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.”