Perimenopause may begin as early as 35. It usually starts about two years earlier for women who smoke than for women who don't.
Women reach menopause at different times. The timing is not related to race, class, pregnancy, breastfeeding, fertility patterns, the birth control pill, height, age of menarche (first period), or age at last pregnancy.
The average age for menopause is 51. If menopause is reached naturally or surgically before the age of 40, it is called early or premature menopause.

Estrogen levels drop very abruptly after induced menopause — when both ovaries are removed surgically or through radiation or chemotherapy. This often intensifies the conditions associated with menopause and may lead to major physical and emotional changes, including depression. Most women who have "natural" menopause experience a more gradual decrease in hormone levels.
It is somewhat reassuring to remember that perimenopause is a temporary phase. And most symptoms are temporary, such as mood changes and hot flashes. For most women perimenopause will last two or three years, though for some it lasts as long as 10 or 12 years.

A few symptoms — vaginal dryness and changes in sexual desire - may persist or worsen after menopause unless they are treated.

Women in perimenopause have reduced fertility but they are not infertile. Although menstruation may be sporadic, pregnancy can happen. That's why women need to consider birth control during perimenopause. All women should discuss their contraceptive options with a clinician — whether or not they are menstruating.

As women age, the number of viable ovarian follicles decreases. It becomes more difficult to stimulate the remaining follicles to release an egg. Still, the body struggles to stimulate ovulation by increasing FSH and LH production. Occasionally, FSH and LH succeed in developing a follicle to maturity and ovulation occurs. However, as menopause nears, these attempts are increasingly ineffective and the menstrual cycle begins to sputter. Menstrual periods become irregular as a result of repeated failures to ovulate. Missed ovulation leads to an excess of estrogen over progesterone, because the follicle did not rupture, no corpus luteum exists to produce progesterone.

Consequently, symptoms of estrogen excess, like headache, fluid retention and irritability can occur. Declining estrogen and progesterone levels can change the frequency, length and intensity of menstrual periods. (Note: irregular periods and heavy bleeding can be signs of a more serious condition. Please contact your physician if you experience these symptoms.) The changes in hormone balance can result in a variety of symptoms. In the end, the few remaining follicles are too worn out to respond, and menstruation ceases entirely. The change has begun!

Certain surgical or medical treatments can bring on earlier than expected. These include:

Hysterectomy

Chemotherapy and radiation therapy

Premature ovarian failure

These surgical or medical conditions often intensify the conditions associated with menopause and may lead to major physical and emotional changes, including depression. Most women who have "natural" menopause experience a more gradual decrease in hormone levels.

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