Average Age of Perimenopause

One of the most common questions I hear in clinic is:
“Am I too young for this to be perimenopause?”

The short answer is: probably not.

What Is the Average Age of Perimenopause?

Perimenopause is the transitional phase leading up to menopause, marked by hormonal fluctuations rather than a sudden stop in periods. While menopause itself (defined as 12 months without a period) occurs on average around age 51, perimenopause typically begins much earlier.

For most people, perimenopause starts between the mid-40s, but for many it can begin in the late 30s or early 40s. And importantly, symptoms can appear years before periods become irregular. For many women the first signs are fatigue, brain fog or difficulty with memory. The vagueness of these symptoms can lead women to forego treatment or support for years!

This is why so many people feel confused, dismissed, or told “you’re too young” when what they’re experiencing is very real.

Why Mental Health Symptoms Are So Common in Perimenopause:

Perimenopause isn’t just about hot flashes or cycle changes..it’s a neurological, cultural, identity and psychiatric transition, too.

During this time, estrogen levels fluctuate unpredictably. Estrogen plays a key role in regulating neurotransmitters like serotonin, dopamine, and norepinephrine, which are essential for mood, focus, sleep, and emotional regulation. When estrogen rises and falls erratically, the brain feels it. I recently learned researchers are studying estrogen as an important component of identity so the changes in how we feel postpartum and/or during perimenopause made a lot more sense to me after learning this!

Research shows that during perimenopause there is an increased risk of:

• Depression, including first-episode depression in people with no prior history
• Anxiety and panic symptoms
• Irritability and emotional reactivity
• Sleep disturbance, which further worsens mood
• Worsening of pre-existing conditions, such as depression, anxiety, ADHD, or PMDD

In fact, perimenopause is one of the highest-risk windows in a woman’s life for the onset or recurrence of mood disorders!

“Is This Hormones or Is This Mental Health?”

The answer is often: both.

This is where many people get stuck. Symptoms may be attributed entirely to stress, aging, or life circumstances—or, conversely, dismissed as “just hormones.” In reality, hormonal changes and mental health are deeply interconnected. We don't fully understand this but it's very clear hormones and mental health aren't separate entities.

Perimenopause often coincides with major life stressors: career demands, caregiving for children or aging parents, relationship shifts, identity changes, and grief around fertility or aging. Hormonal vulnerability layered on top of real-world stress can make symptoms feel overwhelming and unmanageable. Let's not forget the gaslighting that can occur, the vagueness of symptoms and so much more that we, as women, deal with!

Treatment Options That Actually Help:

The good news is that there are effective, evidence-based treatments—and care does not have to be one-size-fits-all.

Depending on your symptoms and history, treatment may include:

• Psychiatric medication, such as antidepressants or mood-stabilizing strategies. Our psychiatry team is prepared to support you through this transition if medication management is part of your plan.
• Hormone therapy, when appropriate, in collaboration with a knowledgeable medical provider. We don't prescribe hormones at this time but we often collaborate with local OBGYNs who do.
• Therapy, particularly approaches that support emotional regulation, identity transitions, and nervous system health. Our clinical team has some of the best clinicians in Texas to support you through this.
• Sleep interventions, which are often foundational and crucial to overall wellbeing.
• Lifestyle and behavioral strategies that support brain health during hormonal shifts which should be part of everyone's treatment plan.

What matters most is that treatment is individualized, collaborative, and grounded in both reproductive psychiatry and general mental health expertise.

You’re Not “Losing It." You’re in a Transition.

Perimenopause can be destabilizing, especially if no one has named what’s happening. Many people come into care saying, “I don’t feel like myself anymore.” That feeling is real and it’s also treatable.

At RPC, we specialize in understanding how hormonal transitions like perimenopause intersect with mental health. You deserve care that takes your symptoms seriously and helps you feel grounded again.

If you’re wondering whether perimenopause could be affecting your mental health, you’re not alone. You don’t have to figure it out on your own.

If you're looking to start or continue your journey toward wellness during perimenopause give us a call at (512) 982-4116 and our staff can guide you through your options!

‍