Under 40? What to Know Now About Perimenopause and Your Family History

Most of what you read about perimenopause is written for women in their late 40s. So if you're 34, or 38, it's easy to think it's not your problem yet. Something for later, like a pension or reading glasses.

But the years before 40 are when you have the most room to set things up well. Your family history is easiest to collect while the people who hold it are still around to ask. Your habits are easier to build before your hormones start changing. And if something does start early, you'll recognise it instead of being told you're too young.

So this one is for women under 40. It covers what runs in your family and what to do with it, the habits that matter most now, how to track your cycle, and when early symptoms need checking.

Why your family history matters before 40

Your family history doesn't tell you what will happen to you. What it does is tell you where to look, and when to start looking. That's useful, because a lot of health problems start years before they cause symptoms.

And it's the question that gets asked least. Most of us know vaguely that "Gran had something with her heart". Very few of us know what it was, or how old she was. The best time to find out is now, while your parents, aunts and grandparents can still tell you.

Here's what to ask, about your parents, brothers, sisters, grandparents, aunts and uncles on both sides:

• Heart attacks, angina or strokes, and how old they were when it happened.
• Type 2 diabetes.
• Broken hips, or osteoporosis (thinning bones).
• Any cancers, which type, and how old they were when they were diagnosed.
• When your mother and sisters had their menopause.
• Blood clots, thyroid problems and high blood pressure.

Write it down, with ages. "Dad, heart attack at 52" is far more useful than "heart problems on Dad's side".

What to do with it: the tools that use your family history

In the UK, there are tools clinicians already use that take your family history and turn it into something you can act on. These are the main ones.

QRISK3, for heart and stroke risk. It estimates your chance of a heart attack or stroke over the next 10 years, and it can be used from age 25. A parent, brother or sister with heart disease before 60 is one of the things it asks about, alongside your blood pressure, cholesterol, smoking and other health conditions. A higher score means checking your blood pressure and cholesterol earlier and more often, and taking the lifestyle side more seriously.

FRAX, for bone risk. It estimates your chance of breaking a bone over the next 10 years, and a parent who broke a hip is one of its questions. FRAX can't be run until 40, so for now, write the answer down so it's ready. Bone loss speeds up around menopause, so the bone you build and keep in your 30s matters.

Type 2 diabetes risk. A parent, brother or sister with type 2 diabetes raises your risk. If that's you, an HbA1c blood test (your average blood sugar over the last 2 to 3 months) gives you a starting number, and I'd recommend repeating it regularly rather than waiting for symptoms.

Inherited cancer risk. Some family patterns of cancer mean you may be eligible for NHS clinical genetics, the service that assesses inherited risk. The patterns that matter include several close relatives on the same side with breast, ovarian, bowel or womb cancer, cancers diagnosed at a young age, ovarian cancer at any age, or a known gene change in the family. If that sounds like your family, the route is a referral to clinical genetics through your GP: ask for it by name. If it comes up in a consultation with me, I write to your GP the same day so they can make the referral. The genetics team are the right people to assess what it means for you.

Early menopause in your family. The age your mother or sisters reached menopause can give a rough clue about yours, because timing partly runs in families. If they went through it early, any symptoms you get before 45 shouldn't be brushed off. They need to be checked.

Know your own numbers

Your family history tells you where to look. Your own numbers tell you where you're starting from. In your 30s, a baseline is useful because you can compare against it later, when things start to change.

• Blood pressure. Easy to check at home or in a pharmacy.
• Cholesterol and HbA1c, especially if heart disease or diabetes runs in your family.
• Thyroid, because thyroid problems are common in women and can run in families.
• Ferritin, your iron stores, especially if your periods are heavy.
• Vitamin D, because in the UK many of us run low over winter.

Ask for the numbers, not just "normal". A result at the very edge of the normal range in your 30s is something to watch, and the clinic aims for the level where you feel well, which is often higher than the minimum.

The Full Comprehensive Hormones & Health Blood Test covers most of these in one go: your hormones, a full thyroid panel, HbA1c, cholesterol, ferritin, vitamin D and B12. You can see all the clinic's tests on the testing page.

The habits that matter most now

None of these are new. Starting them in your 30s is what makes them easier. They're already in place when your hormones start changing, instead of being built while you're tired and not sleeping.

Strength training, 2 to 3 times a week. Muscle and bone both respond to load. Squats, lunges, push-ups, rows, with weights that slowly get heavier over time. Machines at the gym are a perfectly good way in. Swimming and cycling are great for your heart, but they don't load your bones much, so add something with weight or impact too. If you want to add creatine, it has good evidence for muscle and strength when taken alongside strength training, though the research in women is thinner than in men. I wrote about creatine for women here.

Protein at every meal. Aim for around 30g at each meal, rather than most of it at dinner. Breakfast is where most of us fall short, so my free 30g Protein Breakfasts guide is a good place to start.

Sleep. 7 to 9 hours, with the same wake-up time every day. It affects your blood sugar, appetite, mood and how well you recover from training.

Alcohol. The UK advice is no more than 14 units a week, spread over 3 or more days, with some drink-free days. It affects sleep, mood, blood pressure and breast cancer risk, so if heart disease or breast cancer runs in your family, this one matters even more.

If you smoke, stopping is one of the biggest things you can do for your heart, your bones and your lungs.

Track your cycle, so you notice changes early

Your cycle tells you a lot about your hormones, and it usually changes before anything else does. Write down the first day of each period, how heavy it is, and any symptoms that come and go with it, like mood, sleep, headaches or sore breasts.

The changes to look out for are cycles that get shorter or longer by about a week or more, periods that get heavier, worse PMS than you used to have, broken sleep before your period, and night sweats. On their own, none of these mean much. Together, and lasting a few months, they're a reason to ask about it. My free Symptom Tracker makes it easy to see a pattern.

When early symptoms need checking

Perimenopause usually starts in your mid-to-late 40s, but for some women it starts in their late 30s. And for some, the ovaries stop working normally before 40. That's called POI (premature ovarian insufficiency). It affects at least 1 in 100 women, and it can happen in your 20s and 30s.

If you're under 40 and your periods have become irregular or stopped for 4 months or more, and you're not pregnant, it needs to be checked promptly, especially if you have hot flushes, night sweats or vaginal dryness too. The test is a blood test for FSH (follicle-stimulating hormone, the message your brain sends to your ovaries), often repeated 4 to 6 weeks later to confirm it. If it is POI, treatment with hormones is usually recommended until at least the natural age of menopause, around 51, because without it, the risk to your bones and heart goes up years earlier than it should. I've written more about the signs of early menopause and POI, and what to ask for.

And between 40 and 45, menopause symptoms still need checking. That's early menopause, and treatment is usually recommended there too, so there's no need to wait it out.

If you'd like help with it

If you're under 40 and you'd like to get ahead, a Women's Health Consultation is where we go through your family history, your cycle, your habits and your numbers, and work out what to watch and when. And if you already have symptoms, or you think it might be starting early, the clinic's Menopause service is for perimenopause, menopause and early menopause. It's online by video or in person in Milton Keynes. We go through your history, symptoms, cycle and what you've already tried. If blood tests will change the plan, we arrange them, and because the clinic works with around 40 clinics across the UK for the blood draw, most women can have it done near home. Then we go through your results and your options together. If a prescription is the right option for you, it goes through the doctor and pharmacy we work with, and where it's needed, I write to your GP.

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Every Sunday morning I send out my newsletter, Beyond Prescriptions, with 1 women's health lesson and what to do with it. You can sign up here.

Debora Tentis, Women's Health Pharmacist.