​​​​​​So, you’ve been more anxious than usual lately. That’s just stress, right? And that need to kick off the covers the past few nights to cool down? Surely, that’s just because your thermostat is off a little. Maybe. But if you’re in your late 30s or 40s, it could be perimenopause.

If you’re experiencing symptoms typically associated with menopause—but think you’re too young—you’re not alone. A new study revealed that roughly 55 percent of women between 30 and 35 and approximately 64 percent between 36 and 40 feel “moderate” to “severe” menopause symptoms. But most don’t seek treatment until their mid-50s, the age when they believe menopause begins.

“The perception among most women is that they think they’re too young for these symptoms to appear. They think menopause is something that happens to much older women,” says Sarah E. Bartlett, MD​, a gynecologist with The Christ Hospital Physicians-Gynecology. “They don’t realize the actual timeframe in which perimenopause occurs.”

Here, Dr. Bartlett explains perimenopause and why it’s important to recognize​​ and address its signs.

What is perimenopause?

Perimenopause is the phase in a woman’s life right before menopause. Your estrogen levels start to change during this stage.

“We liken perimenopause to puberty in reverse. With menopause, your estrogen level drops and stays low. During perimenopause, it goes up and down,” Dr. Bartlett says. “You’ll experience some bothersome symptoms that don’t require treatment unless you want to improve your quality of life. Even if you don’t seek treatment, it’s vital to recognize perimenopause and talk about it with your doctor.”

Every woman who still has ovaries goes through perimenopause, but the timing is difficult to predict. It starts between two and seven years before menopause. Since women enter menopause between 45 and 54, you could see perimenopause symptoms as early as your late 30s.

Perimenopause affects every woman differently, but the most common signs include:

Pay attention to these symptoms, Dr. Bartlett says, recommending The Menopause Society™ as a resource to learn more about perimenopause. If these signs show up early—in your early 30s, for example—talk to your doctor. Without enough estrogen, you could be at risk for premature aging of your bones, brain and heart.

How can you diagnose and treat perimenopause?

Determining whether you’re in perimenopause can take some time. No diagnostic test for this phase of life exists. And a blood test to check your estrogen isn’t helpful because your hormone level changes from day to day.

“Identifying perimenopause is a diagnosis of exclusion. We need to investigate if your symptoms point to any other health conditions,” Dr. Bartlett says. “But once we rule out other problems like inflammatory or autoimmune conditions, it’s helpful that we can put a name to what you’re experiencing. It can give you satisfaction that you know what’s going on with your body and help you decide on any treatment.”

Perimenopause treatment mainly focuses on relieving your symptoms. To reach that goal, your doctor will likely recommend hormone therapy like birth control pills. Some women are reluctant to take a contraceptive, but the pill can address several perimenopause-related problems, Dr. Bartlett says.

“Birth control gives you a strong enough estrogen dose to control the chaotic hormonal ups and downs,” she says. “It regulates your menstrual cycle and overrides any irregular bleeding. And it also prevents pregnancy because fertility is a bit of a high-stakes game in perimenopause.”

In addition to hormone therapy, Dr. Bartlett says these healthy lifestyle behaviors can also help control any bothersome symptoms:

• Diet: Choose a diet high in fiber and protein, like the Mediterranean diet. This nutrition plan contains healthy fats, fruits and vegetables to support bone health, muscle mass and weight management.

• Sleep: Stick to a regular sleep schedule and try a relaxing night-time routine to help you wind down at bedtime. If you have night sweats, turn on the fan to keep your room cooler.

• Stress: Deep breathing, meditation and yoga can help reduce your stress levels. Additionally, regular exercise—roughly 30 minutes daily, five times a week—can relieve stress and reduce your perimenopause symptoms.

What should you discuss with your doctor?

If you’re experiencing any potential perimenopausal symptoms, make a specific appointment to talk about them with your doctor, Dr. Bartlett says.

“I tell all my patients to keep a list of their symptoms. Be sure you tell me about the ones that bother you the most,” she says. “We can monitor those, see if they point to any other health issues and watch how they change over time.”

She also recommends tracking your menstrual cycle. One missed or late period doesn’t indicate perimenopause. But a consistently irregular period does. If you can show your doctor that your period always shows up randomly, it can help them suggest the best symptom-relieving strategies.

Ultimately, Dr. Bartlett says, it’s important to remember that you’re not the only woman experiencing these changes. And taking the time to address them is critical for your long-term health.

“Make your symptoms and your quality of life a priority. Don’t let your symptoms and the impact they have on you get to the point where they feel insurmountable,” she says. “Talk with your doctor. Educate yourself about perimenopause. That way, you know what to expect over the next five to 10 years, and you’re empowered with knowledge to help you make the best decisions about any treatments you may need.”​