Perimenopause, the transition that typically lasts four to eight years before menopause, is a natural part of aging for most women. Yet many people don’t know whether they’ve entered it, according to a recent study published in the journal Menopause.
As Health reports, about one-third of women 35 and older surveyed through the period- and fertility-tracking app Flo said they were unsure of their reproductive stage. The uncertainty could mean many people aren’t getting the healthcare they need, experts said.
“Perimenopause is Common, but Recognizing it is Not”
For the study, researchers from the UK, Ireland, and the United States set out to assess how many women actually know whether they’ve entered perimenopause, as well as the reasons behind any confusion.
“Understanding these drivers is the first step toward improving education, awareness, and support for women during this transition,” said Yihan Xu, PhD, MSc, MPH, the study’s lead author and a health economist and lead research scientist at Flo Health.
The researchers surveyed 7,640 women through the Flo app. Overall, 34% of participants reported being unsure of their reproductive stage. Uncertainty varied by age and symptom severity, peaking at 42% in women ages 40 to 44 and 37% among those with severe symptoms.
Mindy Goldman, MD, an ob-gyn and a clinical professor at the University of California–San Francisco School of Medicine, cautioned that those results may not be representative of the broader population, given participants were recruited through a women’s health app and may be more engaged with their health than most.
Still, “this study highlights something many clinicians who care for midlife women see every day: Perimenopause is common, but recognizing it is not,” Goldman said. “For readers, the takeaway is reassuring.”
What’s Behind the Uncertainty?
The study’s main strength, Goldman said, is that “it doesn’t just quantify the problem—it explains why women are uncertain.”
So what’s behind the confusion? The most common reason, cited by 56% of participants, was that it’s too difficult to know which symptoms actually point to perimenopause, since many overlap with those of other conditions.
Unlike menopause, which has a clear, easily recognized milestone—12 consecutive months without a period— perimenopause is characterized by fluctuating estrogen and progesterone levels that can cause dozens of symptoms. Irregular periods and hot flashes are some of the most obvious signs, but others, such as joint pain and headaches, are less specific.
“What’s so fascinating about perimenopause is some people have almost no symptoms, and some people have a ton of symptoms,” said Robin Noble, MD, MHCDS, MSCP, a certified menopause practitioner, chief medical advisor of Let’s Talk Menopause, and chief medical officer of EncorVita Health. “It exacerbates the problem.”
A lack of knowledge about what perimenopause actually feels like was the second most common reason for uncertainty, cited by 28% of participants. That was followed by barriers to getting confirmation or support from the healthcare system. Some participants reported feeling dismissed or told they were “too young” despite having symptoms, Goldman said.
Younger women were more likely to report knowledge gaps, while women ages 40 to 44 were most likely to report healthcare barriers.
Why Knowing If You’re in Perimenopause Matters—and How to Tell
Knowing whether you’re in perimenopause is important because it can validate what you’re experiencing and help you get effective treatment sooner, Goldman said.
Hormone therapy, which comes in forms such as patches or pills and replaces some of the estrogen and progesterone the body loses, can help relieve symptoms like hot flashes and vaginal dryness. It can also help prevent bone loss, which can lead to osteoporosis.
“If people don’t know they should be aware, it’s a missed opportunity to really impact their healthspan and their life,” Noble said.
Unfortunately, there’s no “single test” that can tell you if you’re in perimenopause, according to Goldman. Blood and saliva hormone tests aren’t particularly helpful because they capture levels at only one point in time, and levels fluctuate wildly throughout this stage.
Instead of relying on those tests, Goldman said, clinicians make the diagnosis by looking at a woman’s age, menstrual changes, medical history, and symptom pattern. Perimenopause symptoms run the gamut, but common ones include hot flashes, night sweats, headaches, weight gain (especially around the abdomen), and vaginal dryness and irritation.
Your clinician may order blood tests to rule out other conditions that can cause similar symptoms, such as thyroid disease, anemia, or diabetes, especially if symptoms begin unusually early, such as before age 40, Goldman added.
According to her, healthcare providers who treat women in midlife have a responsibility to help patients understand if their reproductive stage could be contributing to symptoms. “We need to recognize the broad spectrum of perimenopause symptoms, listen carefully to women’s experiences, and rely on thoughtful clinical assessment,” she said. “The key is to look at the whole person, not just the lab results.”
If you’re a woman in your late 30’s or older, and you suspect you might have entered perimenopause, consult with your OBGYN and discuss options for easing your symptoms.
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