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Menopause

Flo Health and Mayo Clinic publish global perimenopause awareness study

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The US ranks sixth for perimenopause knowledge, behind the UK, Ireland, Canada, Australia and the Netherlands, research by the Mayo Clinic and period tracker Flo has revealed.

Perimenopause is the transition leading up to a woman’s last menstrual cycle and includes the 12 months afterwards, after which menopause is established as hormone levels change.

It typically happens in the mid-40s and lasts an average of six years, though symptoms may start in the 30s.

The study surveyed more than 17,000 women aged 18 and over across 158 countries about their knowledge of perimenopause symptoms.

The US ranked sixth overall, despite growing public discussion of menopause linked to celebrity advocacy and new workplace policies.

Participants most often recognised common symptoms such as hot flushes (71 per cent), sleep problems (68 per cent) and weight gain (65 per cent).

Broader symptoms, including fatigue, irritability and digestive changes, were far less likely to be identified as part of the perimenopause transition.

Among women aged 35 and over who reported being in perimenopause, the five most common symptoms were physical and mental exhaustion (95 per cent), fatigue (93 per cent), irritability (91 per cent), sleep problems (89 per cent) and depressive mood (88 per cent).

Dr Anna Klepchukova, chief medical officer at Flo, said: “We need to normalise conversations around perimenopause and menopause, so women feel empowered to have honest conversations with their doctors and other support systems.

“This study demonstrates a prolonged commitment from both Flo Health and Mayo Clinic in helping women better understand their bodies and advocating for their health through perimenopause, and every other phase of their health journeys, through medically-backed insights and advice.”

International differences

Perimenopause knowledge scores were highest in higher-income countries such as the UK, Ireland and Australia.

Lower scores emerged in Nigeria, France and parts of Latin America.

Digestive issues ranked among the top three reported symptoms in Nigeria, South Africa, India, France, Ireland and several Latin American countries, while mood symptoms such as depressive mood and anxiety ranked among the top three in Germany, Spain, Venezuela, the Netherlands and India.

Dr Mary Hedges, principal investigator at Mayo Clinic, said: “There is a mismatch in knowledge and expectations of perimenopause and actual symptoms experienced during perimenopause.

Many women in perimenopause may not yet be experiencing hot flashes, and are more likely to be experiencing the cognitive and physical symptoms of fatigue, exhaustion, mood, sleep, or even digestive changes.

“The findings from this study illustrate the need to advance perimenopause research and education, so that we can equip both patients and healthcare clinicians with the knowledge and skills needed to address symptoms and improve the quality of care we provide to women.”

The survey ran from 6 December 2024 to 16 May 2025.

Fertility

Immunotherapy may temporarily restore fertility in premature menopause

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Immunotherapy may temporarily restore fertility in women with autoimmune premature ovarian insufficiency, a pilot study suggests.

Three of the 10 women who received treatment later gave birth to healthy babies.

Premature ovarian insufficiency, or POI, affects just over three per cent of women worldwide and occurs when the ovaries stop functioning before the age of 40.

The condition significantly reduces fertility and can have several causes, including autoimmune processes and genetics.

Researchers at Karolinska Institutet examined whether immunotherapy could make the ovaries temporarily responsive to hormonal stimulation in women with POI caused by autoimmunity.

The study included 12 women aged between 18 and 35 with autoimmune POI.

Two withdrew before treatment began. The remaining 10 underwent ovarian hormone stimulation before receiving rituximab and again four to six months after treatment.

Rituximab is an approved and well-established medicine used to treat several autoimmune conditions and cancers.

None of the women responded to ovarian stimulation before receiving the drug.

After treatment, six developed follicles that made it possible to retrieve eggs in response to ovarian stimulation.

Follicles are small sacs within the ovaries where eggs develop.

Professor Angelica Lindén Hirschberg, the study’s first author and a professor at Karolinska Institutet’s Department of Women’s and Children’s Health, said: “The results show that in some women there remains an egg reserve that can be activated when the autoimmune process is suppressed.”

In five women, mature eggs could be frozen or fertilised.

Three later had embryos transferred and all three gave birth to healthy babies.

For safety reasons, the embryo transfers took place no earlier than one year after treatment.

One serious side effect was reported and was linked to the hormone stimulation rather than the immunotherapy.

Women with autoimmune POI commonly have other autoimmune diseases.

All six women who responded to the treatment also had autoimmune Addison’s disease, a condition in which the immune system destroys the adrenal glands.

The study was a proof-of-concept investigation without a control group and involved a small number of participants, meaning the findings must be interpreted cautiously.

A proof-of-concept study is an early investigation designed to assess whether an approach could work before it is tested more widely.

Professor Lindén Hirschberg said: “This is a first step. To determine whether the method is effective and safe, larger, randomised studies are required.”

The research team has launched a larger randomised study.

The work was carried out by researchers at Karolinska Institutet, Karolinska University Hospital and the University of Bergen.

It was funded by organisations including the Swedish Research Council, the Knut and Alice Wallenberg Foundation, the Novo Nordisk Foundation and Region Stockholm.

The researchers reported no conflicts of interest.

POI is also linked to long-term health risks caused by oestrogen deficiency, including osteoporosis, an increased risk of cardiovascular disease, cognitive decline and poorer mental and sexual wellbeing.

Hormone replacement therapy can relieve menopausal symptoms and reduce many of these risks, but no treatment has been reliably shown to restore fertility in women with POI.

Egg donation was previously the only option for women with the condition who wanted to become pregnant.

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News

EU committee warns of women’s health ‘blind spot’

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An EU committee has backed a report warning of systemic inequalities in women’s health research, diagnosis and treatment across Europe.

The European Parliament’s Committee on Women’s Rights and Gender Equality approved the report, which was initiated by Renew Europe.

Women remain under-represented in medical research and clinical trials.

Around 72 per cent of drug trials do not provide data separated by sex and gender, while only five per cent of global research and development funding is dedicated to women’s health.

The report was led by Renew Europe rapporteur Billy Kelleher MEP of Fianna Fáil in Ireland.

It calls for greater investment in women’s health research, stronger inclusion of women in clinical trials and gender-sensitive diagnostics and treatments, particularly for endometriosis, menopause and cardiovascular disease.

Kelleher, first vice-president of Renew Europe, said: “Women’s health remains one of medicine’s biggest blind spots.

“When research, clinical trials and medical data fail to reflect women’s experiences, the result is poorer diagnosis, treatment and care.”

The report also calls for improved access to sexual and reproductive healthcare, including follow-up to the successful European Citizens’ Initiative “My Voice, My Choice”.

Its recommendations include better support for women’s physical and mental health and access to high-quality care throughout pregnancy, childbirth and the postnatal period, free from discrimination.

It also highlights additional healthcare barriers faced by LGBTQI+ people and women in marginalised communities or vulnerable situations.

Kelleher said: “This report is about closing those gaps and ensuring that women’s health is recognised as a core measure of the quality and fairness of our healthcare systems.”

By placing women’s health higher on the political agenda, the report aims to support the implementation of the EU Gender Equality Strategy and shape future European health policies.

A final vote by the European Parliament is expected in September 2026.

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Menopause

Statins may worsen menopause symptoms, study suggess

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Statins have been linked to more severe menopause symptoms and a higher risk of muscle loss in postmenopausal women, a study suggests.

The medicines are among the most widely prescribed in the world, with strong evidence supporting their use to lower cholesterol and reduce cardiovascular risk.

However, some recognised side effects may resemble symptoms associated with menopause, raising questions about how the two could interact.

The US Food and Drug Administration has flagged potential adverse effects linked to statin treatment, some of which overlap with menopausal complaints.

Researchers examined data from 1,184 postmenopausal women across nine Latin American countries, assessing menopausal symptoms, sarcopenia risk and cognitive function.

They compared women taking statins with non-users after accounting for factors including age and body weight.

As the study was cross-sectional, meaning it examined information collected at one point in time, it could identify associations but could not prove that statins caused the outcomes.

Women taking statins were 56 per cent more likely to have severe menopausal symptoms than those who were not using the medicines.

The difference remained after researchers accounted for other variables.

Statin users were also 65 per cent more likely to be at risk of sarcopenia.

Sarcopenia is the gradual loss of muscle mass and physical function, which tends to accelerate after menopause.

Declining oestrogen levels already make muscle loss a concern at this stage of life. It is linked to a higher risk of falls, fractures and reduced quality of life.

Musculoskeletal symptoms were reported by 53.1 per cent of statin users, compared with 33.9 per cent of non-users.

Researchers said this was separate from the finding on sarcopenia risk and may point to a wider pattern of physical discomfort among women taking the medicines.

Women taking statins also recorded slightly lower scores in tests of delayed memory recall and visuospatial function.

Visuospatial function is the ability to understand the position of objects and their relationship to one another.

The study found no overall association between statin use and mild cognitive impairment, so the differences in individual tests are early signals rather than firm conclusions.

Researchers said effects associated with statins may overlap with menopausal symptoms and add to the overall symptom burden during midlife.

This means symptoms attributed to menopause and possible statin side effects may look similar and, in some cases, could compound one another.

Further research is needed to separate the possible effects of the medicines from symptoms linked to menopause.

The findings are not a reason for women to stop taking statins.

Their cardiovascular benefits are well established, and stopping treatment without medical guidance can carry serious risks.

The study provides more information about what statin treatment may mean specifically for postmenopausal women, who have historically been under-represented in cardiovascular research.

Women who notice more severe menopausal symptoms or changes in muscle strength or physical function while taking statins should discuss them with a doctor.

A healthcare professional may consider whether the symptoms could be related to the medication and whether screening for muscle loss is appropriate.

They may also review whether the current statin remains the most suitable option, as different statins can have different side-effect profiles.

Resistance training and consuming enough protein are well-supported ways to help preserve muscle mass during midlife.

Statins can be life-saving, but the findings suggest their possible side effects should receive greater attention in postmenopausal women.

The study adds to evidence supporting more individualised care for women during midlife.

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