Millennial Perimenopause Age | YMyHealth

When you get together with a group of women in their 20s, 30s, or 40s, there are certain ‘hot topics’ that emerge in conversation. The latest buzzword: ‘perimenopause.’

What’s different now than in the past is that this phase of a women’s life seems to be getting written about in a way that now seems to directly connect it to our fellow millennials, particularly those in their 30s and very early 40s.

For many of us for a variety of reasons, including delaying having a family, seeing and hearing this word is something that gives us great trepidation. Simply put, it feels too soon, and we are not ready for it.

As a generation with a continually growing interest in preventive health and in typical YMyHealth fashion, we wanted to bring you greater context to the meaning of perimenopause and how it fits into the changes many people in their 20s, 30s, and 40s have shared with us that they are experiencing, like often feeling tired.

Primary care physician and women’s health specialist, Navya Mysore, MD, sheds much-needed light on perimenopause from the hormonal connections with fatigue and irritability to the lifestyle changes we can make now to have an easier perimenopause. She also shares the powerful role of exercise and other preventive strategies in achieving better overall health in our 30s, 40s, and beyond.

Framing Perimenopause for Women in Their 20s, 30s, and 40s

Perimenopause is defined as the transition between the time your ovaries begin to produce less hormones and your menstrual cycles become irregular and when they stop altogether, and menopause begins.

Most of the time Mysore sees people experiencing real symptoms of menopause starting as early as 45. Recently though, there have been lots of misconceptions out in the mainstream media that in fact, perimenopause is not only starting for people in their 30s but it’s the root cause of women in this decade and even in their early 40s experiencing everything from being tired to irritable, to the reason for ‘not feeling like yourself’.

Clearly, this has created instant concern that because we are feeling tired, for example, that it means we are nearing the end of our reproductive lives. But ask yourself how many of your friends in this age group have told you that they feel tired in the last six months? For most of us with all we do, the answer would be “yes” for every one of them.

“Hormonal shifts and changes can happen, but I would hesitate to label something like this as perimenopause. If someone is in their early 30s or mid 30s, and you are feeling tired, you're not likely experiencing perimenopause,” Mysore said. “There are so many different things that could be happening to you in your body in terms of energy levels.”

She notes that lower energy levels can be a sign of and caused by changes in metabolism, the thyroid, stress, anxiety, depression, or as a side effect from medication you are taking.

“There's so many different things that could be contributing to how you're feeling,” she said.

One of many reasons why it is so important to be aware of the symptoms for different conditions, and what’s normal and not normal for you. Early recognition can help you feel better and lot less stressed, as you will get to the right doctor sooner to get accurately assessed and started on the right treatment (if any is needed).

Lifestyle Changes to Prepare for and Ease into Perimenopause

Dietary adjustments

Preparation for an easy as possible perimenopause phase adheres to the very same healthy behaviors we are often told to prioritize. That begins with the kinds of foods we put in our bodies. Mysore emphasized that it’s important to make sure you main a healthy diet, meaning lots of fruits, veggies, and less processed foods.

Stress management techniques

Like in so many other conditions, stress affects perimenopause. To have a better experience, Mysore recommends making sure that we're reducing our stress by practicing more mindfulness and meditation.

Navya Mysore, MD, is a primary care physician and women’s health leader. She completed medical school and her Family Medicine residency at McGill University, where she also completed a fellowship in Maternal-Fetal Medicine.
Navya currently is the Medical Director for Women's Health at Nurx from Thirty Madison, leading efforts to transform healthcare by making it more accessible and affordable. Prior to that, Navya was the National Program Medical Director for Sexual and Reproductive Health at One Medical.

Sleep hygiene practices

She not only recommends making sure you are getting enough sleep, but also doing some practical things to make ourselves more comfortable when we do. In particular, planning ahead to cool ourselves down if and when we experience hot flashes. This includes considering having fans by the bed, avoiding different kinds of fabrics for bed sheets—sticking to more to linen or cotton, wearing sweat-wicking clothing when you're going to sleep and having towels nearby if you need them.

Recognizing Perimenopausal Symptoms

Fatigue and irritability: Hormonal connections

There are connections between cyclical changes in hormone levels during your menstrual cycle and these symptoms. For example, Mysore shared that you are more likely to feel tired in your period’s luteal phase.

“So, ovulation onwards you're in your luteal phase, and you are more tired because your body is amping up for your period or fertilization, depending on what is happening at the time. That’s why we tend to suggest doing higher intensity exercise in the follicular phase of your cycle because you are going to have a lot more energy then,” Mysore said. A lot of people also experience irritability around the time of their period because of hormonal changes.

This is all very person dependent though, as some people do not really feel that shift and energy change. However, establishing the connection between the way you feel and hormones in perimenopause is far more challenging.

When people’s cycles become irregular, they go without one for months, yet feel irritable when a period suddenly shows up. In perimenopause, you can experience irritability between periods or at what would be your regular time for a period, even when you are not actually having one.

Distinguishing between normal aging and perimenopausal symptoms

Knowing the difference between the normal aging process and what is part of perimenopause can be confusing. After all, each of us can honestly say that we feel a little bit different as we enter each decade, certainly midway through it, and at the end. A lot of that is just the normal aging process.

“We start to sort of see the impact of how we are treating our bodies with each decade,” Mysore said. This includes seeing how our genetic factors play out particularly in our 30s and 40s.

For example, our 20s is the decade when people commonly begin to be diagnosed with autoimmune issues, and the number of people receiving this type of diagnosis increases as we move into our 30s and early 40s. Whereas, cholesterol shifts more commonly show up in our 30s and even more so with rising levels in our 40s.

Health Changes from 20s to 40s

As women transition from their 20s into their 30s and then into their 40s a lot of things change.

Hormonally, in your 20s your estrogen and progesterone levels continue to increase. It’s a decade in which because of that increased progesterone your body is regularly preparing the uterus for potential pregnancy and reproductive function is stable for most people. Also, your menstrual cycles become much more regular in comparison to your teenage years.

In your 30s there are specific hormonal shifts that characterize each half of the decade. Our early 30s is a time of a relatively stable pattern of estrogen and progesterone levels with regular menstrual cycles and maximum fertility capabilities.

Once you hit your mid-to late 30s though, things start to change. As our egg reserves and our egg quality begin to decrease, our fertility starts to slowly decline. This is accompanied by fluctuations in estrogen and progesterone levels that can impact the timing of periods and duration of ovulation.

By the time we hit age 40, hormone levels will fluctuate even more and so do our menstrual cycles. The perimenopause age, or how old we may be when it starts can be anywhere from our mid-30s to as late as our mid-50s.

But there are many non-hormonal changes happening that are just a normal part of aging, starting with what happens to our body’s basal metabolism and weight. Changes in diet and lifestyle can change what your ‘new’ regular weight, she said.

Also, people who have a family history of high cholesterol (me included), suddenly start to see their numbers creep up after being in the normal range for years.

“That speaks to our body being able to process and have the resilience to some degree of all these things. And we start to sort of see the impact of our diet and genetics,” Mysore said.

Preventive Measures for Better Health in 30s and 40s

While we cannot stop perimenopause from coming, there are lots of things we can do to be in better health when it does.

It’s important to make time to regularly get your health screenings. Not only are we talking about going to see your primary care doctor to get a physical exam, but also getting your pap smear, mammogram, cholesterol screening, blood pressure check, and a colonoscopy (before the screening age of 45 if you have a family history). Plus, getting regular dental cleanings, as bacteria in the form of gum disease can affect your heart.

Another big thing for a healthier and longer life is to be mindful about what you eat. Eating a plan-forward diet—one without meat—as much as you can is best.

“I'm not saying that you need to be vegetarian or vegan, but I think it’s really important to make sure you are having fruits and vegetables, and that you are trying to keep processed foods to a minimum,” Mysore said. “But, I also think life is about living and so you need to do the things that you enjoy, and that one burger is not going to make it or break. It's about the pattern overall.”

It's also equally as important to maintain your mental health, making sure you take time away from your busy, on-the-go life to enjoy the things you love to do, meditate, and to spend time with friends and family who bring you joy.

The Role of Exercise Across the Millennial Age Spectrum

Exercise as a whole, Mysore finds, is the most powerful prevention tool that each of us has.

“I can't say enough about exercise. There's a lot of data to show that is very helpful in terms of helping manage symptoms from hormonal changes. So, hormonal shifts will feel less rough with regular exercise,” Mysore said.

She pointed out that reaping exercise’s immense benefits does not mean doing intense activity for hours every day.

“The recommendation is 120 minutes of medium intensity cardiovascular exercise per week, along with two days of weight bearing exercises. Breaking it up and getting out there to try to move your body every day for at least 30 minutes. Doing at least cardiovascular exercise and weight-bearing exercises can give you that,” Mysore said.

Weight training and strength training are super important as a preventive measure as you think beyond perimenopause into menopause, as we start to lose bone mass as well.

“We want to be doing whatever we can do for osteoporosis prevention,” Mysore said.

Bone Health for Millennial Women

While peak bone mass happens in our teens to mid-20s, now is the time to preserve what we have built.

The three biggest contributors for our bone mass are: calcium, vitamin D, and weight-bearing exercises.

Calcium helps to harden and strengthen bone, vitamin D signals our body to absorb calcium, and weight-bearing exercises can help slow bone loss and even some studies have shown it can build it.

According to Harvard Health, the stress placed on your bone when using weights can actually stimulate extra deposits of calcium and bone-forming cells to be activated.

So, preventive strategies for maintaining our bone density and preventing the development of osteopenia (low bone mass that makes bones weaker) often target those three factors.

What can you do?

Make sure you are getting enough calcium.
Get calcium from your food primarily and supplements what you aren’t getting enough from your diet. You should be getting a total of 1200 mg of calcium a day. Check out this great list of calcium-rich foods.
Take Vitamin D daily.
Mysore recommends 1000-2000 international units of Vitamin D daily.
Make weight-bearing exercises a part of your regular workout routine.

Empowering Millennial Women in Healthcare

Having access to and receiving comprehensive health assessments is critical for women in our 20s, 30, and 40s, to achieve optimal health.

Given the complexity of our hormonal shifts this becomes even more important, especially when comes to demystifying the cause of our symptoms and understanding perimenopause as having a role or not having a role in them.

Most importantly, we must communicate openly with our healthcare providers and partner with them to gain the proper preventive tools that we need to have in advance of taking on this next phase in our lives

Here are three essential questions/topics Dr. Mysore recommends you ask or bring up for discussion at your next primary care doctor’s appointment:

If you are interested in exploring your birth control options, ask about them.
Talk about what your fertility means, how and when it could change, and what your options are. Ask: What steps should I be taking if I am planning on having a family, but not right now?
Ask: What can I do from a preventive aspect to help with my life moving forward into my 40s, 50, and 60s? Talk about multiple preventive measures, including how to prevent mobility loss.

Subscribe to the YMyHealth newsletter to stay up to date on everything that’s health-related for millennials!

Perimenopause Age: A Guide for Millennial Women