Research Highlights Perimenopause Challenges
Nearly 40% of women experiencing perimenopause suffer from moderate to severe hot flashes and night sweats, yet they lack effective treatment options, according to new research.
This study, published in the Lancet Diabetes & Endocrinology, examined the prevalence of symptoms at various menopausal stages among women aged between 40 and 69.
Over 8,000 participants, who identified as women, took part in the Australian women’s midlife years (AMY) study.
After removing those on hormonal medications or individuals who had surgeries influencing hormonal balance or symptoms, researchers from Monash University analyzed data from 5,509 women: 1,250 were pre-menopausal, 344 were early perimenopausal, 271 late perimenopausal, and 3,644 postmenopausal.
Prof. Susan Davis, a senior author, pointed out that while vasomotor symptoms (VMS)—like hot flashes and night sweats—are expected during menopause, the study highlighted that moderate to severe VMS are the most significant indicators of perimenopause, the phase leading up to the last menstrual period.
Other symptoms reported by perimenopausal women included poor memory and low mood, but these did not differ significantly from pre-menopausal symptoms, making them less useful for distinguishing between menopausal stages.
The research indicated that 37.3% of women in late perimenopause reported bothersome hot flashes, which is significantly higher than their pre-menopausal counterparts. Similarly, severe vaginal dryness was noted to be 2.5 times more common among perimenopausal women than those who were pre-menopausal.
While menopausal hormonal therapy (MHT, or HRT) is effective for managing VMS in menopause, there are no approved treatments specifically for perimenopausal symptoms, the researchers pointed out.
Davis emphasized that treatment during perimenopause differs from post-menopause. Women in this stage can still ovulate unpredictably, contraception must be considered, and MHT could lead to heavier bleeding—this complicates treatment options.
Interestingly, the study questioned the common belief that irregular menstrual cycles signal the onset of perimenopause. Many women consult their GPs, questioning if heavier periods and hot flashes are signs of perimenopause, only to be told that if their cycles are regular, they cannot be perimenopausal.
However, the study found that women with regular cycles but experiencing VMS were similarly affected as those with changes in their cycle frequency, suggesting that dismissing these symptoms is misguided.
Dr. Rakib Islam, another author of the study, highlighted that defining perimenopause and menopause strictly through menstrual cycles fails to address women with regular cycles or those who don’t menstruate, such as after certain surgical procedures or hormonal contraception use.
“Our findings support a more symptom-focused approach to enable earlier identification of perimenopause and more timely care,” he added.
Davis noted the importance of not mentioning menopause during participant recruitment to avoid bias in the findings.
Prof. Martha Hickey, chair of obstetrics and gynecology at the University of Melbourne and lead author of a previous Lancet series on menopause, praised the study as significant. She mentioned that it sheds light on a phase often overlooked in menopause research, as pharmaceutical companies frequently exclude perimenopausal women from studies due to their still fluctuating hormone levels.
However, Hickey cautioned that the study’s cross-sectional design limits understanding of how symptoms change as women transition through menopause, noting, “it helps to categorize what symptoms women might experience at a specific stage.”
