Symptom confusion, care barriers drive perimenopause uncertainty

One in 3 US women aged 35 years and older are uncertain about whether they are in perimenopause, with symptom confusion, knowledge gaps, and barriers to clinical confirmation identified as the primary drivers, according to a large, mixed-methods study published in Menopause, the journal of The Menopause Society.¹

Perimenopause, the transitional period leading up to the final menstrual period, typically begins in the mid-40s, though onset varies widely, and affects an estimated 2 million women per year in the United States, with most remaining in this phase for 4 to 8 years, according to The Menopause Society.²

Over half of women in this stage, ranging from 59% to 65%, experience vasomotor symptoms as well as psychological or urogenital symptoms that can impair daily functioning, diminish quality of life, and reduce work productivity. Despite its prevalence, perimenopause remains difficult to recognize for both patients and clinicians, partly because no laboratory test or biomarker can definitively confirm the stage, and because its symptoms overlap with a wide range of other conditions including premenstrual syndrome, thyroid disease, and mental health conditions.

“We aimed to quantify the prevalence of perimenopause uncertainty
and explore the underlying drivers,” said the study authors, led by Yihan Xu, PhD, of Flo Health Inc, in London, United Kingdom.

How common is perimenopause uncertainty, and who is most affected?

The investigators conducted a cross-sectional survey of 7640 US-women aged 35 years and older to estimate the prevalence of perimenopause uncertainty and examine subgroup differences by age and symptom severity.¹ Overall, 34% (95% CI: 33%-35%) of participants reported being unsure of their reproductive stage.¹ Uncertainty varied significantly by both age and symptom severity (P < 0.001), peaking at 42% (95% CI: 41%-43%) among women aged 40 to 44 and at 37% (95% CI: 36%-38%) among those with severe symptom burden.

What is driving perimenopause uncertainty in women?

Content analysis of 409 free-text responses identified 3 primary uncertainty drivers. Symptom confusion and attribution were the most common, accounting for 56% of responses, reflecting difficulties interpreting bodily changes and distinguishing perimenopause symptoms from other causes.^1,2 Knowledge gaps and information-seeking accounted for 28% of responses, highlighting limited health literacy, age-based assumptions, and active searches for evidence.¹ Barriers to confirmation and care accounted for 16%, describing dismissive health care encounters and reluctance among clinicians to acknowledge perimenopause.

Younger women aged 35 to 39 were more likely to cite knowledge gaps, while health care barriers peaked in the 40-to-44 age group (P = 0.05).¹ Limited public awareness, inconsistent clinical recognition, inadequate clinician training in perimenopause and menopause care, and the propagation of misinformation about menopause symptom management were identified as compounding factors.²

What do these findings mean for clinical practice?

Based on the findings, researchers recommend that clinicians adopt more flexible, multidimensional approaches to recognizing perimenopause symptoms, normalizing cognitive, emotional, and physical changes that can occur before significant menstrual irregularity develops, rather than relying on cycle changes as the principal diagnostic indicator.²

“This large study showed that one in three US women aged older than 35 years are not sure whether they are in perimenopause,” said Stephanie Faubion, MD, medical director, The Menopause Society and co-author of the study.

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“Further, the study highlights that symptom confusion, misconceptions, and barriers to care are leaving many women without the clarity and support they need during the menopause transition,” added Faubion. “Recognizing perimenopause uncertainty as a common experience can help shift the conversation from searching for a diagnosis to providing women with the information, validation, and support they need to navigate this natural life transition with confidence.”

References:

1. Xu Y, Fergus D, Hewings-Martin Y, et al. Exploring prevalence and drivers of perimenopause uncertainty among US women: a mixed-methods study. Menopause. Published online 2026. Accessed July 14, 2026. https://menopause.org/wp-content/uploads/press-release/MENO-D-25-00558.pdf
2. The Menopause Society. Many women still confused about perimenopause. Press release. Published July 14, 2026. Accessed July 14, 2026. https://menopause.org/press-releases/many-women-still-confused-about-perimenopause