Hormonal health
Study finds 40% of perimenopausal women untreated

Nearly 40 per cent of perimenopausal women in a new study had untreated and potentially debilitating vasomotor symptoms such as hot flushes and night sweats.
This first-of-its-kind study explored how symptoms differ across the menopause transition and which best define the onset of perimenopause – the phase before full menopause.
It found that moderate to severe vasomotor symptoms (VMS) – including hot flushes and night sweats – were nearly five times more common in perimenopause than in premenopause. Vaginal dryness was 2.5 times more common, making it the second most defining symptom of perimenopause.
Researchers from Monash University in Australia analysed data from 5,509 women aged 40 to 69 between 2023 and 2024.
Of those, 1,250 were premenopausal, 344 were early perimenopausal, 271 were late perimenopausal and 3,644 were postmenopausal.
Professor Susan Davis, who leads the Monash University Women’s Health Research Program, said: “We already knew that VMS symptoms like hot flushes and night sweats are typical menopausal symptoms; however, our study clearly shows that a new onset of VMS is highly specific to perimenopause, being nearly five times more likely than in premenopause.”
Vasomotor symptoms are physical reactions related to hormonal changes that affect blood vessel control, leading to sudden heat (hot flushes) and night sweats.
Davis said: “Less variation was found for other symptoms including poor memory and low mood; however, vaginal dryness was the most discriminative sexual symptom from premenopause to perimenopause.
“While other symptoms might emerge in the perimenopausal stage, they lack specificity to that stage as these other symptoms are also common in premenopausal women, e.g. poor memory was only 1.7 and 1.3 times more likely in early and late perimenopause compared with premenopause.”
A significant finding was that women who still had regular cycles, but experienced changes in menstrual flow and VMS, reported symptom severity similar to early perimenopausal women – despite being classified as premenopausal under current definitions.
Davis said: “These findings suggest that classic VMS should be considered as a diagnostic criterion for perimenopause or postmenopause when menopause can’t be distinguished by the bleeding pattern, for example, after a hysterectomy or endometrial ablation, or, for women with a hormonal IUD.
“This finding supports the likelihood of perimenopause commencing before menstrual cycles vary by at least a week, and that women whose periods have become much heavier or much lighter and who also have VMS should be considered as having entered their perimenopause.”
Dr Rakib Islam, first author from Monash University’s School of Public Health and Preventive Medicine, said the study’s national reach and depth of analysis linked defined menopause stages to validated symptom profiles.
“This study stands out for its national reach and methodological depth, linking clearly defined menopausal stages with validated symptom profiles in over 5,500 women. This level of detail is essential to improve how we identify and manage the menopause transition,” Islam said.
“Current approaches for classifying women by menopause stage overlook women with regular cycles and women who no longer menstruate, e.g. after a hysterectomy.
“Our findings support a more symptom-based approach, enabling earlier recognition of perimenopause and more timely care.”
Menopause
Hormone therapy users report healthier lifestyles

Menopausal women using hormone therapy reported healthier diet, exercise and sleep habits than non-users in a study of more than 10,000 women.
The menopause transition is associated with a higher risk of chronic health conditions and symptoms including hot flushes and problems affecting the urinary and genital systems.
Hormone therapy is often used to manage these symptoms, but it remains unclear whether it affects health outcomes directly or indirectly through changes in health behaviours.
Previous research has produced mixed results, with some studies suggesting that postmenopausal women pay greater attention to maintaining a healthy lifestyle.
The cross-sectional analysis examined whether menopause status and hormone therapy use were linked to diet, physical activity and sleep duration.
A cross-sectional study assesses participants at one point in time. It can identify associations but cannot establish whether one factor directly caused another.
Diet, exercise and sleep are described as modifiable health behaviours because people may be able to change them to improve their health.
The researchers found that postmenopausal women who had never used hormone therapy reported eating less fruit and vegetables.
Women who had never used the treatment were also 19 per cent less likely to meet guidelines for muscle-strengthening activity.
Sleep duration was shorter among postmenopausal women who had never used hormone therapy.
Compared with premenopausal and perimenopausal women, the likelihood of meeting sleep guidelines was 14 per cent lower among never-users, 26 per cent lower among current users and 24 per cent lower among past users.
Perimenopause is the transitional period before menopause, when hormone levels and menstrual periods can change.
Researchers said these findings may be linked to higher levels of follicle-stimulating hormone among postmenopausal women who do not use hormone therapy.
They may also relate to lower levels of oestradiol, a form of oestrogen, which have previously been associated with poorer sleep.
Hot flushes and urogenital symptoms can also disrupt sleep, although hormone therapy may ease these symptoms.
Dr Stephanie Faubion, medical director for The Menopause Society, said: “This large observational study underscores that women who use hormone therapy tend to adopt overall healthier lifestyles.
“Although this association may partly reflect better symptom control enabling healthier behaviours, healthy-user bias is likely a significant contributor.
“Women who choose to use hormone therapy are often more proactive in their healthcare and may systematically differ from nonusers in socioeconomic resources, access to care, and health literacy.
“This largely explains why early observational studies of hormone therapy suggested cardiovascular benefits that were not confirmed in subsequent randomised, controlled trials.”
Fertility
Weight loss jab shows early promise in improving PMOS fertility

A weight loss jab may improve fertility outcomes in women with PMOS, early findings from an ongoing clinical trial suggest.
The proof-of-concept analysis found that injectable semaglutide may offer reproductive benefits while also addressing obesity and metabolic dysfunction.
It is the first report to examine how injectable semaglutide may improve reproductive outcomes in women with PMOS while also addressing obesity and metabolic dysfunction.
The work forms part of the ongoing RESTORE clinical trial.
Melanie Cree, professor at CU Anschutz and first author of the report, said: “Women with PMOS frequently face a frustrating choice between treatments that target reproductive symptoms and those that address metabolic health.
“Our early findings suggest injectable semaglutide may have the potential to improve both, offering a more comprehensive approach to care.
“This medication is incredibly promising when someone responds with 10 per cent weight loss.”
The trial is examining whether semaglutide can restore ovulation and improve reproductive health in adolescents and adults with polyendocrine metabolic ovarian syndrome, known as PMOS.
PMOS, formerly known as polycystic ovary syndrome or PCOS, is a hormone and metabolic condition linked to irregular periods, raised testosterone levels, infertility risk, obesity and increased cardiometabolic disease.
Cardiometabolic disease refers to conditions linked to the heart and metabolism, such as heart disease, high blood pressure and type 2 diabetes.
Existing treatments, including metformin and hormonal contraceptives, often do not fully address reproductive and metabolic complications at the same time.
The analysis focused on participants aged 12 to 35 who lost at least 10 per cent of their body weight during treatment.
Researchers said reproductive improvements appeared earlier than expected, prompting them to report preliminary findings while the wider study continues.
Cree is also a paediatric endocrinologist at Children’s Hospital Colorado.
Endocrinologists are doctors who specialise in hormones and hormone-related conditions.
Cree said: “What makes this work particularly important is that it focuses specifically on women with PMOS receiving injectable semaglutide.
“Although GLP-1 medications have transformed obesity treatment, there remains a significant need for rigorous data examining how these therapies affect fertility and reproductive function in this population.”
The RESTORE study is evaluating semaglutide treatment in girls and women with PMOS and obesity.
Its broader aim is to determine whether weight loss and metabolic improvements can restore ovulation and improve reproductive outcomes.
Ovulation is the release of an egg from the ovary, a key part of the menstrual cycle and fertility.
The authors said the findings are from an early proof-of-concept analysis and that larger, longer-term studies will be needed to confirm whether the reproductive benefits last.
The findings suggest injectable semaglutide may become a treatment option for women with PMOS seeking improvements in both metabolic and reproductive health, if future studies confirm the results.
Menopause
Apple Health adds menopause and perimenopause tracking

Apple announced menopause and perimenopause tracking for its Health app at WWDC 2026, with symptom logging and cycle alerts for some users.
The update expands the app’s cycle tracking beyond fertility and menstrual periods.
If logged cycle patterns suggest a user may be experiencing perimenopause, the app will send a notification prompting a conversation with a doctor.
However, this perimenopause-specific cycle deviation notification is only for users aged 40 and over and is not intended to replace a doctor’s diagnosis or treatment.
Stacey Ford, Apple’s vice-president of OS management, said users will also be able to log menopause and perimenopause symptoms in the Health app.
Educational content will also be available to help users learn more about these life stages and understand changes in their bodies.
Every year, about 2 million women enter perimenopause, the stage before menopause when levels of the hormone oestrogen decline.
According to a February 2025 survey involving 4,432 participants aged over 30, more than half of women aged 30 to 35 experienced moderate or severe perimenopause symptoms.
The findings suggest perimenopause does not affect only older adults.
About 6,000 women in the US enter menopause every day, according to the Society for Women’s Health Research.
Given the number of women affected by perimenopause and menopause, the update broadens the Health app’s scope.
The app launched in 2019, meaning it has gone seven years without these women’s health tracking features, which could help users better understand their bodies and prepare for informed conversations with doctors.
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