Before 45: What every woman must know about early menopause and perimenopause

Just like menstruation, menopause is a natural occurrence in a women's life and as the World Health Organization points out, for most women, menopause is marked by the end of monthly menstruation (also known as a menstrual period or ‘period’). This happens due to loss of ovarian follicular function and this means that the ovaries stop releasing eggs for fertilization. Menopause also signals the end of a woman's reproductive years and is an immensely important transition in a woman's life cycle which has a significant bearing on her emotional and physical state.

When does menopause hit women

Dr Mannan Gupta, Chairman & HOD - Obstetrics  & Gynaecology, Elantis Healthcare New Delhi, shares that the average woman goes through menopause between 45 and 55 years old, while others can start to see some signs of menopause in their early or mid-forties. Dr Richa Arora Miglani, Head - Laparoscopic, Robotic and Cosmetic Gynaecology RG Hospitals, Delhi, agrees that while menopause is often associated with the early 50s, but the transition toward menopause can begin earlier.

What is perimenopause and what are the symptoms

It is not unusual for women in their 40s to experience symptoms of perimenopause and seek medical advice for changes in their periods, sleep, mood, energy levels, or sexual health.

“The time leading up to menopause, which is referred to as perimenopause, involves a lot of fluctuations in hormones and changes in physical health, sleep and mood. By observing these changes at an early stage, women can seek medical help and deal with any problems in an effective way,” says Dr Gupta.

One of the first signs of perimenopause is the change in periods. “The menstrual patterns can vary from irregularities to a change in heavier or lighter cycles. There can also be hot flashes, night sweats, sleepless nights, changes in the mood and irritation. Besides that, a woman can experience dryness in private parts, headaches, pains in joints and tiredness,” says Dr Gupta.

Dr Miglani points out that while symptoms can be common, the experience of perimenopause is highly individual. Some women may have noticeable symptoms, while others may experience relatively few changes, she adds.

Transition to menopause: When it starts early

Menopause is when the transition from perimenopause to menopause begins, usually around the age of 45. “In cases where the process starts prematurely, meaning before the age of 40, it is commonly known as premature menopause. However, the clinical aspect of premature menopause always requires examination. Numerous factors such as heredity, smoking, autoimmune diseases, chemo treatment and certain surgeries could bring on menopause,” says Dr Gupta.

Dr Miglani emphasises that it is also important to distinguish between perimenopause and menopause occurring earlier than expected. “Menopause before the age of 45 is generally considered early menopause, while a decline in ovarian function before the age of 40 is termed premature ovarian insufficiency (POI) and warrants appropriate medical evaluation,” the doctors says.

She points out that women should not dismiss persistent or significant changes as simply a consequence of stress or ageing. Several other health conditions can produce symptoms that resemble those associated with perimenopause. “For example, thyroid disorders and anemia may contribute to changes in energy, sleep, mood, or menstrual patterns. A proper medical assessment can therefore help determine the underlying cause,” adds Dr Miglani.

When to check with gynaecologist

For women noticing new or persistent symptoms in their 40s, consulting a gynecologist can be an important first step, says Dr Miglani. “Evaluation can help clarify whether the symptoms are related to perimenopause or another condition and allow an individualised approach to symptom management,” the doctor says.

She adds that beyond addressing immediate symptoms, timely medical guidance can also help women understand and protect their long-term health during this important stage of life. “The goal is not simply to normalize the symptoms, but to ensure that women have the information and support they need to navigate the transition confidently,” says Dr Miglani.

Dr Gupta says that menopause can also lead to considerable changes in health and might affect women at some later time. “One of the most significant changes brought upon by the onset of menopause is the decrease of estrogen levels which brings upon the following health implications, a number of deterioration in bone health and changes in risks,” Dr Gupta says, adding, “Therefore, women who are worried about their early menopause symptoms should consult a doctor rather than minimise their importance. Depending on the condition as well as the specific case of health, doctors may call for exams, dietary recommendations and hormonal treatment when needed.”

Adhering to a well-rounded diet, participating in regular exercise, getting enough sleep and abstaining from smoking can help in the transition process, says Dr Gupta. He has a key word of advice: It is fundamental that women realise that menopause is not a disease and represents an important phase of their lives that requires attention, informed choices and individualised treatment.