You’re unlikely to be thinking about the menopause in your 30s. After all, that’s something you don’t have to start prepping for until your 40s at the earliest…right? Not exactly, experts say.
“It’s definitely not too early to think about it,” says Samantha M. Dunham, MD, the co-director of the Center for Midlife Health and Menopause at NYU Langone Health and a clinical associate professor in the department of obstetrics and gynaecology at the NYU Grossman School of Medicine.
Being aware of what’s coming will pay off down the line, adds Karen E. Adams, MD, a menopause specialist at the Stanford Health Care Gynaecology Clinic and clinical professor of medicine in the department of obstetrics and gynaecology at the Stanford University School of Medicine. “The more you can arm yourself with education and information, the better.”
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Your third decade is an ideal time to get a head start on preparing yourself physically and mentally. “People really can impact their perimenopausal and menopausal experiences by preparing for it in their 30s,” Dr. Adams says.
What to expect when you’re in menopause
Even though it’s nearly universal among menstruating people, menopause isn’t something we’re taught much about. “Most of us had somebody who told us about puberty,” but it’s less common to have “the talk” about menopause, Dr. Adams points out.
Knowing what’s coming (and roughly when it’ll go down) can save you from being caught off guard, Dr. Adams says. You’ll be more equipped to recognise early signs and symptoms if you prep for menopause in your 30s, instead of shrugging them off or misattributing them.
You’ll also be more prepared to advocate for yourself at the doctor.
Keep the typical timeline in mind.
Menopause doesn’t officially start until it’s been 12 consecutive months since your last period. For most people, this happens between ages 45 and 55, according to the NHS, and at 52 on average. (About 5% of people go through early menopause, per the NHS, which can start at age 40 or, in rare cases, earlier.)
“Menopause doesn’t happen overnight,” explains Mary Jane Minkin, MD, a menopause specialist at Yale Medicine and clinical professor of obstetrics, gynecology, and reproductive sciences at the Yale School of Medicine.
First comes perimenopause, the transitional period when your levels of oestrogen and progesterone begin to fluctuate. Perimenopause usually starts in your 40s and lasts two to eight years (though it can sometimes start in your 30s, Dr. Dunham says).
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Ask a relative when they went through menopause.
There’s a “familial tendency” to menopause onset, Dr. Minkin says, meaning that the age your mother started going through it can tell you a lot (though not everything!) about when you might, too.
If multiple people in your family hit menopause around 41 or 42, “that’s a pretty good tip that you may go through menopause early,” Dr. Minkin explains. Ask your mum or other relatives when it happened for them—and, while you’re at it, what it was like for them, since learning more about other people’s firsthand experiences here will help you feel more ready too.
Start cycle-tracking your periods.
The earliest phase of this can be sneaky. “It doesn’t announce itself and say, ‘Hello! You’re perimenopausal now!” Dr. Minkin says. Hormone levels can change so much from one day to the next that blood tests are “notoriously unreliable” when it comes to predicting menopause, Dr. Minkin explains. Instead, it’s all about noticing the signals.
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“The first obvious sign is a change in period timing,” Dr. Dunham says. Your cycle might start to lengthen, shorten, or become irregular, and your periods can become shorter or longer. Tracking your cycle, starting now, gives you a baseline so you can spot deviations when they occur and report them to your provider, Dr. Minkin says.
Know the telltale physical symptoms.
Hot flushes are an incredibly common symptom of perimenopause. “They’re pretty unmistakable,” Dr. Adams says. “It’s not just feeling a little bit warm. It’s like somebody turned on a heat lamp.” You might get hot flashes mostly during the day, mostly at night (called night sweats), or both, Dr. Adams adds.
Keep more subtle symptoms on your radar, too, Dr. Dunham says—like trouble sleeping, fatigue, and joint aches. Sleep issues are often chalked up to life stressors common around that time, Dr. Minkin notes, like work, raising a family, or ageing parents. “It’s hard to say, ‘Oh, it’s my hormones.’”
Be aware that your emotions might run a little wild.
You’ll want to steel yourself for those mood changes you hear so much about—they’re extremely real. “The emotional roller coaster is very profound for some people,” says Dr. Minkin. (Though it varies, she adds—some lucky people feel just fine.)
She notes that knowing that there are biological reasons to explain seemingly “random” changes in your mood might help you be a little more compassionate with yourself—as well as seek help when you need it.
You might feel off in ways that seem an awful lot like PMS—maybe you’ll notice you’re unusually angry, irritable, moody, anxious, or depressed—except those moods will strike randomly throughout the month instead of tied to your cycle, Dr. Adams explains. “Some days, you feel better, some days, you don’t,” she says. You might feel like you’re not coping with the same everyday stressors as well, Dr. Minkin adds.
These mood shifts happen because the drastically fluctuating levels of oestrogen and progesterone in your body also impact serotonin, a chemical in the brain that influences your sense of well-being.
Those mood swings can also make you more likely to experience depression, especially if you have a history of it. A doctor can help you better evaluate if your mood shifts are tied to perimenopause or something else.
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Look out for sexual symptoms, too.
In your 30s, you’re probably clued in to how you usually feel during sex. When that suddenly takes a turn, menopause might be the reason. Other signature signs of perimenopause include vaginal dryness and pain during penetration.
Falling levels of oestrogen—which helps keep the vaginal walls lubricated, elastic, and thick—can cause thinning, drying, and inflammation, according to the American College of Obstetricians and Gynecologists (ACOG).
You might also notice a difference in your libido. Some women have less of a desire to have sex, Dr. Minkin says, especially later in menopause. Vaginal dryness and painful sex can contribute to this, along with a lower sex drive (due to falling oestrogen) and arousal response (meaning blood flow to the vaginal tissues is slower).
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Still, many people have thriving sex lives during and after menopause, Dr. Minkin notes, so don’t think this spells doom for yours.
What to do now to get your body ready for menopause later on
Menopause brings on major biological shifts, meaning you’ll most likely go through big physical changes. Bone loss, changes to your bladder and vaginal health, loss of lean muscle mass, and increased cardiovascular risks can all occur, Dr. Dunham says.
But your lifestyle choices in your 30s and beyond give you a “huge amount of control” over how you weather those changes, Dr. Adams says.
Build up your bone health.
You start to lose bone mass around perimenopause, which raises your risk of osteoporosis. It’s crucial to enter this period starting out with “the highest bone mass that you can,” Dr. Adams says. “You can increase your peak bone mass with what you do in your 30s.”
Getting plenty of vitamin D and calcium is key for bone health. Dr. Minkin encourages people to make sure they have ample amounts of both in their diet. You can talk to a doctor about testing your vitamin D or calcium levels for a better sense of your needs.
Another hugely helpful thing you can do is have a strength training routine, which has been shown to slow age-related bone loss and even build up bone mass, Dr. Adams says.
If you smoke, quit. “Cigarettes are poison for your bones,” Dr. Minkin says.
Nail the diet and exercise basics.
It’s a great time to take stock of your relationship to the essentials for building a strong health foundation, like nutrition and movement. “The earlier you can take charge, the better you’re going to do,” Dr. Minkin says.
Eating well and exercising can help offset some of the menopause-related changes to your body, like elevated cardiovascular risks and loss of muscle mass, Dr. Adams says. (Not to mention that it’ll make you feel better in the here and now.)
Eating a wide variety of plant-based foods (like veggies, fruits, beans, legumes, and whole grains) can boost your heart health, Dr. Adams says. She advises making sure you eat enough protein (to protect yourself against the menopause – and age-related lean muscle loss that usually starts in your late 30s) and calcium-rich foods (to prevent bone loss), too.
When it comes to exercise, Dr. Minkin recommends aiming for a mix of aerobics and strength training. Strength training, again, will help prevent loss of not only bone mass, but also lean muscle tissue. Another benefit of having a gym habit before you hit perimenopause? Fewer hot flashes, Dr. Adams says.
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Do your Kegels.
Urinary incontinence—a.k.a. leaking a little pee—becomes more of a concern around menopause. Lower levels of oestrogen can cause the urethra lining to thin, and your pelvic muscles can also weaken, the North American Menopause Society explains.
Kegel exercises, which strengthen the pelvic floor can help prevent this to some degree, Dr. Minkin says. “I want everybody doing Kegel exercises!”
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Gather your support network.
Menopause doesn’t have to be a solo journey. Opening lines of communication with your loved ones sooner rather than later can help you feel more supported when you start making the transition, Dr. Minkin says.
Talk to a provider you trust about what’s coming.
In an ideal world, you’d have a long-standing relationship with a trustworthy doctor before you start perimenopause, Dr. Minkin says. That way, they’d know your history and you’re already comfortable with them. You want to be able to say, “Look, this is what’s going on. Do you think it might be related to perimenopause?” Dr. Minkin explains.
Of course, it’s not always realistic or possible to stick with the same doctor for years. What you can do is start having conversations with your current team, if you have one, or looking for potential providers in your area now so that you know who to turn to when you start experiencing symptoms.
That person doesn’t have to be an ob-gyn, Dr. Minkin says. A primary care practitioner, nurse midwife, physician’s assistant, or advanced practice nurse are all good options, she says. What matters most is finding someone who’s understanding and knowledgeable about menopause, Dr. Minkin says.
That said, not all clinicians are well-versed in menopause care, Dr. Adams points out. Too many people are dismissed by providers who tell them, “You’re too young,” or, “That’s normal,” she adds. “You need to find somebody who knows what they’re doing.”
Dr. Adams recommends asking providers questions like, “Have you worked with people going through perimenopause before?” and, “Do you have multiple ways of approaching menopause care?”
Some of those methods include hormone therapy, vaginal oestrogen, lifestyle changes, and antidepressants, which can all provide tremendous relief for your symptoms, Dr. Minkin says.
You and a doctor can discuss what makes the most sense for you, but it might also take some trial and error, Dr Adams says. “This is never one-size-fits-all medicine. It’s very individualised.”
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You can also find a practitioner who’s certified in menopause care by the North American Menopause Society. (These practitioners are clustered in metropolitan areas, Dr. Adams notes, but many see patients virtually.)
Talk to your partner and family about what to expect.
“Having a partner who understands what you’re going through is very important” if you’re in a long-term relationship, Dr. Minkin says. She encourages starting open conversations about menopause whenever you feel like you’re ready, including right now.
“People tend to do better [with menopause] when their partners are educated,” Dr. Adams says. (Some research suggests that when a partner is educated about menopause symptoms, effects, and treatment options—as well as the role a spouse can play—the menopausal partner’s satisfaction in the relationship increases.)
Loop your partner in on the basics so they can better understand your experience. You can also recommend some reading: The experts both recommend looking through the North American Menopause Society’s website, which provides plenty of free info online (or you can simply send them this article).
Know that it’s not all doom and gloom.
Menopause is a lot. Getting ready in the immediate, and thinking about menopause in your 30s, “can get you back to feeling like yourself again” sooner when the time comes, Dr. Adams says. “Menopause is inevitable, but suffering is not.”
While there are multiple treatment options, the gold standard is oestrogen therapy, Dr. Adams says. This can help with symptoms, as well as lower your risk for health concerns like osteoporosis, she explains.
Taking a combination birth control pill during perimenopause can help even out your hormones and regulate your period. “It’s a terrific option because it helps mask the symptoms, and can take people right up until their time of menopause,” Dr. Dunham says.
Other oestrogen delivery systems—like oestrogen skin patches, gels, and vaginal rings—are great alternatives that avoid the slightly elevated risk of blood clots associated with oral contraceptives, Dr. Adams says.
The stale old narrative that it’s all downhill after menopause just isn’t true. Things can actually get pretty good on the other side of menopause. “There are some upsides,” Dr. Dunham points out.
Period cramps and PMS are a thing of the past, and you get to enjoy sex with no risk of unplanned pregnancies.
Dr. Adams says many of her patients experience a “menopausal zest,” which she describes as self-reinvention, a feeling of greater authenticity, and even an increase in satisfaction with your life more broadly.
“It’s not like the end of your life,” Dr. Dunham says. “It’s more like the beginning of the next part.”
A version of this article originally appeared on Self.