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.

Menopause is linked to grey matter loss in key brain regions, along with increased anxiety, depression and sleep problems, new research suggests.

The study also found that hormone replacement therapy (HRT) does not appear to mitigate these effects, though it can slow the decline in reaction times.

Grey matter is brain tissue that contains nerve cell bodies and helps process information, control movement and manage memory and emotions.

Dr Christelle Langley from the University of Cambridge department of psychiatry said: “Most women will go through menopause, and it can be a life-changing event, whether they take HRT or not.

“A healthy lifestyle – exercising, keeping active and eating a healthy diet, for example – is particularly important during this period to help mitigate some of its effects.

“We all need to be more sensitive to not only the physical, but also the mental health of women during menopause, however, and recognise when they are struggling.

“There should be no embarrassment in letting others know what you’re going through and asking for help.”

Researchers analysed data from UK Biobank of almost 125,000 women, who were classified into three categories: pre-menopause, post-menopause who have never used HRT, or post-menopause who have used HRT.

Participants answered questionnaires about their experience of the transition, self-reported mental health, sleep patterns and overall health.

Some took part in tests of cognition, including tests of memory and reaction times. Around 11,000 participants also underwent MRI scans, allowing the researchers to examine brain structure.

Post-menopausal women were more likely than those pre-menopause to have sought help from their GP or a psychiatrist for anxiety, nerves or depression, and to score more highly on questionnaires for symptoms of depression.

They were also more likely to have been prescribed antidepressants.

Although women in the HRT group had greater anxiety and depression compared with the non-HRT group, further analysis showed these differences were already present before the transition began.

The researchers suggest that in some cases, a woman’s GP may have prescribed HRT in anticipation of symptoms worsening.

Women post-menopause were more likely to report insomnia, get less sleep, and feel tired.

Those on HRT reported feeling the most tired of all three groups, even though there was no difference in sleep duration between these women and those not on the medication.

In both groups of women post-menopause, the researchers found significant reductions in grey matter volume.

These differences occurred particularly in the hippocampus, which is responsible for forming and storing memories; the entorhinal cortex, a gateway for passing information between the hippocampus and the rest of the brain; and the anterior cingulate cortex, which helps manage emotions, make decisions and focus attention.

Post-menopausal women who were not on HRT had slower reaction times than those yet to start the transition or who were on HRT.

However, there were no significant differences between the three groups when it came to memory tasks.

Dr Katharina Zühlsdorff from the department of psychology at the University of Cambridge said: “As we age, our reaction times tend to get slower – it’s just a part of the natural ageing process and it happens to both women and men.

“You can imagine being asked a question at a quiz – while you might still arrive at the correct answer as your younger self, younger people would no doubt get there much faster.

“Menopause seems to accelerate this process, but HRT appears to put the brakes on, slowing the ageing process slightly.”

Professor Barbara Sahakian, the study’s senior author from the department of psychiatry, added: “The brain regions where we saw these differences are ones that tend to be affected by Alzheimer’s disease.

“Menopause could make these women vulnerable further down the line.

“While not the whole story, it may help explain why we see almost twice as many cases of dementia in women than in men.”

Postmenopausal women on hormone replacement therapy lost 35 per cent more weight while taking tirzepatide, a new study suggests.

The research reviewed data from 120 participants with overweight or obesity who received tirzepatide, marketed in the UK at Mounjaro, for weight management for 12 or more months.

Those using the drug alongside hormone replacement therapy (HRT) were compared with similar participants who were not on hormone therapy.

Tirzepatide is approved by the US Food and Drug Administration for treating overweight and obesity.

Menopause can accelerate age-related weight gain and increase the likelihood of these conditions, which raise the risk of cardiovascular disease, type 2 diabetes and other illnesses.

The study was led by Mayo Clinic in the US.

Regina Castaneda, postdoctoral research fellow at Mayo Clinic and first author of the study, said: “This study provides important insights for developing more effective and personalised strategies for managing cardiometabolic risk in postmenopausal women.”

Cardiometabolic risk refers to factors that increase the chances of heart disease and metabolic conditions such as diabetes.

Maria Daniela Hurtado Andrade, endocrinologist at Mayo Clinic and senior author of the study, said: “In this observational study, women who used menopausal hormone therapy lost about 35 per cent more weight than women taking tirzepatide alone.

“Because this was not a randomised trial, we cannot say hormone therapy caused additional weight loss.

“It is possible that women using hormone therapy were already engaged in healthier behaviours, or that menopause symptom relief improved sleep and quality of life, making it easier to stay engaged with dietary and physical activity changes.”

Dr Castaneda said the findings are clinically meaningful but more studies controlling for these factors are needed.

The magnitude of this difference warrants future studies that could help clarify how GLP-1-based obesity medications and menopausal hormone therapy may interact.

Interestingly, preclinical data suggest a potential synergy, with oestrogen appearing to enhance the appetite-suppressing effects of GLP-1,” she said.

GLP-1 is a hormone that helps regulate appetite and forms the basis for several weight loss medicines, including tirzepatide.

Dr Hurtado Andrade added: “Next, we plan to test these observations in a randomised clinical trial and determine if benefits extend beyond weight loss, specifically, whether hormone therapy also enhances the effects of these medications on cardiometabolic measures.

“If confirmed, this work could speed the development and adoption of new, evidence-based strategies to reduce this risk for millions of postmenopausal women navigating this life stage.”