Perimenopause at 42: What to Expect, Why It Gets Dismissed, and How to Advocate for Yourself

At 42, you might have expected another decade before any of this became relevant. But the average age for perimenopause to begin is somewhere between 40 and 44, which means 42 is squarely in the middle of normal. You're not early. You're not unusual. You're exactly where a lot of people are.

What nobody tells you in advance is how hard this stage can be to identify. The early symptoms of perimenopause are diffuse. They overlap with burnout, with stress, with the general accumulation of a demanding decade. Doctors sometimes dismiss them. You might dismiss them yourself. But they're worth paying attention to, because understanding what's happening gives you options.

Why 42 is well within the normal range

Perimenopause doesn't follow a single calendar. The menopausal transition typically begins somewhere between 40 and 50, with the average age of menopause itself (12 consecutive months without a period) being around 51 to 52. If perimenopause lasts 4 to 8 years on average, then starting at 42 or 43 puts you on a completely typical timeline.

Where you personally begin the transition is shaped by genetics more than anything else. When your mother went through menopause is one of the strongest predictors of when you will. Smoking accelerates the timeline. A very low body weight, certain autoimmune conditions, and some cancer treatments can also bring it earlier. But for most people at 42 who start noticing changes, no specific cause explains it. This is just when your transition began.

Knowing that you're in a normal range matters, not just for your peace of mind, but because it changes how you talk to your provider and what kind of support you can access.

Early symptoms at 42 and what they feel like

Early perimenopause is sneaky. The symptoms often arrive one at a time, each easy to explain away with a separate story.

Changes in your cycle. This is usually the first thing people notice. Your period might arrive earlier than expected (a shorter cycle, typically defined as less than 24 days) or occasionally later. You might have a heavier flow one month and a lighter one the next. Spotting between periods can begin. PMS, particularly the emotional components like irritability, low mood, and anxiety in the week before your period, often intensifies before any other symptom appears.

Sleep changes. Waking between 2 and 4 AM, trouble falling asleep despite fatigue, or lighter less restorative sleep are hallmark early signs. Progesterone, which declines first in the transition, is one of your brain's primary sedating hormones. As it drops, your sleep often becomes more fragile.

Mood shifts that don't make sense. Anxiety appearing out of nowhere, a shorter fuse, or a low-grade flat feeling that doesn't fully lift can all signal fluctuating estrogen. Estrogen influences serotonin, dopamine, and GABA. When it swings, your emotional steadiness goes with it.

Physical changes. Joints that feel stiffer in the morning. Headaches that arrive around your period more reliably. A slight shift in how your body holds fat, particularly around your midsection. Skin that feels drier or less elastic. These are slower changes, easy to attribute to aging in general, but often driven by declining estrogen.

Brain fog. Forgetting words. Losing your thought mid-sentence. Feeling slower to process things that used to be quick. This is one of the most unsettling early symptoms because it doesn't feel hormonal. It feels like something is wrong with your brain. It usually isn't. Estrogen supports brain blood flow and neurotransmitter activity, and when it fluctuates, cognitive sharpness goes with it.

Why these symptoms get dismissed

The dismissal of perimenopause symptoms in the early 40s is extremely common, and it happens for a few converging reasons.

First, many providers still associate perimenopause with the late 40s or early 50s. When you come in at 42, it genuinely may not be the first explanation that comes to mind. Second, the symptoms are nonspecific. Fatigue, mood changes, sleep disruption, and brain fog can have many causes. It's medically reasonable to rule other things out first. The problem is when ruling things out becomes a reason to stop looking entirely.

Third, a single FSH blood test taken on the wrong day can come back in the normal range and be used to dismiss the possibility entirely. FSH fluctuates dramatically during the early transition. A normal result on one day doesn't mean perimenopause isn't beginning. But that nuance often doesn't make it into the appointment.

If you've been told "your labs are normal" and sent home with your symptoms unaddressed, you are far from alone. The next step is to ask more specific questions and, if needed, to seek out a provider with more specific knowledge of the perimenopause transition.

How to push for proper testing

Walking into your appointment with specific requests changes the dynamic. You don't have to accept a vague reassurance.

Ask for: FSH and estradiol tested on day 2 or 3 of your cycle (the early days of your period) for the most informative baseline. AMH (anti-Mullerian hormone), which reflects ovarian reserve and fluctuates less across the month than FSH, giving a more stable picture. A full thyroid panel (TSH, free T3, free T4), because thyroid dysfunction mimics perimenopause closely. Ferritin, because low iron stores cause fatigue, hair loss, and mood changes that can compound hormonal symptoms.

Bring documentation. A simple log of your last 3 to 4 cycles, noting length, flow, and when symptoms are worst, is more persuasive than a general description. It also helps the provider understand the pattern.

If hormonal contraception is part of your current routine, know that it artificially suppresses FSH and estradiol. Lab results while on the pill will generally not reflect your actual ovarian status. Ask your provider how to interpret results in that context, or discuss whether a temporary break for testing makes sense for your situation.

If your primary care provider is not engaging with this seriously, ask for a referral to a gynecologist or a menopause specialist. These providers have more specific training and are more likely to have up-to-date knowledge of the perimenopause transition in people in their early 40s.

What the next several years might look like

Perimenopause is not a fixed experience. It evolves in stages, and understanding the rough arc can help you feel less blindsided by what comes next.

In the early transition, cycles are still mostly regular but starting to shift. Symptoms may be mild and intermittent. You may have months that feel entirely normal followed by weeks that don't. This unpredictability is itself a characteristic feature of the early stage.

As the transition progresses, cycles become more irregular. Some may be skipped entirely. Flow can vary significantly. Vasomotor symptoms like hot flashes and night sweats may become more frequent or more intense. This middle stage, often in the mid-to-late 40s, tends to be the most symptomatic for many people.

The late transition, marked by periods that are sparse and widely spaced, typically lasts one to three years before the final menstrual period. After 12 consecutive months without a period, menopause is confirmed.

For someone starting the transition at 42, this whole arc might play out over 8 to 10 years. That sounds like a long time, but it also means you have years to make choices that support your health throughout. Strength training, nutrition that prioritizes protein and bone support, sleep habits, and stress management all pay forward during this transition and beyond it.

Building a toolkit that grows with you

The most useful thing you can do right now is start paying attention. Tracking your cycle, your symptoms, your sleep quality, and your mood across a month reveals patterns that would otherwise be invisible. You might notice that your worst anxiety reliably falls 5 to 7 days before your period. Or that your sleep deteriorates in a specific part of your cycle. That information is actionable.

PeriPlan is built specifically to make this kind of tracking useful during perimenopause. The day-type system maps how you're feeling against your cycle in a way that builds into a meaningful picture over time. You're not just logging data into a void; you're building the information your provider needs to help you make good decisions.

Beyond tracking, the practical pillars are consistent. Strength training two to three times a week protects bone density and supports mood. Protein intake becomes more important as you move through the transition (aim for around 100 grams per day if that's achievable for you). Managing cortisol through sleep, stress reduction, and appropriate exercise prevents the cascade of symptoms that high cortisol accelerates. Limiting alcohol, which disrupts sleep and amplifies hot flashes more as perimenopause progresses, is worth considering even if it's not yet a problem.

Hormone therapy is a legitimate option to discuss now, not only when symptoms become severe. For most healthy people in their 40s, the risk-benefit profile is favorable. Starting a conversation with an informed provider while things are manageable, rather than waiting until you're in crisis, gives you much more choice.

Being 42 and in perimenopause is not a problem to be solved. It's a transition to be understood. The symptoms are real, the biology is real, and the management options are real.

You deserve a provider who takes this seriously and a clear picture of what your own pattern looks like. Both of those things are within your reach.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.