Menopause
Study reveals gap between perimenopause expectations and experience
A study of 17,494 people has revealed a gap between perimenopause symptoms people expect and those they report, with fatigue and exhaustion far outranking hot flushes.
While 71 per cent associated perimenopause with hot flushes, those reporting perimenopause cited exhaustion (95 per cent) and fatigue (93 per cent) far more often.
Among more than 12,000 participants over age 35, the most common symptoms were fatigue (83 per cent), exhaustion (83 per cent), irritability (80 per cent), low mood (77 per cent), sleep problems (76 per cent), digestive issues (76 per cent) and anxiety (75 per cent).
Researchers at Mayo Clinic conducted the study with Flo, a women’s health application, assessing symptoms among 17,494 people from 158 countries.
First author Mary Hedges is a community internal medicine physician at Mayo Clinic in Florida.
Hedges said: “This study shines a light on how little we still understand about perimenopause and how much it affects people’s daily lives.
“At Mayo Clinic, we’re working to expand that understanding so we can improve awareness and guide care that truly meets the needs of each patient.”
The findings show fatigue, mood changes and sleep-related issues sit at the centre of many people’s experiences during perimenopause, the years leading up to the final menstrual period and the first year after it ends. This transition can start in the 30s and last several years.
When asked what they associate with perimenopause, participants most often named hot flushes (71 per cent), sleep problems (68 per cent) and weight gain (65 per cent).
The study distinguishes between exhaustion and fatigue, with exhaustion defined as a general decrease in performance, impaired memory, decreased concentration and forgetfulness, whilst fatigue refers to physical exhaustion.
Researchers noted that hormone shifts may disrupt the body’s natural rhythms and restorative sleep, while mood changes can be influenced by hormones, inflammation and diet.
Women with primary infertility may face a higher risk of early menopause and reach it about a year earlier, a study suggests.
The findings suggest women with primary infertility may be more likely to enter menopause before the age of 45.
The increased risk appeared most notable among women with unexplained infertility or a history of endometriosis.
Dr Stephanie Faubion, medical director for The Menopause Society, said: “This study shows that women with primary infertility, specifically those with unexplained infertility or a history of endometriosis, were at risk for early menopause.
“Given that early menopause is linked to adverse long-term health consequences, these women may benefit from counselling that they are at risk of early menopause.
“This will allow them to monitor for early menopause and to seek treatment with hormone therapy, if indicated.”
Early menopause is usually defined as menopause before age 45, while premature menopause is menopause before age 40.
Women who experience menopause earlier may face symptoms for longer and have a higher risk of long-term health problems.
These can include cardiovascular disease, osteoporosis and neurocognitive disorders. Osteoporosis weakens bones, while neurocognitive disorders affect memory, thinking or brain function.
The study, highlighted by The Menopause Society, involved nearly 700 people, roughly half of whom had been diagnosed with primary infertility.
It found that women with a history of primary infertility underwent natural menopause about one year earlier than those without such a history.
Researchers found no association between infertility and premature menopause.
Infertility affects around one in six people globally and can have consequences beyond family planning.
Previous research has linked infertility with higher rates of cancer and cardiovascular disease, although causes vary and may involve genetic, hormonal, in-utero or lifestyle factors.
In-utero factors are influences that occur while a baby is developing in the womb.
Earlier studies looking at links between infertility and early or premature menopause have produced mixed results, with some not accounting for different types of infertility.
The new study suggested that women with unexplained infertility or a history of endometriosis may have an increased risk of early menopause.
Endometriosis is a condition where tissue similar to the lining of the womb grows elsewhere in the body. It can cause pain, heavy periods and fertility problems.
Known risk factors for early or premature menopause include tobacco use, low body mass index, not having given birth and starting periods at a younger age.
Women who have had more childbirths and those with a history of oral contraceptive use have previously been linked to later menopause.
The researchers said women with primary infertility may benefit from additional counselling because of the systemic and long-term health effects of early menopause.
They also said women should be encouraged to seek evaluation and treatment if they experience a new loss of menstrual cycles.
Smartwatch data may help track menopause sleep changes after researchers analysed more than 94,000 nights of Apple Watch sleep records.
The study analysed more than 94,000 nights of sleep data from 338 participants in the Apple Women’s Health Study.
It found that many participants spent more time awake during the night in the 12 months before and after their final logged menstrual period.
For the past several years, Apple has used the Apple Watch to support large-scale health studies through the Apple Research app.
These include the Apple Women’s Health Study, the Apple Heart and Movement Study, and the Apple Hearing Study, which launched in 2019 with research partners including Harvard, Brigham and Women’s Hospital, the American Heart Association and the University of Michigan.
In February 2025, Apple said those studies had grown to more than 350,000 participants across the US.
Recently, researchers at Harvard T.H. Chan School of Public Health published results on how sleep patterns change during perimenopause.
The study looked at wake after sleep onset, or WASO, which measures how much time a person spends awake after first falling asleep.
In the 18 months leading up to menopause, 60 per cent of women with sleep tracking data showed increased WASO compared with the previous six months.
The average increase was 7 per cent.
Researchers also found that, in the 12 months before and after the last logged menstrual period, participants spent about 0.8 per cent more of their sleep time awake after menopause than before.
However, the findings varied widely between participants.
Some women had much larger increases in time awake after menopause, while others had no meaningful sleep change at all.
The researchers said this reflects the fact that each person experiences perimenopause and menopause differently.
Participants who tracked sleep also logged menopause symptoms.
Hot flushes were reported by 82.3 per cent of participants, irritability by 68.1 per cent, mental exhaustion by 65.7 per cent and sexual symptoms by 65.6 per cent.
Among participants with more severe menopause symptoms, the symptoms most closely linked with worse sleep were bladder symptoms, joint symptoms, heart discomfort and depressive symptoms.
The researchers also shared recommendations that may help women sleep better during perimenopause.
These include maintaining a cool sleeping environment, keeping a consistent sleep schedule, getting regular movement, avoiding common bladder irritants and limiting fluids in the hours before bedtime, and prioritising relaxation or mindfulness techniques as part of a bedtime routine.
Women are still being failed by menopause care despite a surge in online advice, with experts saying symptoms are too often minimised or dismissed.
The researchers exposed a gap between the surge of menopause information available online and the quality of medical care women receive.
A team of anthropologists and psychologists explored the physical and emotional toll of menopause, including its impact on work and personal lives, through interviews with 60 women aged 45 to 61 between March and June 2021.
The findings were published in a new book, We Need to Talk About Menopause.
The interviews showed how women continue to “needlessly suffer” as they sort through misinformation from influencers, celebrities and so-called experts.
The authors said: “You would think in an age where humans are developing commercial space flight, self-driving cars, and AI personal assistants who can project movies onto the palm of your hand, we would understand more about menopause, something a little over half of the population is guaranteed to experience in their lives.”
The interviews revealed wide variation in women’s experiences of doctors.
Some felt they could have an open dialogue, while others said they were “shut down”, including being told they were too young for menopause.
One woman said she bled heavily for a year before she was taken seriously.
The authors said menopause is still poorly understood, with disagreement over whether it should be seen as a medical condition or a natural part of ageing.
There are more than 100 recognised symptoms, although some women experience none.
Among those interviewed, 78 per cent reported weight gain and redistribution, particularly around the belly area, which was resistant to diet and exercise.
Fifty-eight per cent experienced mood disturbances including anxiety, depression, irritability and unprecedented levels of rage.
Many women said they were blindsided by symptoms they had never known existed.
One participant said she only realised rage was a menopause symptom after seeing it mentioned in a television commercial.
Women also described severe memory problems and brain fog that colleagues mistook for incompetence, leading successful professionals to question their abilities at the peak of their careers.
Brain fog can include problems with concentration, memory and clear thinking.
According to Statistics Canada, 70 per cent of women turn to the internet as their primary source of menopause information.
The authors said this information vacuum has spawned a £14.7bn global “meno-tech” industry, with influencers, celebrities and telehealth companies offering products ranging from £98 creams to unnecessary blood tests.
They said: “The growth of interest in menopause has also been accompanied by a wave of unsubstantiated information.
“Many websites market expensive creams, supplements, and weight-loss schemes that promise to keep women youthful and attractive, with little evidence to support their claims.
“Reliable, accessible information about menopause and perimenopause is still lacking. Despite increased attention to the importance of physician training and the search for menopause specialists, the medical profession as a whole continues to provide limited support in this area.”
The authors also highlighted the effect of menopause in the workplace.
The House of Commons Women and Equalities Committee has warned that Britain is “haemorrhaging talent” because of menopause, with 14 million workdays lost each year, according to the Office for National Statistics.
Despite this, studies have shown 80 per cent of UK employers have yet to implement proper support measures for menopausal women.
Some women said simple workplace adjustments made a significant difference.
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