenty of exercise. Exercise supports bone health, which tends to decline during perimenopause and menopause. Exercise also improves mood and sleep. 
• Maintaining a balanced diet. Calcium-rich foods in particular support bone health. Fruits, vegetables, healthy fats, and whole grains can help limit the impact of menopause symptoms.    
• Limiting alcohol, caffeine, and tobacco. These substances can exacerbate certain menopause symptoms like hot flashes, insomnia, and low mood. Limiting your intake and being mindful of how these substances make you feel can help.

Another big lifestyle factor to monitor during menopause is sleep. During this time, try to stick to a routine by going to bed and waking up at the same time each day. Light clothing can also help to ease hot flashes.

Prioritize Self-Care

Like any transition in life, menopause can be emotional. You may feel sad about the end of your reproductive years. You may also feel anxious about getting older. These feelings are completely normal – so don’t be too hard on yourself!

To usher in this new chapter in a positive way, try to be proactive with your self-care routine. This involves setting aside time for relaxation, social connection, and creativity. 

To start, reflect on what makes you feel happy and at ease. Then make it a priority to build some positive activities into your schedule. This may also mean setting some boundaries and saying ‘no’ sometimes – but that’s okay! 

Don’t Be Afraid to Seek Help

Even though there are a lot of things you can do to take care of yourself, sometimes you just need some extra help. 

If you’re feeling overwhelmed with menopause symptoms, the first point of contact should be your doctor. They can help you explore potential treatment options. Commonly recommended menopause treatments and remedies that can help ease symptoms include:

• Hormone replacement therapy (HRT)
• Antidepressants
• Cognitive behavioral therapy (CBT)
• Yoga, breathing exercises, and mindfulness meditation
• Natural remedies such as black cohosh, ginseng, and red clover

If you find it difficult to juggle all the hormone tests, recommendations, and lifestyle changes, we would love to support you in our Hormone Health Clinic. Our experienced hormone health practitioners can help you navigate your hormone charts in the Mira App and manage any nutritional or lifestyle challenges you may be facing. 

Please note: hormone health coaches do not provide diagnoses, treatments, treatment adjustments, or medication prescriptions. Our services are not a substitute for a doctor’s advice, treatment plan, or diagnosis. If you experience any emergency, please contact your healthcare provider immediately.

Frequently Asked Questions