Ask Dr. Sarah: Can You Start Menopause in Your 30s, or even 20s?

It’s a question I hear more often than you might expect: “Can I go through menopause in my 30s, or even younger?” or “Am I menopausal already?”

Menopause is a term we use to signify that the period has completely stopped for one year. So what is the problem with using this terminology? Most women can have all the symptoms of menopause, have very low levels of hormones and still have a period for decades before it stops!

So, if you’re in your early 30s, or even 20s, and exhausted, foggy, have anxiety, high cortisol, weight gain, gut issues, insomnia, and other symptoms, and wondering if something bigger is going on—you’re not alone. It can be scary to even ask the question, but I’m so glad you’re here. You can have all the symptoms of menopause and still not be menopausal – but that doesn’t mean you don’t need to start BHRT.

I’m Dr. Sarah Daccarett, MD, founder of Inner Balance and a specialist in women’s hormones and longevity. If you’re reading this, you may be trying to connect the dots between your symptoms and your hormones—and this article will help you understand what menopause is, what perimenopause is and why their terminology is really confusing women. Most importantly, what to do next.

Let’s get clarity together.

Perimenopause vs Early Menopause

What is the difference? The bottom line: The only difference is that the period stops fully in early menopause. Early menopause is rather rare, but can still happen.

On the other hand, perimenopause is very common! Where women have all the symptoms of menopause, but are still having a period. The ovaries just stop working as well as they used to and can’t make consistently enough estradiol and progesterone to support you.

What’s confusing is that many women in their 30s still get a period but have severe symptoms of hormonal decline. They may also be told that everything is “normal” based on standard blood work—but they don’t feel normal.

Common symptoms of low hormones (perimenopause)

• Crushing fatigue that doesn’t improve with rest
• Insomnia or waking at 4am for no reason
• Weight gain or body composition changes
• Low libido or vaginal dryness
• Anxiety, irritability, or mood swings
• Brain fog or trouble concentrating
• Increased sweating or BO
• Thinning hair
• Dry skin, eyes, mouth and hair

What are women being told who are young and have menopausal symptoms?

• Your fatigue and symptoms are from kids, or extreme stress (career, caregiving, burnout)
• You are too young to be experiencing this and too young to start BHRT. That HRT is only for menopausal women and you have to wait until the period stops.

Some women are told they have “estrogen dominance,” high cortisol, adrenal fatigue, or thyroid issues. Others are offered antidepressants or supplements. But no one is looking at the bigger hormonal picture.

That’s where Inner Balance comes in.

Let’s look at a few real-world examples of women and their lab results – who benefited from starting hormone therapy.

Labs in Perimenopause vs Menopause

Menopause example hormone panel (simplified & basic panel):

Perimenopause example hormone panel (simplified & basic panel):

In menopause, all hormones are low and FSH is elevated. This makes labs easy to interpret and doctors more comfortable with making a diagnosis. However, you shouldn’t have to wait for your doctor to be comfortable before you can be comfortable. You don’t need to wait for confirmation labs – or your period to stop.

In perimenopause it is common for estradiol to measure as normal, or even elevated. This gives the impression of “estrogen dominance” and women are told to lower their estrogen with supplements, high fiber diets or other measures.

The problem with this approach is that FSH is elevated. This shows that the brain doesn’t think there is enough hormone around – consistently. The brain is screaming at the ovaries to produce more estradiol and progesterone, but the ovaries cannot make progesterone and only makes inconsistent spikes of estradiol. The treatment is to start both estradiol and progesterone BHRT. Taking estradiol and progesterone calm the brain, reduce FSH and prevent the ovary from over producing estradiol. This results in more stable estradiol levels that are lower and progesterone is restored as the dominant hormone – treating the estrogen dominance.

I often get asked “Dr. Sarah, won’t taking estradiol make my high estrogen even higher?” The short answer is: No. Taking estradiol, calms the brain and suppresses the ovary from making your life a roller coaster with the ups and downs of estrogen production. The ovaries are fatiguing or failing in perimenopause – the elevated estradiol supports that there is dysfunction in the ovaries and support is needed. Read more about the myth of estrogen dominance.

If you have been trying everything to lower your estrogen and aren’t getting the results you want – maybe it is time to take a different approach.

What to Do About It

First, breathe.

You are not broken. You’re not too young. And you do have options.

Here’s the path we often take at Inner Balance:

• Step 1: Evaluate your symptoms with a quiz or consult
• Step 2: Decide if its right for you
• Step 3: Begin foundational hormone support
• Step 4: Adjust based on how you feel (not just numbers)
• Step 5: Continue building a long-term hormone optimization plan

This isn’t about “fixing” you. It’s about supporting the hormonal foundation your body needs to thrive. If you’re experiencing experiencing any of the following, it’s time to consult someone who understands hormones:

• Weight gain, or harder time exercising
• Insomnia
• Anxiety, depression or irritability
• Fatigue, brain fog, or lack of focus
• Hair loss, dry skin, dry eyes, itchy ears, or itchy skin
• 100+ lesser known symptoms

You don’t have to wait until menopause. If your hormones are off now, there’s no benefit to struggling through it for 10+ years. Here are some stories of women who benefited from getting started.

Take the First Step

Hormone changes can happen earlier than most people think—and the earlier you recognize the signs, the sooner you can start feeling like yourself again.

Want answers?

• Take our Health Quiz
• Read our guide: 12+ Signs Your Hormones Are Off
• Read our guide: Can you start HRT before menopause?

You deserve clarity, support, and real solutions—no matter your age.

—Dr. Sarah Daccarett, MD