Are you in perimenopause? Why 1 in 3 women can’t tell

Perimenopause is a universal stage of female reproductive aging, when menstrual cycles become less regular and symptoms linked with fluctuating hormone levels are common. Perimenopause can last up to a decade. When someone hasn’t had a period for 12 consecutive months, they have gone through perimenopause and are now considered to be in postmenopause.  

Yet recognizing when perimenopause actually begins can be incredibly difficult for some women, as found in a new study by Flo’s science team and researchers at the Center for Women’s Health, Mayo Clinic. The research is published in the journal Menopause, the flagship publication of The Menopause Society. 

For millions of women, these years are filled with confusing bodily changes and a frustrating lack of answers. 

Who is unsure about being in perimenopause?

Our scientists asked Flo app members in a survey to report their reproductive stage. The answer options were perimenopause, postmenopause, neither, or unsure. Survey participants who selected that they were unsure about their reproductive stage were offered the opportunity to explain why. 

The researchers found that a staggering 34% of study participants in the United States were unsure of their reproductive stage. 

This peaked among women aged 40 to 44, which is when symptoms common during perimenopause often begin. In addition, uncertainty about being in perimenopause was highest among women who reported severe symptoms. 

The team analyzed the themes they observed in these answers to understand why women were unsure about being in perimenopause. 

Interpreting complex symptoms

The biggest driver of uncertainty, accounting for 56% of responses, was symptom confusion. 

The hallmark signs of perimenopause are irregular or missed periods. However, in the study, some women reported symptoms in the absence of changes to their cycles. This mismatch made them doubt they were in perimenopause. 

For others, preexisting health conditions, such as endometriosis, or other life events, such as postpartum weaning or discontinuing hormonal contraception, caused them to question whether their symptoms were due to perimenopause or other circumstances. 

Without a clear roadmap, many women felt like they were playing a guessing game with their own bodies. 

Understanding female biology

The second most common reason for uncertainty was a lack of knowledge, accounting for 28% of responses. 

Some women confused perimenopause with postmenopause, while others admitted they didn’t know what the word “perimenopause” meant or which symptoms to expect. Another group firmly believed they were simply “too young” to be experiencing perimenopause. 

In response to their uncertainty, some participants actively sought clarification by gathering information about perimenopause from a variety of sources. 

However, relying on family history, peer conversations, or the internet often led to conflicting advice that deepened confusion, highlighting significant gaps in female health education. 

Navigating uncertainty with healthcare professionals 

Finally, 16% of women reported that their uncertainty was driven by barriers to receiving medical confirmation or care.

For some, this was because they were hesitant to seek clarification. They felt resistant or afraid to acknowledge perimenopause because they associated it with getting older or losing their fertility. 

Others actively sought help from healthcare professionals. Yet their concerns were dismissed, and they were told they were “too young” or didn’t have “enough symptoms” to be in perimenopause, or their symptoms were attributed to another health condition. 

These clinical encounters left women feeling frustrated, unheard, and even more uncertain than before.  

Taking out the guesswork

“If you’re feeling unsure about perimenopause, our research proves you’re in good company. But you shouldn’t have to navigate this life transition in the dark,” comments Mila Zhaunova, PhD, Flo’s director of science. 

In a previous study about perimenopause, our scientists reported a clear mismatch between the symptoms that people expect during perimenopause, like hot flashes, and the ones most commonly experienced. In this study, the top symptoms reported by women in perimenopause were physical and mental exhaustion, fatigue, irritability, and sleep problems. 

By bringing these patterns to light, we can change the narrative and validate people’s experience of the physical and emotional changes that can happen during perimenopause. 

This is where digital tools can make a difference. Digital symptom tracking tools can help build an understanding of symptom patterns over time. Having this data can empower people to explore lifestyle support options and advocate for themselves when speaking to doctors.