Five years ago, as an OB/GYN, you rarely saw women in their early 40s or even 30s asking about hormone replacement therapy. And when they did, it was often brushed off.

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It makes me sad to admit that our training in perimenopause and menopause was poor at best — both in medical school and residency. On one hand, most of our teachers were men, which I believe played a huge role in the lack of empathy for what women experience in their 40s. On the other hand, women themselves were less vocal about their symptoms and often suffered in silence.

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Now, after caring for hundreds of women over the past 12 years, I’ve noticed that symptoms are showing up earlier — sometimes in the late 30s. The age range between 38 and 50 is where individualized care really matters, because as we’ve said before, there is no one-size-fits-all solution for perimenopause.

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The Challenges of Perimenopause Care

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As an OB/GYN, you’re constantly balancing symptoms, the need for birth control, possible plans for children (whether first or additional), heavier or irregular periods, and of course… what their friends are taking. Let’s be honest: when life is hectic and you’re dealing with fatigue, insomnia, or weight gain, you’re definitely going to listen to your best friend or what you saw on social media.

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I try to approach this “gray area” with an open mind: every patient is different. And honestly, lab results won’t tell you exactly how far you are into perimenopause or menopause. It’s like chasing a toddler: one minute they’re going one way, and the next, they’re sprinting in the opposite direction.

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Birth Control vs. Hormone Therapy

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For women in very early perimenopause, birth control is often recommended — especially if periods are irregular or heavy. But it’s also needed to prevent pregnancy. Because yes, even in perimenopause, pregnancy is still a real risk. Almost every OB/GYN has had patients on menopause hormone therapy who became pregnant. It isn’t common, but it can happen until you’ve officially reached menopause (one full year without periods).

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Some patients, however, don’t tolerate birth control well, or they’re further along into perimenopause. In those cases, menopausal hormone therapy (MHT) can work wonders. I always remind patients that because it takes years for the female body to reach this stage, it also takes us some time to figure out the best treatment. We aim to get it right the first time, but sometimes dosage adjustments are necessary — and that’s completely normal.

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The Bottom Line: It’s Never Too Early

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On the science side, is menopause actually happening earlier? So far, there’s no strong evidence to support that. In fact, some studies suggest menopause may even be occurring later. However, there are theories that perimenopausal symptoms, early menopause, and primary ovarian insufficiency could be on the rise. Environmental and lifestyle factors, as well as chronic health conditions that are becoming more common, might play a role.

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So, to answer the original question: no, it’s never “too early” to consider hormone therapy. Every body is unique, and your symptoms deserve attention no matter your age. Don’t hesitate to ask your OB/GYN or healthcare provider about the best treatment for you.

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Want help with your perimenopause symptoms? Book a 15-min FREE virtual consultation with us to see if we’re the right fit for your menopause care.

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And don’t forget to visit our Services page to explore our perimenopause and menopause care packages!

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References: 

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Appiah, D. et al (2021). “Trends in Age at Natural Menopause and Reproductive Life Span Among US Women, 1959-2018.”

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