On average, women hit menopause around age 51, but many begin to notice signs long before that milestone. That transition period is also known as perimenopause.
Officially, menopause occurs when a woman hasn't had a period for a full year, and perimenopause often begins about eight to 10 years before that. (Note that menopause that occurs before age 45 is typically referred to as ‘early menopause’, while ‘premature menopause’ occurs before age 40.)
During both perimenopause and menopause, changes in estrogen and progesterone levels in particular can bring on a vast range of symptoms, from brain fog and moodiness to hot flashes and changes in body composition, says Lifeforce Physician Kimberly Hartzfeld, DO, OB-GYN, IFMCP. Some women may experience dramatic changes, while others notice gradual changes, and in some cases, little at all.
Still, early menopause — and the decline in estrogen that comes with it — can put a woman at risk of certain chronic diseases, Dr. Hartzfeld says. That's because estrogen protects our heart, bones, and brain, and supports our glucose metabolism, skin integrity, and even our mood.
If you're in your 40s and you're noticing menopause-like symptoms, visit your doctor for an evaluation. "There is no need to grin and bear it," Dr. Hartzfeld says. "There are many treatment options, like hormone replacement therapy (HRT), that can help reduce the symptoms of perimenopause and improve your quality of life."
Here's everything you need to know about the signs of menopause at 40 and how to manage your symptoms.
1. Irregular periods
If you find that your periods once arrived like clockwork, and now they sneak up on you at odd moments in the month, it might be time to get your hormones checked.
"When hormones fluctuate, ovulation becomes unpredictable, and the time between periods can become shorter or longer," says Dr. Hartzfeld. Perimenopause causes fluctuations in hormone levels, which can trigger irregular menstrual cycles. But many other factors can also cause irregular periods. If you haven't had a regular period in three to six months, Dr. Hartzfeld recommends visiting your doctor. A medical professional can rule out other causes of cycle irregularity, such as thyroid or pituitary disorders.
2. Sleep issues
About 31% of women report having sleep issues during perimenopause, research shows. It's not just the night sweats that can make it hard to fall and stay asleep. Dips in estrogen and progesterone can also cause the onset of conditions such as sleep apnea.
Still, it's important to keep a regular sleep/wake cycle, shut off blue light at least an hour before bed, avoid caffeine after 2 pm and alcohol in the evening, and keep your bedroom dark and cold (around 65 to 67 degrees F), says Dr. Hartzfeld. You'll also want to make stress management a daily priority, with meditation and deep breathing exercises — check out the Wim Hof breathing method, Dr. Hartzfeld recommends.
If you're still having difficulty sleeping, consider a natural supplement to support sleep, like Lifeforce's Peak Rest™.
3. Weight gain or changes in body composition
Gaining weight, especially around the waistline, is a hallmark symptom of aging — but it can also clue you into possible hormonal changes. "When estradiol (a form of estrogen) and progesterone decrease during perimenopause, there's a propensity for fat to be stored around the midsection," Dr. Hartzfeld says.
As some hormones plummet, others can see an uptick. The fourth decade of life can bring about more stress, which means higher levels of the stress hormone cortisol. "Many women find that their 40s are a time filled with many responsibilities and stress due to a busy career and caring for children," Dr. Hartzfeld says, adding that high cortisol is a stimulus for fat deposition in the mid-section.
On a related note, lifestyle factors such as poor sleep (a common symptom of perimenopause) can also increase our cortisol. And, not sleeping well can make it harder to hit the gym or keep up with our running routine, which can lead to weight gain over time.
That's why Dr. Hartzfeld recommends prioritizing your sleep, as well as your nutrition and fitness. She recommends following a Mediterranean diet focusing on lean protein and fiber, as well as reducing processed and refined carbs. What's more, "Women in perimenopause and menopause should incorporate strength training to support muscle mass, which is the powerhouse of your metabolism," Dr. Hartzfeld says.
But if your lifestyle isn't the problem and you're still struggling with your weight, Dr. Hartzfeld says that there are ways to manage perimenopause-related weight gain, such as hormone therapy, to help stabilize fat distribution.
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4. Hot flashes and night sweats
Some days you feel cool, calm, and collected; other days, your body's thermostat is through the roof. Hot flashes and night sweats are common during perimenopause — about 75-80% of women will have hot flashes at some point during the menopausal transition, Dr. Hartzfeld says.
During perimenopause, women experience swings in estradiol, which can lead to sudden increases in body temperature, also known as hot flashes.
5. Changes in mood and focus
You might be quick to blame your overextended schedule or an overbearing boss for your short temper. But feeling moody, anxious, or foggy, may all point to perimenopause.
Changes in cognition and mood, such as lack of focus, anxiety, depression, irritability, and mood swings, are directly and indirectly caused by a decrease in hormone levels, Dr. Hartzfeld says. Declining hormone levels can lead to poor sleep, and in turn, contribute to brain fog and mood swings, she says.
Getting quality shut-eye is one of the best ways to help improve your mood and focus. But if you're still struggling, it may be worth speaking to your doctor about hormone therapy, which research shows may help regulate how the brain processes emotions.
6. Headaches or migraine
Headaches and migraines can begin or worsen during perimenopause, often triggered by fluctuating hormones and sleep issues. The silver lining: Migraines typically improve or even disappear once a woman reaches menopause, Dr. Hartzfeld says.
There are many options for migraine treatment, including hormone therapy, sleep supplements/medications, changing your diet, over-the-counter pain medications (NSAIDS), and prescription migraine medications. It's best to speak to your doctor about the best treatment options for you.
But if you want to start small, in the comfort of your own home, consider cleaning out your kitchen. "I recommend avoiding certain foods that can trigger migraines, such as alcohol (especially red wine), foods high in nitrates (such as cured meats), aged cheeses, dried fruits, caffeine, fermented dairy, and artificial sweeteners." Dr. Hartzfeld says.
7. Changes in sex drive
Low libido is one of the more common signs of perimenopause. Here's why it can occur: Lower estradiol levels have been associated with reduced sexual desire, research shows. This decrease in estradiol can also cause vaginal dryness and pain with intercourse. "As intercourse becomes painful and less pleasurable, it can cause a reduction in desire," Dr. Hartzfeld says. In addition to low estradiol, persistently elevated cortisol (from high stress) and low testosterone levels are also associated with reduced libido.
If using a water-based lubricant doesn't help, Dr. Hartzfeld recommends trying Revaree (hyaluronic acid) and vitamin E vaginal suppositories to increase lubrication and reduce painful sex. But persistent symptoms may require a prescription DHEA suppository or vaginal estrogen cream. "The gold standard treatment is vaginal estrogen cream, which supports the vaginal tissue and increases lubrication," Dr. Hartzfeld says.
Frequently Asked Questions (FAQ)
What are the early signs of menopause at 40?
Symptoms of early menopause or perimenopause are the same as menopause, which is marked by 12 consecutive months without a menstrual period. Symptoms can include hot flashes, night sweats, sleep disturbances, a change in mood or focus, brain fog, migraines, joint pain, weight gain, and reduced libido.
Is it normal to experience menopause at 40?
Menopause that occurs before age 45 is known as early menopause. Premature menopause occurs before age 40. Some of the causes of early or premature menopause include smoking, family history of early menopause, genetic disorders (such as Turner Syndrome), surgical menopause (removing uterus and ovaries), certain medications/treatments (chemo, radiation), and autoimmune diseases, Dr. Hartzfeld says.
How can I manage the symptoms of menopause at 40?
A healthy diet, regular exercise, getting good sleep, and managing stress can help ease perimenopause and menopause symptoms. But if your symptoms persist, you'll want to visit your doctor to get your hormone levels checked and discuss potential treatments, such as hormone replacement therapy.
This article was medically reviewed by Vinita Tandon, MD, ABIM Board Certified in Endocrinology and Metabolism.
References
Baker, F. C., de Zambotti, M., Colrain, I. M., & Bei, B. (2018). Sleep problems during the menopausal transition: prevalence, impact, and management challenges. Nature and Science of Sleep, 10, 73–95. https://doi.org/10.2147/NSS.S125807
Shafir, T., Love, T., Berent-Spillson, A., Persad, C. C., Wang, H., Reame, N. K., Frey, K. A., Zubieta, J. K., & Smith, Y. R. (2012). Postmenopausal hormone use impact on emotion processing circuitry. Behavioural Brain Research, 226(1), 147–153. https://doi.org/10.1016/j.bbr.2011.09.012
Cappelletti, M., & Wallen, K. (2016). Increasing women's sexual desire: The comparative effectiveness of estrogens and androgens. Hormones and Behavior, 78, 178–193. https://doi.org/10.1016/j.yhbeh.2015.11.003
AlAwlaqi, A., Amor, H., & Hammadeh, M. E. (2017). Role of hormones in hypoactive sexual desire disorder and current treatment. Journal of the Turkish German Gynecological Association, 18(4), 210–218. https://doi.org/10.4274/jtgga.2017.0071
