Lack of awareness and healthcare barriers fuel perimenopause uncertainty

Perimenopause is an underrecognized life stage that is often accompanied by complex and fluctuating symptoms. A new study sought to quantify the prevalence of perimenopause uncertainty and identify the primary causes. It found that perimenopause uncertainty is prevalent and largely because of knowledge gaps and barriers to confirmation and care. Results of the study are published online today in Menopause, the journal of The Menopause Society.

Perimenopause is the transitional period leading up to the final menstrual period. Known as a time of considerable hormone changes, it usually begins when women are aged in their mid-40s, although onset can vary widely. It is estimated that approximately two million women begin perimenopause each year in the United States and remain in this phase for roughly 4 to 8 years.

Perimenopause symptoms can significantly affect women's well-being, with more than half (59%-65%) experiencing hot flashes as well as psychological or urogenital symptoms that can impair daily functioning, diminish quality of life, and reduce work productivity. Despite its prevalence, recognizing perimenopause remains a challenge for both women and clinicians. A key reason is that there is no laboratory test or biomarker to definitively determine the perimenopause stage. Complicating a clear diagnosis is the fact that perimenopause symptoms vary widely and evolve over time. These symptoms also overlap with a wide range of other conditions, including premenstrual syndrome, thyroid disease, and mental health conditions.

Limited public awareness and inconsistent clinical recognition further compound this uncertainty. Many women report little prior knowledge about perimenopause, and clinicians typically receive inadequate training and education on perimenopause and menopause care. In addition, there has been a propagation of misinformation about menopause and symptom management in recent years.

Prior studies have described elements of perimenopause uncertainty, such as confusion about symptoms, misconceptions about the age at which symptoms might occur, and invalidating healthcare encounters, but most were small, focused only on women aged older than 40 years and were rarely US based. In addition, there is no known study to have quantified how common perimenopause uncertainty is, what its common drivers are, and whether those drivers differ across age groups or levels of symptom burden.

In this new study involving more than 7,600 US women aged 35 years and older, researchers sought to estimate the prevalence of perimenopause uncertainty and examine subgroup differences by age and symptom severity. Overall, 34% of participants reported being unsure of their reproductive stage. Uncertainty varied by age and symptom severity, peaking at 42% in those aged 40 to 44 years, and 37% in those with severe symptom burden.

Symptom confusion and attribution were the most common (56%), reflecting difficulties interpreting bodily changes and distinguishing perimenopause from other causes. Knowledge gaps and information-seeking accounted for 28% of responses, highlighting limited health literacy, age-based assumptions, and active searches for evidence. Barriers to confirmation and care (16%) described dismissive healthcare encounters and reluctance to acknowledge perimenopause. Younger women (aged 35-39 y) were more likely to cite knowledge gaps, whereas healthcare barriers peaked in the 40 to 44-year-old age group.

Based on these results, the researchers recommend that clinicians should be more open and flexible to consider the multidimensional symptom profiles of perimenopause and normalize cognitive, emotional, and physical changes that can occur earlier rather than over-relying on menstrual irregularity as the principal indicator. Although cycle irregularity is characteristic of perimenopause, many women have symptoms before they experience significant cycle changes.

Survey results are published in the article "Exploring prevalence and drivers of perimenopause uncertainty among US Women: a mixed-methods study."

This large study showed that one in three US women aged older than 35 years are not sure whether they are in perimenopause. Further, the study highlights that symptom confusion, misconceptions, and barriers to care are leaving many women without the clarity and support they need during the menopause transition. Recognizing perimenopause uncertainty as a common experience can help shift the conversation from searching for a diagnosis to providing women with the information, validation, and support they need to navigate this natural life transition with confidence."

Dr. Stephanie Faubion, medical director for The Menopause Society and one of the authors of the study